SAMWUMED has partnered with Medscheme for Hospital Benefit and Pharmacy Benefit Management.
- Hospital pre-authorisation and case management
- Hospital claims adjudication
For Hospital Pre-authorisation contact – 0860 33 33 87
For doctor claims related to hospital authorisation contact the scheme directly on – 0860 104 117
Under normal circumstances and in line with the Scheme rules, pre-authorisation must 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 paid by the member.
Information needed for 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
- chronic medication authorisation and enquiries
- medicine claims clinical adjudication
For Chronic Medicine Authorisation contact – 0860 33 33 87