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EDI & Electronic Statements

 



MMSA currently accepts claims in either paper or electronic form. However,
when submitting electronically the payment cycle is dramatically reduced. Another
benefit is that in most cases, your software supplier can provide the interface to
Sovereign using your existing practice management software.

There are several options your software supplier has available to send claims
electronically to Sovereign:

VANs (Value Added Networks)
Claims are delivered from you to Sovereign's mailbox which is emptied on a daily basis. Contact one of the following vendors for further details:

Firstnet
Mailbox address: 6004930005825

Traffex
Mailbox address: ZA010525.NATMED1
Helpdesk: 0800 117 888

You may also want to approach one of the so-called "clearing houses" who collect
claims from several practices and then forward them to the appropriate medical
schemes using a VAN.

Email - Submission specification
Should the cost of the VAN option be too prohibitive, perhaps email is the right
solution for you. All that is required is a modem and an email account with one of the local ISPs (Internet Service Providers). Claims are sent as an attachment in a pre-defined format (see below). All incoming emails are fully audited and an
automated receipt is returned to your inbox.

At the moment these facilities are provided by the following:


Mediswitch
Mediswitch currently provides pharmacies with facilities to submit ACUTE, CHRONIC and PAT claims to MMSA. Development is currently underway to enable general practitioners to submit all types of claims via Mediswitch.

Medikredit
Medikredit also provides pharmacies with facilities to submit ACUTE,
CHRONIC and PAT claims. At the moment, Medikredit also allows for general practitioners to submit ACUTE, CHRONIC and PAT claims. Development for the acceptance of all general practitioner claims is pending.

HealthBridge
HealthBridge is currently in the final stages of testing. They will soon be providing real-time claiming facilities to general practitioners. All types of claims will be accepted.

Interpharm
Development is currently underway to accept ACUTE, CHRONIC and PAT claims via Interpharm.

The format of submitted claims may be one of:

EDIFACT (MEDCLM)
The internationally recognised messaging standard and the preferred format.

Specification
Example

External claim file format
Our own, internally developed format.

Specification

For more info email : edi-info@nmp.co.za