SAMWUMED has partnered with Medscheme for Hospital Benefit and Pharmacy Benefit Management.

Hospital 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

Pharmacy Management

  • chronic medication authorisation and enquiries
  • medicine claims clinical adjudication

For Chronic Medicine Authorisation contact – 0860 33 33 87