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Welcome to 2019!
Datamax, the new owners of Made to Measure, have committed to supporting Made to Measure products to the best of our ability. To this end we have provided the tariffs on the first working day of the year, a full two weeks earlier than was usual previously.
Please read below for full details on how to get your 2019 tariffs loaded. Bear in mind, though, that now might be a good time to consider upgrading to Panacea. Why? Here are a few reasons:
- Panacea tariffs are fully automated. You do not need to load anything manually and the whole process involves only a few clicks to select your options from Panacea's Tariff Wizard.
- Panacea can maintain an unlimited number of pricelists, i.e. we generate one pricelist for each medical aid.
- Most Panacea pricelists are generated from actual price files supplied by the medical aids, i.e. they are 100% accurate.
- Panacea can automatically match each pricelist with the equivalent medical aid.
- Panacea can implement a variety of billing scenarios, e.g. scheme-matching pricing and balance billing
For full details on Panacea, please visit our website by clicking
here
.
How to import / update your medical aid tariffs for 2019:
1. 2019 rates.
These rates are supplied free of charge as a courtesy to our users. If you do not understand how the billing works please read this https://madetomeasure.freshdesk.com/solution/articles/17000069875-how-the-billing-works-.
The basic procedure is to import the Discovery rates (4 below) and then import the Medical Aid %'s(5 below)
2. This Update includes:
i/ Discovery rates (DHR) for most of the allied disciplines (see 4 below) for funds that use the DHR.
ii/ Medaid %'s for the funds that use the 2010 base rate to calculate the price for each code. NOTE This will not be 100% accurate to what the fund pays. It is an approximate value. To improve accuracy see 6 below.
iii/ Namibian rates
iv/ IOD rates will only increase in April.
v/ Private rates are never provided - maintain them yourself.
3. Backup and update the program:
Take a backup. If you are not on the latest version it is advisable do the update. Professional users apply Profupdate from this Knowledge Base ( this is not essential this year as there have been very few changes made to the old program). Synergy users go to Housekeeping -> Upgrade in the program.
4. Get the new Discovery rates (DHR):
i/ Disciplines 91 Biokinetics, 04 Chiropractics, 08 Homeopathy, 66 OT, 72 Physio, 86 Psychology, 82 Speech Therapy / Audiology, 81 counselling, 84 dietetics, 83 Hearing aid Acoustician, 88 Nurses, 89 Social Work, 13 Oral Hygeine, 68 Podiatry, 85 Psychometry, 22 Psychiatry, 39 Radiology,
On the tariff code screen go to 'Import' then 'WebUpdate' then again 'Import'.
ii/All other disciplines -
On the tariff code screen use the 'Increase' button to increase the Discovery column by 5% for the 2019 increase.
NB Before billing check each code price to those from the Discovery website - if you charge too much by 5c they will pay the patient instead of you.
iii/ If you have a special contract with Discovery you will need to enter the special rates that replace the DHR.
iv/ Doctors and specialists can calculate more accurate rates using units and RCF see 7 below.
5. Update the medaid %'s.
On the Medical Aid screen, go to 'Import', then 'WebUpdate' , then again 'Import'.
On Professional any funds that have been set to use their own column will revert to the Medaid 2010 column after this update and you will need to reset them to use their special column again. This will not happen in Synergy where only those funds that use the MedAid2010 column will have their %'s changed.
Physio's will need a special column for the Bestmed rates
Note that if you have set patients to use a different rate to the medical aid standard, then they will revert to standard when you do this update.
6. Improve accuracy on funds using % based billing.
i/ Tweak the % to suit your practice / discipline -
Do this easy calculation for a few of your codes to get a range of %'s
Medaid 2010 price is the price for the code on tariff code screen in column2
Actual price is the published actual rate that the medical aid says they will pay for that code.
(Actual price - Medaid 2010 price ) / Medaid 2010 price x 100 = % above the 2010 rate that this medical aid will pay for this code
Add 100 to this % before entering it in on the Medical Aid screen in the Billing %
It is best to use the lowest of the range of %'s you get so that all your invoices are = or slightly less than the published price. This way you will avoid irritating small amounts that have to be written off.
ii/ For 100% accuracy you will need to create a column of rates especially for the fund. Use the 'columns' button on the tariff codes screen and type in the actual rate per code. Then go to the Medical Aid screen and change the billing on the fund to use the new column at 100%.
Funds that it may be helpful to do this for are GEMS, NMS, Bestmed, Bankmed.
Physios will need to set up a special column for Bestmed as they have added new codes and also changed the weightings on existing codes which makes them impossible to calculate from the 2010 base rate.
Note that Professional users are limited to 5 extra columns while Synergy users have no limit on columns.
iii/ Exception codes can be created for specific codes when the % increase does not work - especially for Doctor's consultations.
(See Helpfiles - 'exception' )
7. Doctors - Improve accuracy by calculating from units and RCF
RCF values are available for most funds / plans.
2019 DHR RCF are:
GP anaesthetist (AU type 30 ) =85.386
Spec anaesthetist (AU type 30 ) = 102.464
CPU (clinical procedure units type 20) =13.567
To use this option see HelpFiles 'Tariff codes Units'
8. Help with updates.
The procedure is explained here https://madetomeasure.freshdesk.com/solution/articles/17000075574-how-to-update-your-medical-aid-rates-from-within-the-program and in the helpfiles
Datamax support can help you telephonically with these updates. Note that if you have problems with anti Virus software blocking the downloads you may require the services of a technician. For most disciplines it is also easy to update the rates manually - see https://madetomeasure.freshdesk.com/solution/articles/17000075575-how-to-update-your-medical-aid-rates-manually
8. Disclaimer.
While we try our best to give you the most accurate information possible, we cannot be liable for any errors / discrepancies. Please check your rates and adjust as needed.
9. Medical Aid %'s
These %'s represent the accumulated increases by each fund over the past 9 years and are used, in conjunction with the MedAid2010 rate, to calculate each treatment line's value.
| MEDCOD |
MEDNAME |
ADMIN |
Base Tariff |
2019 % |
2019 on base |
Notes |
ROUND |
| 027 |
AECI (Healthcare) |
Medscheme |
MedAid2010 |
5.40 |
167.48 |
|
10c |
| 276 |
Affinity |
Pan-African Managed Care |
MedAid2010 |
5.00 |
162.75 |
|
|
| 224 |
Alliance Midmed |
MMSA |
MedAid2010 |
5.00 |
165.78 |
|
10c |
| 037 |
Anglo America Scheme |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 036 |
Anglovaal |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 042 |
Bankmed |
Discovery Health |
MedAid2010 |
5.00 |
166.40 |
|
10c |
| 043 |
Barloworld |
Medscheme |
MedAid2010 |
5.00 |
165.15 |
|
10c |
| 045 |
Bestmed |
Bestmed |
MedAid2010 |
5.00 |
165.28 |
Physio need own column
|
10c |
| 048 |
BMW Employees |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 050 |
Bonitas |
Medscheme |
MedAid2010 |
5.00 |
162.98 |
|
10c |
| 056 |
BP Southern Africa |
MMI |
MedAid2010 |
5.00 |
172.12 |
|
10c |
| 733 |
Building & Construc Ind |
Status Medical Admin |
MedAid2010 |
5.00 |
166.08 |
|
10c |
| 079 |
CAMAF |
Sanlam Health Care |
MedAid2010 |
5.00 |
168.38 |
|
10c |
| 052 |
Cape Medical Plan |
Cape Medical Plan |
MedAid2010 |
5.00 |
179.37 |
|
10c |
| 561 |
Carecross |
Carecross |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 389 |
Centre for Diabetes |
Sanlam Health Care |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 009 |
Commed |
Allcare |
MedAid2010 |
5.00 |
165.77 |
|
10c |
| 129 |
Compcare |
Status Medical Admin |
MedAid2010 |
5.00 |
166.11 |
|
10c |
| 704 |
Compsol |
Compsol |
IOD |
5.00 |
100.00 |
|
1c |
| 066 |
De Beers |
De Beers |
MedAid2020 |
5.00 |
165.93 |
|
R1 |
| 125 |
Discovery |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 269 |
Engen |
MMI |
DHR |
5.00 |
100.00 |
|
10c |
| 460 |
EssentialMed |
EssentialMed |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 160 |
Fedhealth |
Medscheme |
MedAid2010 |
5.10 |
164.06 |
|
10c |
| 779 |
Fishing Industry |
MMI |
MedAid2010 |
5.00 |
168.45 |
|
10c |
| 083 |
Foschini |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 875 |
GEMS |
MHG |
MedAid2010 |
5.00 |
164.35 |
|
10c |
| 518 |
Genesis |
Difiniti |
MedAid2010 |
5.00 |
168.11 |
|
10c |
| 349 |
Getmed |
Getmed |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 181 |
Glencore Xtrata |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 363 |
Golden Arrow |
MMI |
MedAid2010 |
5.00 |
171.33 |
|
10c |
| 082 |
Good Hope |
Status Medical Admin |
MedAid2010 |
5.00 |
160.68 |
|
10c |
| 259 |
Grintek GEMAS |
Status Medical Admin |
MedAid2010 |
5.00 |
164.84 |
|
10c |
| 597 |
Hairdressing Trade |
Hairdressing Trade |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 870 |
Harmony |
Sanlam Health Care |
MedAid2010 |
5.00 |
164.06 |
|
10c |
|
Health4Me |
MMSA |
|
5.00 |
161.90 |
|
10c |
| 444 |
Horizon Medical Scheme |
Medscheme |
MedAid2010 |
6.00 |
170.21 |
|
10c |
| 523 |
Hosmed |
Medscheme |
MedAid2010 |
5.20 |
168.46 |
|
10c |
| 439 |
Impala |
Providence |
MedAid2010 |
5.00 |
164.06 |
|
10c |
| 364 |
Imperial Group |
MHG |
MedAid2010 |
6.05 |
169.50 |
|
10c |
| 510 |
Keyhealth |
MMSA |
MedAid2010 |
5.40 |
171.00 |
|
10c |
| 525 |
LA Health (LAMAF) |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 099 |
Libcare |
VMed |
MedAid2010 |
5.40 |
170.21 |
|
10c |
| 008 |
Liberty Health Blue |
VMed |
MedAid2010 |
5.00 |
168.12 |
|
10c |
| 945 |
Lonmin |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 302 |
Makoti |
Enablemed |
MedAid2010 |
5.00 |
163.44 |
|
10c |
| 104 |
Malcor |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 038 |
Massmart |
Universal Health |
MedAid2010 |
5.00 |
168.84 |
|
10c |
| 180 |
MBMed |
Medscheme |
MedAid2010 |
5.00 |
164.68 |
|
10c |
| 418 |
Medicall |
Private Health Care |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 256 |
Medihelp |
Medihelp |
MedAid2010 |
5.00 |
169.81 |
|
10c |
| 265 |
Medimed |
Providence |
MedAid2010 |
5.00 |
164.83 |
|
10c |
| 250 |
Medipos |
MHG |
MedAid2010 |
5.40 |
170.70 |
|
10c |
| 111 |
Medshield |
Medshield |
MedAid2010 |
5.50 |
165.76 |
|
10c |
| 121 |
Metropolitan(Metstaff) |
MMI |
MedAid2010 |
5.00 |
169.07 |
|
10c |
| 362 |
MMED |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 822 |
Momentum Health |
MMSA |
MedAid2010 |
5.00 |
159.62 |
|
10c |
| 940 |
Moto Health Care |
MMSA |
MedAid2010 |
5.00 |
166.55 |
|
10c |
| 206 |
Namibia Health Plan |
Medscheme Namibia |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 512 |
Naspers |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 010 |
NBCRFLI??? |
Universal Health |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 016 |
Nedgroup |
Medscheme |
MedAid2010 |
5.00 |
167.19 |
|
10c |
| 067 |
Netcare (NMS) |
Discovery Health |
MedAid2010 |
5.00 |
166.40 |
|
10c |
| 624 |
Nufawsa Sick Benefit |
Eminent Wealth |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 987 |
OcsaCare |
Carecross |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 012 |
Old Mutual Staff |
Lethimvula |
MedAid2010 |
5.20 |
164.68 |
|
10c |
| 859 |
Oneplan |
OnePlan |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 142 |
Opmed |
Opmed |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 143 |
Parmed |
Medscheme |
MedAid2010 |
4.90 |
163.29 |
|
10c |
| 146 |
PG Group |
MMI |
MedAid2010 |
5.20 |
166.08 |
|
10c |
| 376 |
Pick 'n Pay |
MMI |
MedAid2010 |
5.40 |
167.48 |
|
10c |
| 266 |
Platinum Health |
Platinum Health |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 219 |
Polmed |
MedScheme |
MedAid2010 |
5.00 |
169.71 |
doctors 170.52 |
10c |
| 219d |
Polmed for Doctors |
MedScheme |
MedAid2010 |
5.00 |
170.52 |
|
10c |
| 642 |
Primecure Thlakano |
Primecure |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 154 |
Profmed |
PPS |
MedAid2010 |
5.25 |
167.91 |
|
10c |
| 162 |
Quantum |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 818 |
Rand Mutual |
RMA |
IOD |
|
100.00 |
|
1c |
| 607 |
Rand Water |
Sanlam Health Care |
MedAid2010 |
5.00 |
167.64 |
|
10c |
| 161 |
Remedi |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 061 |
Resolution Health |
Agility GHS |
MedAid2010 |
5.00 |
164.21 |
|
10c |
| 608 |
Retail Meat Trade |
Retail Meat Trade |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 946 |
Retail Medical Aid Schem |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 780 |
Roshmed |
Roshmed |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 581 |
RU Med/ TEMS |
Providence |
MedAid2010 |
5.00 |
164.06 |
|
10c |
| 179 |
SAB (SA Breweries) |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 176 |
SABC / SAUK |
Medscheme |
MedAid2010 |
5.00 |
164.37 |
|
10c |
| 611 |
SAMWUMed |
SAMWUMed |
MedAid2010 |
5.40 |
168.75 |
|
10c |
| 174 |
Sappi - discontinued |
MHG |
MedAid2010 |
5.00 |
0.00 |
|
10c |
| 118 |
SAPS Wellness |
MHG |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 175 |
Sasolmed |
Medscheme |
MedAid2010 |
5.00 |
164.22 |
|
10c |
| 022 |
SedMed |
SedMed |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 004 |
Selfmed |
SelfMed |
MedAid2010 |
5.00 |
176.02 |
|
10c |
| 188 |
Sibanye Gold |
Providence |
MedAid2010 |
5.00 |
164.06 |
|
10c |
| 116 |
Sisonke Health |
Providence |
MedAid2010 |
5.00 |
164.06 |
|
10c |
| 178 |
Sizwe |
Sechaba |
MedAid2010 |
5.00 |
168.92 |
|
10c |
| 937 |
Sizwe Primary Network Op |
Sechaba |
MedAid2010 |
5.00 |
168.12 |
|
10c |
| 522 |
Spectramed |
Agility Global Health |
MedAid2010 |
5.00 |
165.77 |
|
10c |
| 614 |
Spes Bona |
Spes Bona |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 072 |
Suremed |
Providence |
MedAid2010 |
5.00 |
164.06 |
|
10c |
| 240 |
Swazimed |
Medscheme |
MedAid2010 |
5.00 |
164.05 |
|
10c |
| 769 |
Thebemed |
Providence |
MedAid2010 |
5.00 |
170.51 |
|
10c |
| 228 |
Tiger Brands |
Status Medical Admin |
MedAid2010 |
5.00 |
166.11 |
|
10c |
| 003 |
Topmed |
Private Health Administrators |
MedAid2010 |
5.00 |
170.85 |
|
10c |
| 194 |
Transmed |
MHG |
MedAid2010 |
5.00 |
166.85 |
|
10c |
| 778 |
TruCare |
Universal Health |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 944 |
Tsogo Sun Group |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 615 |
Ultracare |
Ultracare |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 920 |
Umvuzo Health |
Umvuzo |
MedAid2010 |
5.00 |
166.85 |
|
10c |
| 484 |
Unity Health |
Ambledown |
MedAid2010 |
5.00 |
161.90 |
|
10c |
| 566 |
Universal Health and Acc |
Universal Health |
MedAid2010 |
5.00 |
166.85 |
|
10c |
| 431 |
Universal Worker Plan |
Universal Health |
MedAid2010 |
5.00 |
166.85 |
|
10c |
| 197 |
University of KZ-Natal |
Discovery Health |
Discovery 2013 |
5.00 |
100.00 |
|
10c |
| WCA |
WCA / IOD |
|
IOD |
5.00 |
100.00 |
|
10c |
| 201 |
Witbank Coalfields |
Witbank Coalfields |
MedAid2010 |
5.40 |
169.89 |
|
10c |
| 198 |
Witsmed |
Discovery Health |
DHR |
5.00 |
100.00 |
|
10c |
| 202 |
Wooltru |
MHG |
MedAid2010 |
5.30 |
170.18 |
|
10c |
|
|
|