SAMWUMED recognises the importance of Managed Care in the provision of quality healthcare for our members. As such, we have contracted Medscheme as our Hospital Benefit Management, Oncology Benefit Management and Pharmacy Benefit Management Service Provider and Aid for AIDS as our HIV/AIDS Management Service Provider.
Medscheme is responsible for the following Hospital Benefit Management services:
- hospital pre-authorisation and case management
- hospital claims adjudication
For Hospital Pre-authorisation contact 0860 33 33 87
For doctor claims related to your hospital authorisation contact the scheme directly on 0860 104 117
Under normal circumstances and in line with the Scheme rules, Medscheme requires pre-authorisation to be completed before any planned admission to hospital at least 1 business day before the procedure is performed or within 1 business day following an emergency admission. Not obtaining authorisation for an admission may result in a R1 000 co-payment being applied.
Remember to have the following information available when requesting a hospital authorisation:
- member name and surname
- member number and beneficiary code
- treatment date
- treating provider’s practice number
- place of service practice number
- relevant diagnosis and/or procedure codes
Medscheme is responsible for the following Pharmacy Benefit Management services:
- chronic medication authorisation and enquiries
- medicine claims clinical adjudication
For Chronic Medicine Authorisation contact 0860 33 33 87
AfA is responsible for all HIV/AIDS related clinical services
