Claiming and claims refunds simplified On the odd occasion that a service provider expects you to pay for medical services upfront or personally, you may be able to submit these claims to POLMED for a refund. Here are some useful tips to make sure that your claims are promptly processed. By when must I submit my claims? Q How will you know if your claims have been SUBMIT YOUR CLAIMS CORRECTLY useful tips! paid? A Once the claim has been assessed, you will receive a claims statement that will reflect the outcome of the payment process. The outcome can also be viewed on our Customer Online facility by visiting www.polmed. co.za; login with your registered PIN. There are various ways of submitting claims to POLMED for processing: Check your claims prior to submission Fax: 0860 104 114 Q When can I expect to be refunded if a OR EPOLMED needs to receive claims within four months following the month in which the services were provided. On receipt of your account from the service provider, check that the following information appears on the account: EAfter that time, a claim becomes stale and will not be paid. It is therefore important that all accounts be submitted to POLMED timeously. E your membership number; E your surname and initials; E the patient’s first name, surname and dependant code; E the name of the Scheme (POLMED) and benefit option (Higher Plan or Lower Plan); E the name and practice number of the service provider; E tariff codes – this is a code that refers to the pricing of a medical service/product; E the ICD-10 (diagnostic) code that relates to the health service you received; E cost of each treatment, item or procedure; and E proof of payment can either be: E a valid receipt from the service provider, showing the practice details; or E an electronic fund transfer (EFT) slip; or E a bank deposit slip. EYou will forfeit your right to claim if you fail to stick to the timeframe of four months of the date of service for the submission of claims. refund is due to me? E-mail: [email protected] A If a refund is due to you, POLMED will pay it at the end OR Post: POLMED, Private Bag X16, Arcadia 0007 OR Drop your claim at any of our regional offices. Q What happens after you send us your claim? A Once the claim is received it is recorded on the system. The claim will be assessed to make sure all the information on it matches the information we have on record for the patient. Whether the claim is paid or how much will be paid will be determined by the POLMED rules, your available benefits at that point in time and the POLMED rate. of the month. POLMED makes refunds electronically, so you need to make sure that we have your correct banking details on record. If your bank details have changed, please inform POLMED in writing and provide a copy of your most recent bank statement or a stamped letter from the bank confirming your banking details. You may e-mail the information to [email protected] or fax it to 0860 888 114. You should never send your banking details via SMS or give it to someone over the telephone.
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