How to claim from POLMED Medical Aid


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There are various ways of submitting claims to POLMED for processing: Email: polmedcurrentclaims@medscheme.co.za Fax: 011 758 7660 Post: POLMED Private Bag X16 Arcadia 0007 or Visit any POLMED regional walk-in branch. You will receive a claims statement that will advise you of the outcome of the payment process. You can also view the outcome via the Member zone on our website at www.polmed.co.za.



Claims must be submitted within 120 days of the service date. Claims received after this period will be rejected as stale. •Copies of accounts will be accepted for processing or payment. . In cases where the service provider charges above POLMED rates, you will be responsible for payment of the balance of the claim directly to the provider. Obtain a detailed account/statement from the service provider.

Information Required In The Claim

Service provider

  • Name and practice number.
  • Referring doctor’s practice number.
  • In the case of a group practice, group practice number and the name of the practitioner who provided the service.

Member 

  • Membership number
  • Scheme name and benefit plan (Marine or Aquarium)
  • Main member’s initials and surname.
  • The patient’s name, other initials and surname (if it is not the principal member), as well as the dependant code (as it appears on the back of the POLMED membership card).
  • Date of birth of patient.

Other

  • Date of service.
  • Account/reference number.
  • Tariff code(s) – this is a code that refers to the pricing of a medical service/product.
  • CD-10 code(s). • Cost of each treatment, item or procedure.
  • In respect of medication claims, the name, quantity, dosage and net amount payable by the member should be provided