SAMWUMED Claims Procedure

Members must submit the following information:

Beneficiary Information

• Membership number.
• Scheme name and benefit plan (Option A or Option B).
• Main member’s initials and surname.
• The patient’s name and surname.
• If the claim is not for the principal member, the dependent’s code as it appears on the back of the SAMWUMED membership card is required.
• Date of birth of the patient.

Treatment Information

• The date of the service.
• Account/reference number.
• Valid Tariff/NAPPI/Procedure Code (pricing of a medical service/product).
• ICD-10 code(s).
• Cost of each treatment, item or procedure.
• If the claim is related to medication the name, quantity, dosage and net amount payable by the member should be provided.
• Healthcare provider (e.g. pharmacy, doctor, hospital, etc.
• Name and practice number.
• Referring doctor’s practice number (e.g. for specialist claim).
• In the case of a group practice, the group practice number and the name of the practitioner who provided the service.