• Member has to consult the GP/Specialist with a specific condition/problem and the specialist referral process has to be followed.
• The General Practitioner/Specialist completes a request for admission and gives it to the member. The member should use this request to obtain authorisation for the hospital admission from Case Management.
• The hospital authorisation request from the GP/Specialist should contain the following detail:
• The patient’s
  • Name
  • Date of birth
  • Medical scheme number
  • Contact details
• The hospital details and practice number
• The admitting/treating GP/specialist’s details and practice number
• Admission date
• Diagnosis
• ICD 10 code
• Tariff code(s)/procedure(s)

• Case Management evaluates the reffering request with the assistance of the Medical Advisor and authorises the admission.
• Member receives an authorisation number via SMS, email, telephone or from Platinum Health facility.
• Hospital authorisation request/pre-admission documents need to be send or taken to the hospital before admission date. This is to ensure pre-admission documentation is completed and captured on the hospital system to ensure problem-free admission.
• Member to supply the authorisation number to the hospital.
• Subject to clinical protocol approval.

• Case Management evaluates the referring request with the assistance of the Medical Advisor and rejects hospital admission.
• Member receives notification via SMS, email, telephone or from Platinum Health facility; stating the reason why the authorisation request was declined.
• Members can contact Case Management and Platinum Health facilities at their sites with regards to follow-up queries

After-hours hospitalisation admissions should be arranged with the Case Manager on call and all related documentation submitted to Case Management on the first working day after the hospital admission.

• The GP/specialist completes a request for admission and gives it to the member. The member should use this request to obtain authorisation for the hospital admission from Case Management. Please take not that pre-authorisation for your hospital admission has to be obtained from the Scheme within two (2) days prior to your admission.
• The hospital authorisation request from the GP/Specialist should contain the following detail:
• The patient’s
  • Name
  • Date of birth
  • Medical scheme number
  • Contact details
• The hospital details and practice number
• The admitting/treating GP/specialist’s details and practice number
• Admission date
• Diagnosis
• ICD 10 code
• Tariff code(s)/procedure(s)

• Case Management evaluates the reffering request with the assistance of the Medical Advisor and authorises the admission.
• Member receives an authorisation number via SMS, email, or telephone.
• Hospital authorisation request/pre-admission documents need to be sent or taken to the hospital before the admission date. This is to ensure pre-admission documentation is completed and captured on the hospital system to ensure problem free admission.
• Member to supply the authorisation number to the hospital.

• Case Management evaluates the referring request with the assistance of the Medical Advisor and rejects hospital admission.
• Member receives notification via SMS, email, or telephone; stating the reason why the authorisation request was declined.
• Members can contact Case Management and Platinum Health facilities at their sites with regards to follow-up enquiries.

• Emergency admissions can be arranged telephonically between the referring GP/Specialist/Hospital and the responsible Case Manager, but; the documentation still needs to be finalised afterwards.

• After-hours hospital admissions should be arranged with the Case Manager on call and all related documentation to be submitted to Case Management on the first working day after the hospital admission.