Knowledge Hub
Categories:
- Allergy [1]
- Antimicrobials & infection [5]
- Autoimmune [1]
- Chemical Pathology [15]
- Endocrinology [1]
- Epidemiology [3]
- Gastrointestinal [2]
- Genetics [6]
- Genitourinary [2]
- Haematology [9]
- HIV/TB [3]
- Infectious Diseases [10]
- Neurology [4]
- Obstetric and Neonatal care [4]
- Oncology [1]
- Ophthalmology [1]
- Respiratory [2]
- Serology [3]
- Virology [44]
With regard to Designated Service Provider (DSP) Contracts the following law is pertinent for service providers who are not a DSP:
- In terms of Section 59 (2) of the Medical Schemes Act 131 of 1998 the medical scheme must pay valid invoices within 30 days of receipt thereof or advise both the member and service provider of reasons why the invoice is not valid and provide the opportunity to correct the invoice.
- Where services are in respect of medical emergencies or involuntarily obtained services for PMB conditions, the scheme has to pay for the full cost of the services provided without deduction or co-payment or limiting the tariff amount. (Regulation 8 (1) of the Medical Schemes Act no. 131 of 1998.)
- DOH notice 214 of 2021 requires that a scheme pays for services provided at the same rate and in terms of the same rules as they pay their DSPs in respect of services voluntarily obtained, whether they are PMBs or not.
- The process followed in respect of appointing a DSP is required to be fair, equitable, transparent, competitive or cost effective as required in terms of Notice 214 of the DOH.
In summary:
- The law protects the patient’s choice to use their laboratory of choice, even if it is not a DSP, and the scheme is still obliged to reimburse us at the scheme rate for valid claims.
- This is true for PMB conditions as well as non-PMB conditions.
- The medical scheme must pay valid invoices within 30 days or advise both the member and service provider of reasons why the invoice is not valid and provide the opportunity to correct invoice.
- A scheme must pay for the services provided at a tariff not less than what they would pay a DSP.
- Should any patient have a valid claim rejected because we are not a DSP, we can assist.
β-Hydroxybutyrate
Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus, and consists of the biochemical triad of ketosis, hyperglycaemia and acidaemia. DKA usually occurs as a result of an absolute or relative insulin deficiency and an...
Diagnosis of B12 and Folate Deficiency
Vitamin B12 and folate are vitamins required for normal haematopoiesis and neurologic function. They are often considered together, although folate deficiency has become exceedingly rare in individuals who are living in developed countries and...
Xpert® MTB/RIF Ultra assay
The WHO recommends that each patient with suspected tuberculosis should benefit from at least one NAAT (nucleic acid amplification test), as these tests have enhanced sensitivity and specificity above conventional microscopy. Over the past...
Schistosomiasis / Bilharzia
Schistosomiasis is a parasitic disease of public health importance. Due to the variable presence of diagnostic laboratory parameters in the natural history of the disease, laboratory findings should be interpreted in the context of the clinical history...
Syphilis
PathCare utilizes the Treponema pallidum antibody assay as a screening test for syphilis. This is in line with international reporting standards. The Treponema pallidum antibody test is an economic and reliable automated syphilis serology test. It utilizes...
Thrombotic Thrombocytopenic Purpura (TTP)
TTP is a relatively uncommon condition characterized by die formation of platelet-rich thrombi in the arteriioles and capillaries with widespread multi organ thrombosis. It is a clinical diagnosis and a MEDICAL EMERGENCY! In the South African Setting,...
Serum Free Light Chains
Serum Free Light Chains - An Essential Test in Myeloma. Multiple Myeloma (MM) is the 2nd most common haematological malignancy. Serum free light chain (s-FLC) testing now forms an integral part of the management of MM. The serum levels of free light...
16s rRNA PCR
A new molecular test improves PathCare laboratories' capacity to detect and identify bacteria involved in 'difficult' infections. A 16s rRNA molecular test is now offered by the molecular laboratory in our reference laboratory at N1 City, Goodwood. The test is useful...
Apolipoprotein B & A1
The association between cardiovascular disease (CVD) risk and plasma low density lipoprotein-cholesterol (LDL-c) level is indisputable. Accordingly, all screening and therapeutic guidelines are based on total cholesterol (TC) or LDL-c levels....