About Affiliated Providers  

 

What is a provider?

 

GetMed defines a provider as a person, business, or institution that provides or gives health care. For example, a doctor

is a provider. A hospital is a provider. An ambulance company is a provider. There are many other provider types.

 

GetMed affiliated provider types

 

GetMed affiliated providers are those who meet GetMed’s accreditation requirements and have agreed to provide care to

GetMed managed care beneficiaries in terms of our managed care protocols with the understanding that GetMed

recognises and respects the professional and medical independence and integrity of any affiliated provider.

 

There are two types of GetMed affiliated providers: Network and Non-network.

 

1. Network Providers  

• Have signed an agreement with a Provider Network Organisation (PNO) that has been contracted to GetMed as PNO to provide care through their network members. Examples of PNO’s are: DENIS, PPN, Medicross, Netcare, Mediclinic, IPA’s, etc.
• Agreed to submit claims and handle other paperwork for GetMed beneficiaries using the GetMed managed care system.
• Agreed to accept payment directly from GetMed and to accept the GetMed negotiated tariff as payment in full for their services to GetMed members.
• Agreed to adhere to the managed care guidelines described in this provider guide.

 

1. Non-network Providers  

• Do not have a contractual relationship with any PNO contracted to GetMed.
• There are two types of non-network providers: Participating and Non-participating.  
• Participating providers  
• Have agreed to submit claims for GetMed beneficiaries using the GetMed managed care system.
• Agreed to accept payment directly from GetMed, and to accept the GetMed negotiated tariff as payment in full for their services.
• Agreed to adhere to the managed care guidelines described in this provider guide.
• Non-participating providers  
• Have not agreed to accept the GetMed negotiated tariff or submit claims for
• Have the right to charge beneficiaries up to NHRPL tariff for services.
• Understand that GetMed will reimburse members to a maximum of the relevant negotiated tariff or NHRPL as prescribed by the Insurance policy or Sick Benefit Fund Rules.
• Are identified in GetMed records and other relevant materials as Non-affiliated providers.

 

All affiliated providers are required to have malpractice insurance.

GetMed Provider Guide May 2008

 

For information on how to become an affiliated provider, mail us at providers@getmed.co.za, visit

www.getmed.co.za  or call 0800 002 505 (toll-free) and speak to any Provider Support Consultant.