Claims
HOW TO SUBMIT CLAIMS OR ACCOUNTS
Submit claims/accounts as soon as possible and include all relevant information within four months of date of service – these are the golden rules for achieving prompt settlement of your medical claims/accounts by Platinum Health. This will assist the scheme to pay the provider before the account becomes overdue and members are threatened with legal action or held accountable for claims/accounts. Platinum Health has an agreement with designated service providers (DSP’s) to submit claims/accounts directly to the scheme in order to streamline the payment of claims/accounts. A remittance advice will be sent to the service provider on a monthly basis confirming payments made. Members are also kept informed as Platinum Health emails or posts statements of claims paid to members on a monthly basis.
It is very important that Platinum Health has your updated contact details which include your residential, – postal and e-mail addresses as well as your telephone number. To update your contact details, download the “Request to change membership details, scheme option or card request” form below or collect one from your local Client Liaison Officer and complete the relevant contact detail changes. The next step is to forward the form to Platinum Health via either fax or hand in to your local Client Liaison Officer.
Please note: It remains the member’s responsibility to ensure that the scheme receives all claims/accounts in time for prompt payment.
Medical service providers are required to include the following information on all accounts:
- Member’s initials, surname and address;
- Member’s medical scheme number;
- The date and the service or supplies provided, and the tariff code for the service or suppliers;
- The name and date of birth of the patient who received the service or supplies;
- Platinum Health authorisation number, where applicable.
- Platinum Health authorisation number, where applicable.
In addition, state other information which will help Platinum Health process claims timeously:
- Verify that the member or a dependant did receive the service or supplies by signing the account submitted.
- Members who pay cash for services and then claim from Platinum Health must attach proof of payment, together with the account, as the scheme processes the tariff codes used by the provider for the refund to the member. If the refund documentation does not reach Platinum Health in time, the provider will be paid and the member must request the refund from the provider.
- The only acceptable proof of payment is a receipt of the money paid (such as a credit card transaction slip), a receipt or a zero-balance statement from the provider.
Submit claims within four months of treatment date to prevent the claims from becoming stale, thus resulting in non-payment. Details to be confirmed by the member:
- Membership number
- Dependant code;
- Authorisation number, if the account is from a specialist; and
- Treatment date
Submit all claims and refunds to Platinum Health Claims at:
- Email to: ZZGPlatinumHealthClaims@platinumhealth-co-za-platinumhealth.datafree.co
- Rustenburg Client Liaison Office at your operation
- Mail to Platinum Health, Private Bag X82081, Rustenburg, 0300
Claims Statements
Members may contact Client Liaison at 080 000 6942 from 08:00 to 16:00, Monday to Friday, to obtain their claims advice.
Step-by-step guide for MEMBERS on HOW TO SUBMIT
CLAIMS
- Tax invoice/account number
- Member’s initials, surname and address
- Membership number
- Dependant code
- The date, tariff code and detail of the services/supplies provided
- Authorisation number, if the tax invoice/account is from a specialist.
- Verify that the member or dependant did receive the service or supplies, by signing the tax invoice/account.
Fax: 086 591 4598
Mail: Platinum Health, Private Bag X82081, Rustenburg, 0300
Hand in at Client Liaison Office at your operation
Step-by-step guide for MEMBERS on HOW TO REQUEST REFUNDS
ACCOUNT featuring the following details:
- Member’s initials, surname and address;
- Member’s medical scheme number;
- The date, tariff code and detail of the services/ supplies provided,
- The name and date of birth of the patient who received the services/supplies; and
- Platinum Health authorisation number, where applicable.
VERIFY that the member or dependant did receive the service or supplies, by signing the account submitted.
BANK CONFIRMATION LETTER if the member changed bank accounts OR if the member has not been refunded during the last 3 months.
Fax: 086 591 4598
Mail: Platinum Health, Private Bag X82081, Rustenburg, 0300
Hand in at Client Liaison Office at your operation
Member statements with full details of payments are emailed or posted to members. (It is Important for members to ensure their contact numbers, email & postal addresses are updated with the Scheme)
CLIENT LIAISON CONTACT DETAILS
TELEPHONE
014 590 1700 or 080 000 6942 (toll free)
phclientliaison@platinumhealth-co-za-platinumhealth.datafree.co
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