Health Professional Zone: Member validation and virtual quote. User manual and frequently asked questions

Transcription

1 Health Professional Zone: Member validation and virtual quote User manual and frequently asked questions

2 About this guide We ve improved some of the online functionalities member validation and simulate claim in the Health Professional Zone. This document answers questions about why we made these updates, and how it can benefit your practice. We also show you how to use the improved member validation and quote tools on in the Health Professional Zone. Why we ve updated the member validation and quote tools We did some research and found that practices used the Health Professional Zone on the website most for member validation and to simulate claims. Therefore, we wanted to make these functionalities even better to offer your practice added value and make it even easier for you to work with all our members. How it benefits your practice With the improvements we ve made, you get to see the same information our service consultants give you. Without calling us, you can now get more detailed membership validations, up-to-date information about funds, and more exact quotes based on the codes you use. Member validation What you saw before: The old member validation screens only showed you the plan type and the active or withdrawn status of the main member and dependants. What you will see now: When you validate a membership online now, you can see the member s role, name, surname, birth date, gender, status of the membership, authorisation, as well as the primary or secondary GP listed for KeyCare Plans. You also have the option to check available funds, so it is like having a Discovery Health specialist at your practice. Simulate claim (now called virtual quote) You can now get a detailed quote in real time that will confirm how the Scheme will pay the services your practice provides. You can fill in the specific codes to get the virtual quote, and you will see: Funding details for your practice Amounts the patient will have to pay or not pay Reasons for any partial payments. These virtual quotes are, however, not a guarantee of payment. But the information you get will help you make informed decisions about submitting claims.

3 How to get started Log into and go to the Health Professional Zone. In the Health Professional Zone, you will go directly to these updated online tools. From here, you can validate a membership, check funds and do a virtual quote. Get started by inserting your practice details under Select your practice. Still on the same page, go to: Member validation and fund checker Here you can validate a patient s membership by membership number or identity number. Select the option you want to search by, insert the details and click on Validate member to get details of the membership.

4 After you click on Validate member, you will get basic membership details. There is a Print button, which will allow you to print these details. You can also check available funds. Just insert the amount in the field under Check available funds and click on Check funds. You will get a message that tells you whether or not the member has enough funds. Just below this on the same page, you can:

5 Create a virtual quote (or simulate a patient claim) To get a virtual quote and look at authorisations, click on the Member validation and virtual quote link. It is just below the Check funds information. You can also get to Member validation and virtual quote from the top navigation pane in the Health Professional Zone. Click on Health Professional tools and select Member validation and virtual quote from the list under Patient Management. When you have clicked on Member validation and quote (from both of the pages above), you will go to this page. Here, you can insert your practice details and the membership details.

6 The next screen will give you the option to get more information about the membership, and to create a virtual quote line by line, using exact coding standards and ICD-10 codes. Getting more information: Click on the drop-down arrow next to the membership details. When you click on the arrow, you will see authorisation details, chronic medicine registration and the listed secondary and primary GPs for KeyCare Plans. Create a virtual quote (still on the same page). Close the drop down, and complete the claim details by inserting the relevant codes your practice wants to use and click on Create virtual quote.

7 The Print button will allow you to print the details from this detailed member validation. The next screen will show you exactly how the claim will be processed and paid based on the codes you have used in the quote. Please read the disclaimer that goes with each of the virtual claims. You have the option to go Back to update the claim details. Note: You can search and validate each member a maximum of three times a day. You can also click on Print to print the virtual quote results.

8 Summary The website now gives you the ability to do a quick member validation and quick fund check, or a more detailed member validation and quote. There are two ways to get to the more detailed member validation and quote, from the member validation page or by using the top navigation bar called Health professional tools. If you need any more help to use the tools in the Health Professional Zone, phone Frequently asked questions Why only three attempts for any fund check or virtual quote? During a consultation you generally validate a membership or do a fund check, which means you access the system twice. We have set the limit for checking funds and creating virtual quotes at three times for each membership, which covers the average use in a practice. Please note: You can still validate a membership as often as you need to from the landing page. The maximum times (3) you can access a membership apply only to check funds or to create a virtual quote.

9 Can the days of therapy (DOT) be set at 0? The days of therapy cannot be 0. You have to insert a 1, even for medicine, consultations or procedures. Treatment is always provided for a minimum of one day. When do you need to do a virtual quote, and when can you check a rand value? You can do a virtual quote when you have the relevant NAPPI and procedure codes, and you want to know how the Scheme will pay for these. You can do a fund check to see whether a member has a specific rand value available at that time.

10 How can you print the details? All the pages you can print will have a Print button. For now, you can print the following pages: 1. The landing page and member validation results; 2. The detailed member validation; and 3. The virtual quote results. Do you need a membership number, or can you use other details for a virtual quote? Yes, you need the membership details to do a virtual quote. There are two ways to search for membership details: 1. By using the membership number on the medical aid card 2. By using the member s ID number and first name What information can you view on member validation (from the landing page)? When you validate membership details from the landing page, you ll see whether or not a member has an active membership, and whether there are funds in the MSA (Check funds). The more detailed membership information is available under Member validation and quote.

11 Are the funds reserved when you check funds on the website? No, it just provides you with information about the available funds. We do not reserve funds. Do you need NAPPI and procedure codes to complete a virtual quote? Creating a virtual claim works the same as the previous tool. NAPPI and procedure codes are always required for a quote. If you do not have the codes, you can use Check funds for a specific rand value. Do you have to validate a membership and check funds before you can do a virtual quote? No, you don t have to validate a membership or check funds before you can create a virtual quote. You can go directly to Member validation and quote from the landing page or from the top navigation. (

12 Is there a real-time claims submission functionality on the Health Professional Zone? No, you cannot submit claims in real time on the website. Real-time claims submission is only available through certain trading partners.