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2019/12/19 – Denis Orthodontic pre-authorisations

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Orthodontic Requirements

The following are required for orthodontic pre-authorisations:

  • A cephalometric analysis
  • An orthodontic treatment plan
  • A panoramic x-ray
  • Pre-treatment photographs showing the bite in occlusion: the front view, left-side view and right-side view
  • Pre-treatment photographs showing a full occlusal view of the mandibula and the maxilla
  • A cephalometric x-ray

    Note:

Please submit clear copies of documents and radiographs to ensure authorisation requests are processed as fast as possible.

Further clinical information may be requested to support an authorisation request.

Click to view the DAI INDEXV5.pdf

Email: ortho@denis.co.za
Fax:    0866 770 336
Post:   Private Bag X1, Century City, 7446​

2019/12/19 – Denis Periodontic pre-authorisations

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Periodontic Requirements

The following are required for periodontic pre-authorisations:

  • A full periodontic chart of CPI-scoring
  • A full treatment plan
  • X-rays
  • A detailed maintenance plan for the remainder of the benefit year

    Note:

  • Please submit clear copies of documents and radiographs to ensure authorisation requests are processed as fast as possible.
  • Further clinical information may be requested to support an authorisation request.

Email: perio@denis.co.za
Fax: 0866 770 336
Post: Private Bag X1, Century City, 7446​

2019/12/19 – Denis In-Hospital pre-authorisations

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In-hospital Requirements

The following are required for in-hospital pre-authorisations:

  • Hospital practice number
  • Anaesthetist practice number
  • Treating clinician
  • Hospital admission date
  • Procedure code(s) with ICD10 code(s) and where relevant the applicable tooth numbers
  • Main Complaint
  • If applicable, medical report of special medical conditions
  • A medical report to clinically susbstantiate a medical condition that warrants General Anaesthetics
  • Clear x-rays of the impacted teeth are required

    Note:

  • Please note that all hospital cases are assessed individually.
  • Further clinical information may be requested to support an authorisation request.

Email: hospitalenq@denis.co.za
Fax: 0866 770 336
Post: Private Bag X1, Century City, 7446​

2019/12/12 – CompCare Year End Provider communication

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IMPORTANT COMPCARE WELLNESS MEDICAL SCHEME NOTIFICATION FOR 2020
With regards to the CompCare and Selfmed amalgamated Scheme (CompCare) please be advised of the following important operational information that will come into effect from 1 January 2020:
· As from 1 October 2019 onwards, all Selfmed options have been administered by Universal Healthcare and the process remains in place from 1 January 2020 onwards;
· It is important to note that some of the Selfmed options will merge into CompCare options and one new option will be created.
The new option layout is displayed below:
Merging of CompCare Benefit Options
1 January 2020 onwards
Changes to 2019 Options for 2020
2019 Option
2020 Option
Selfmed 80%
merges into
Pinnacle
Med Elite
merges into
Pinnacle ED ANDDynamix
SelfNET Essential
merges into
SelfNET
Med XXI and Axis
become
MedX (new option)
CompCare Benefit Options
CompCare options for 2020:
– Pinnacle; and
Pinnacle Efficiency Discounted (ED) Option
– Dynamix; and
Dynamix Efficiency Discounted (ED) Option
– Symmetry; and
Symmetry Efficiency Discounted (ED) Option
– Selfsure
– Mumed; and
Mumed Efficiency Discounted (ED) Option
– UniSave
– MedX; and
MedX Efficiency Discounted (ED) Option
– NetworX; and
NetworX Efficiency Discounted (ED) Option
– SelfNET
Please note the following:
· Please confirm with your patients which option they are on – some patients may have changed options to an option other than the option with which its merges;
· Please ensure that you do not use any Selfmed membership numbers or switching/clearing codes;
· The patients’ authorizations for chronic medication will be transferred to the new option in cases where the options merge;
· In certain instances where members elect to change their option, chronic formulary changes might require the member to reapply for chronic authorization; and
· A patient on MedX will have different benefits when compared to the MedXXI and Axis options – please ensure that the member does have cover for treatment planned.
Please refer to the below table for confirmation of the switching codes:
Claims switching / routing codes
ADMINISTRATOR
SCHEME
PLAN NAME
OPTION
MEDIKREDIT
DATAMAX CODE
EDISERVECODE
HEALTHBRIDGE CODE
ITRACK CODE
LENASIA CODE
MEDISWITCH CODE
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
DYNAMIX
DYNAMIX
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
90831
129P
129P
QEDI :129P, Destination : SSCC0000
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
MASSMART
NETWORX
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
92198
129P
129P
QEDI :129P, Destination : SSCC0000
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
MEDELITE
MEDELITE
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
93222
129P
129P
QEDI :129P, Destination : SSCC0000
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
MEDX
ED
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
93234
129P
129P
QEDI :129P, Destination : SSCC0000
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
MEDX
MEDX
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
93227
129P
129P
QEDI :129P, Destination : SSCC0000
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
MUMED
ED
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
92457
129P
129P
QEDI :129P, Destination : SSCC0000
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
MUMED
MUMED
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
90768
129P
129P
QEDI :129P, Destination : SSCC0000
UNIVERSAL NETWORK
COMPCARE UNIVERSAL
NETWORX
NETWORX
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
90960
129P
129P
QEDI :129P, Destination : SSCC0000
UNIVERSAL NETWORK
COMPCARE UNIVERSAL
NETWORX ED
NETWORX ED
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
TBA
129P
129P
QEDI :129P, Destination : SSCC0000
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
PINNACLE
PINNACLE
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
90938
129P
129P
QEDI :129P, Destination : SSCC0000
UNIVERSAL NETWORK
COMPCARE UNIVERSAL
PINNACLE ED
PINNACLE ED
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
TBA
129P
129P
QEDI :129P, Destination : SSCC0000
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
SELFNET
SELFNET
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
93217
129P
129P
QEDI :129P, Destination : SSCC0000
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
SELFSURE
SELFSURE
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
93221
129P
129P
QEDI :129P, Destination: SSCC0000
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
SYMMETRY
ED
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
92443
129P
129P
QEDI :129P, Destination: SSCC0000
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
SYMMETRY
SYMMETRY
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
90928
129P
129P
QEDI :129P, Destination: SSCC0000
UNIVERSAL HEALTHCARE
COMPCARE WELLNESS
UNISAVE
UNISAVE
Dispensing Dr (COMDD – 620699); Pharmacy (CCOMP – 620680)
COMPCARE
STATUS
92561
129P
129P
QEDI :129P, Destination: SSCC0000
Contact Details
CompCare Contact Details
First Time Claims Submission:
General/Claims Enquiries:
Tel: 0861 222 777
Pre Authorisation and Hospital Admissions:
Oncology:
Case management:
Hospital accounts:
Chronic Medicine Management:
Tel: 0860 111 900
Yours sincerely,
The Universal Provider Team

2019/12/13 – MMI Dental Network Rates 2020

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Dental network rates for 2020

 

Dear Dental Service Provider

 

We would like to thank you for being available to our members and appreciate your contribution to the network. We look forward to continue working with you in 2020.

Funds managed by Momentum Dental Risk Management

Momentum Dental Risk Management, part of Momentum Health Solutions administration services, administers the medical aid options and insurance products listed below. Please take note that the Momentum Medical Scheme Impact Option will no longer exist from 1 January 2020, and the Wooltru Core Option is now known as the Wooltru Network Option.

 

 

Scheme rates

We attach the 2020 dental network rates. Only the procedures on the list are covered and will be paid by Momentum Health Solutions at the agreed rate, as per the attachment. No co-payments or split billing is allowed. Kindly load these fees on your system to ensure that you charge accordingly

 

Member consent

If members need treatment that is not listed, please inform them and ask them to sign a Momentum Dental Network Consent letter. This letter allows you to indicate the tariff code and price for the procedure and includes a space for the member’s signature, to verify that they understand that the additional cost will be for their own pocket.

Contact and address details

It is important for us to have your valid contact information at all times. Please ensure that we have the following information for your practice:

  • Physical address – Please supply the full physical address as this address is posted on our provider list, which members use to search for a practice.
  • Telephone number – Please provide a number where members can contact your practice for appointments.
  • Email address – We communicate changes, price lists and other important information to you throughout the year. If we have the email address of your bureau or other accounts administrator in our records, the information will not reach you.

Please inform us about any changes to your contact information.

If you have any queries, you are welcome to contact our call centre:

· Telephone: 012 065 0131

· Email: registrations@momentummetropolitan.co.za

 

Yours in good health

Debbie de Waal

Momentum Dental Risk Management

 

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