Issue link: https://www.hub.camaf.co.za/i/1512927
2024 ALLIANCE PLUS & ALLIANCE NETWORK 15 What should I do if I have paid the claim? Ensure that the statement reflects the payment or you can include your receipt. Do not place a receipt over important detail on the invoice. All claims are paid directly to the provider unless proof of payment is indicated. Please ensure that all details on the scanned copy are clear - codes, dates etc. If you have not received notification that your claim has been processed within 24 days of submission, follow up immediately with the Customer Care Department on 0860 100 545 to avoid a potential late claim rejection. How can I track my claims? On the website or mobile app, as a member, with your personal login details and password. How frequently are claims paid? In terms of the Medical Schemes Act all claims must be settled within 30 days of receipt of the claim by the scheme, unless there are queries on the account e.g., incomplete information. CAMAF has weekly pay runs and payment is made directly into the member's or service provider's bank account and a detailed remittance advice is sent to you. If you have asked for electronic communication you will receive notification when your claim has been received and when it has been paid. What do I have to do to ensure that my claim will be paid in terms of PMB regulations? Ensure that your PMB Chronic condition is registered with the scheme and that you have followed the scheme requirements in terms of: • using a Designated Service Provider (DSP) in the case of medication • adhered to the formulary / protocol applicable to your chosen option • that the correct ICD10 code has been quoted on the account. BACK TO CONTENTS PAGE