Imperial Med Group Medical Scheme Claiming Procedure : imperialgroupmed.co.za
Name of the Organization : Imperial Med
Type of Facility : How To Claim Imperial Group Medical Scheme?
Head Office : Braamfontein
- 1 What is Imperial Group Medical Scheme?
- 2 Settling of Claims
- 3 How To Claim Imperial Group Medical Scheme?
- 4 Responsibilities of Imperial Group Medical Scheme
- 5 Contact Address
What is Imperial Group Medical Scheme?
** Imperialmed is the in-house medical scheme for all permanent employees of Imperial Holdings Limited and its associated and subsidiary companies.
Related / Similar Facility : Imperial Group Medical Scheme
Settling of Claims
** A Member should establish that Healthcare providers charge at Scheme Rate.
** Some Healthcare Providers submit their claims directly to the Medical Aid, while others prefer the patient to pay them directly after the consultation or treatment.
** If payment has been made by the patient, the Scheme shall reimburse the member based on the acceptance of the claim.
** You can scan and e-mail claims to the Scheme or take a photo and e-mail your claim to the Scheme.
** Please make sure the scan or photo is of a good, readable quality.
** The majority of doctors and other service providers (notably large pathology laboratories) submit claims directly to the Scheme using electronic data interchange (EDI).
** This process normally works extremely well and ensures quick, direct payment to the supplier.
** However, it does not absolve the member from the ultimate responsibility for ensuring that the account is settled, or for any co-payment that is due.
** Suppliers who submit claims directly to the Scheme are obliged to send duplicate accounts to members to check whether the services and the amounts charged are in fact correct.
** Check your claims statement to verify that the accounts have been paid.
** It could be inconvenient for members when such an account is discovered to be unpaid after the maximum period for the submission of claims has passed.
** Should changes be made to the benefits granted by the Scheme, claims submitted after the changes will be paid according to the rules that existed at the date of the service and not the rules that exist at the date when the claims are submitted or received.
How To Claim Imperial Group Medical Scheme?
Kindly follow the below steps to claim the Imperial Group Medical Scheme
Step 1 : Check for the following information on your Doctor’s bill/invoice.
Required information :
The Scheme’s registered name – ImperialMed
The main member and the patient treated :
** The main member’s name and the name of the patient treated (main member or dependant) as registered and indicated on the membership card
The membership number :
** The Membership number as indicated on the membership card
The doctor’s practice number :
** Doctors registration number on the Health Professions Council of South Africa
ICD-10 code(s) :
** This is a diagnosis code, eg.”J11.1″
Signed proof of payment :
** Proof of payment signed by the member and indicated as ‘PAID’ (where applicable).
Step 2 : Sign in and date the claim, sign the proof of payment.
Step 3 : Email – imperialmedclaims AT mhg.co.za
Place in an envelope and post to us
PO Box 32759
Step 4 : Upon processing claims, an e-mail notification will be generated and sent via Email or Post.
Step 5 : Payments to members and providers are made twice per month.
Responsibilities of Imperial Group Medical Scheme
** Understand how Imperialmed works.
** Keep the Scheme up to date on any changes to your membership details.
** If you do not notify the Imperial Group Medical Scheme timeously, this may have financial consequences for you as a member.
** Check all accounts from service providers, as well as your claims statements from the Scheme, to make sure that all your details are correct and that your claims have been processed correctly.
** Inform the Scheme before you are admitted to hospital, as you require a pre-authorisation number for in-hospital services.
** If you do not obtain a preauthorisation number, you may have to make a co-payment of R500
** File all your documentation from the Scheme and keep it in a safe place so that you may refer to it at any time.
** Keep your membership card in a safe place so that no one else can use it.
** Follow all the procedures set out by the Scheme.
** Review your circumstances annually to ensure that you are on the correct benefit plan.
PO Box 32759