Medical Aid Providers and their Plan Options must be configured here. Tariff sheets must first be setup. It is common practice that different plans allow subsets of Tests and Profiles to be claimed. At the same time, different amounts may be paid. Such information must be configured in the Tariff Sheet module.

Fields

• Code: The Medical Aid Provider Code
• Name: The Name of the Medical Aid Provider
• Claims Method: None (unspecified), Batch or Web Service may be selected. Consult with THASA for detailed information on integration options.
  • None: indicates that no automated system for submitted claims has been configured
  • Batch: Generally an export file format where all claims for a day, week or other period is generated for submission to the Medical Aid Provider.
  • Web Service: THE SOFTWARE communicates directly with the Medical Aid Providers claims platform. This requires sophisticated module configuration and sometimes programming.
• Profile Billing: For those Medical Aid Providers which pay claims for entire profiles, select this option. For those Medical Aid Providers which pay for each individual tests, do not select this option
• Chronic Management: The Doctor record which results are submitted via for Medical Aid claims.
• Activation Code: Used by Web Service integrations
• Destination Code: Used by Web Service integrations

Medical Aid Plan Options

Medical Aid Providers often have more than one Plan Option. Click the Add Plan button to add plans for the Medical Aid Provider

• Code: The Plan Code
• Name: The Name of the Plan
• Description: Basic descriptive information about the Plan
• Tariff Sheet: The Tariff Sheet which must be used each Subsidiary when submitting a claim. It is important to remember that each Subsidiary may operate a different practice number. As the result the Medical Aid Provider may recognise the each Subsidiary differently. For example a Histo Pathologist may be paid differently from a Clinical Pathologist for an FBC profile.