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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.
- 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.
Influenza A, influenza B and RSV detection rates were below 5% throughout September. Human rhinovirus/enterovirus detection rates ranged from 29.6-35.5%, thus showing a slight decrease in comparison to August.
In the past, our knowledge of the epidemiology of infective diarrhoea in routine clinical practice, was incomplete because the traditional methods of microscopy and culture are insensitive and detect only a limited range of pathogens.
Pertussis is a highly infectious respiratory infection caused by Bordetella pertussis. It remains endemic in all countries, despite high vaccine coverage.
Hereditary cardiomyopathy and arrhythmia disorders are genetically heterogeneous meaning that within each category there are multiple disease genes, and many different pathogenic (disease-causing) variants with overlapping phenotypes.
Influenza A and B detection rates remained below 2% during August, with the influenza season officially having ended in July.
Two SARS-COV-2 variants are currently getting coverage in the press, namely BA.2.86 and EG.5. Both are subvariants or lineages of Omicron, however, renewed interest has stemmed from the large number of mutations detected in these viruses.
Anaemia is defined as a reduced haemoglobin level in the peripheral blood. When blood does not contain enough haemoglobin, cells do not receive enough oxygen and symptoms may arise.
Influenza A detection rates continued to decline during July, dropping below 2% in week 30 (week ending 30 July).
Schistosomiasis (Bilharzia) is an intravascular parasitic infection caused by flukes (trematodes) of the genus Schistosoma.