Betma will process, and pay valid claims

We will process the claims received according to your benefits and policy conditions. Payment is subject to the correct information being supplied and meeting submission cut-off times. There is a weekly payment cycle for members. However, payment into your bank account may only reflect after a few days, depending on which bank you use.

Statements

When we process a healthcare provider claim, a claims statement will be distributed to the healthcare provider by email within three(3) weeks of payment. We send weekly statements to providers and members if a claim has been processed for them. Payment is subject to the correct information being supplied and meeting submission cut-off times. There is a weekly payment cycle for members. However, payment into your bank account may only reflect after a few days, depending on which bank you use.

Claims process

We have made the claims process as simple as possible for you and your treating provider. The list below provides all the details required when submitting a claim to us either by you or your treating provider.

Information that must be on the claim:

• Membership/policy number
• Patient’s name and surname
• Patient’s date of birth
• Diagnosis
• Date of service (include admission & discharge dates for hospitalisation)
• A detailed description, per item, of the treatment or service received/provided (i.e. name of medicine, ward level)
• Quantity (i.e. 30 Disprin, 3 days in General Ward)
• Tariff code (if available)
• Amount charged per service or treatment (as per the contracted Tariff price list)
• Name of the treating healthcare professional
• Facility name (i.e. General Hospital, Africa Medical Clinic)
• Total charged (the sum of the individual amounts charged on the claim)
• Pre-authorisation number (if applicable)
• Proof of payment (receipt or proof of electronic (EFT) payment), in the case of a refund request for the principal member. The only document we will accept as proof of payment is a receipt or proof of electronic (EFT) payment. If the correct proof of payment is not attached, the account will be rejected.
• Signature of the insured person or principal member if the insured person is a minor
• Signature of the provider
• Date of the account and account reference number