HOW DO I SUBMIT CLAIMS TO THE SCHEME?

Platinum Health has an agreement with designated service providers (DSP’s) to submit claims directly to the Scheme in order to streamline the payment of claims. If however, a member should receive a tax invoice/account from a Medical Service Provider, the member is advised to contact Platinum Health Client Liaison to determine whether the tax invoice/account has been submitted to the Scheme. If it has not been submitted to the Scheme, the member has to ensure it is submitted within four months of date of services/supplies, to prevent it from becoming stale, resulting in non-payment.

1. Confirm the following details feature on the tax invoice/account:

• Tax invoice/account number 

• • Member’s initials, surname and address 
  • Membership number 
  • Dependant code 
  • The date, tariff code and detail of the services/supplies provided 
  • Authorisation number, if the tax invoice/ account is from a specialist. 
  • Verify that the member or dependant did receive the service or supplies, by signing the tax invoice/account.

2. Submit the claims, within four months, to the Scheme VIA any of the following channels:

Email: phclientliaison@platinumhealth.co.za
Fax: 086 591 4598
Mail: Platinum Health, Private Bag X82081, Rustenburg, 0300
Hand in at Client Liaison Office at your operation

3. Processing of claims received:

Claims and refunds are processed in accordance with the Medical Scheme Rules, Rates and Tariffs.

4. Payment of claims: Payment commences after the claims is processed.

5. Member receives notification of payments VIA:

SMS notifications 

Member statements with full details of payments are emailed or posted to members (It is important for members to ensure their contact number, email & postal addresses are updated with the Scheme)