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- Autoimmune [1]
- Chemical Pathology [15]
- Endocrinology [1]
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- Genitourinary [2]
- Haematology [9]
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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.
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.
Serum Free Light Chains
Learn more about how Serum Free Light Chains (s-FLC) testing now forms an integral part of the management of Myeloma in this downloadable pdf. Serum Free Light Chains
Serum Glucan test
Candida is reported as the fourth most common group of pathogens isolated from blood amongst hospitalised patients. Find out more about the Serum Glucan test in this downloadable pdf. Serum Glucan test
Measles outbreak
Read more on what measles is, the clinical features of measles, how infection is acquired, what specimens should be submitted, complications as well as treatment in this downloadable pdf. Measles outbreak
Lupus anticoagulant in antiphospholipid syndrome
Learn more about the definition, diagnoses, testing and reporting of Lupus anticoagulant in antiphospholipid syndrome in this downloadable pdf. Lupus anticoagulant in antiphospholipid syndrome
Iodine Allergy: A Medical Myth
The term 'iodine allergy' is frequently used, and usually refers to a history of an allergic reaction to seafood or iodinated radiological contrast media, or to a contact allergy to povidone-iodine antiseptic preparations. Find out more about why this is a medical...
Human Papilloma Virus – High Risk Types
Read more about high-risk DNA typing and mRNA E6/E7 testing in this downloadable pdf, now offered by PathCare. Human Papilloma Virus - High Risk Types
Influenza
South Africa carries a heavy influenza burden with more than 12 000 deaths each year due to influenza associated severe acute respitory illnesses. Find out about the most effective strategy to prevent influenza in this downloadable pdf. Influenza
CSF analyses in acute bacterial meningitis
Find out more information on the examination of the cerebrospinal fluid (CSF), which is crucial in establishing the diagnosis of bacterial meningitis, in this downloadable pdf. CSF analyses in acute bacterial meningitis
Cystic Fibrosis
The sweat test is considered the “gold standard” for the diagnosis of the classical form of CF. The diagnosis of CF is confirmed by two or more positive sweat test results on separate occasions in a patient with suggestive clinical features. Find out more in this...