Organisation : Momentum Health
Facility : Claims Procedure
Location : Centurion
INGWE Health Claims Procedure
Submit a claim :
** Submit a claim within 4 months following service date
** You need to send us your claim by the last day of the 4th month following the month in which you received the service.
Related : Momentum Health Cancel Medical Cover & Refund : www.southafricain.com/7514.html
** If we receive the claim after this date, you will need to pay any outstanding amounts to the provider.
Check that we have your correct banking details :
** Claims refunds are only paid into a South African bank account by electronic funds transfer (EFT).
** Please call us on 0860 102 493 if you need to update your banking details.
Check your account & receipt
** Make sure that your membership number is clearly shown on both the account and the receipt.
Please ensure that the account shows the following :
** Your name and initials
** Your membership number
** The treatment date
** The name of the patient as shown on your membership card
** The amount charged
** The tariff
** The ICD-10 code
** Please check that prescriptions for medicine show all your details and that the correct amount for medicine dispensed is shown on the claim.
** If the pharmacy omits any of these details, we will not be able to process your claim.
** Email the account to us at claims AT momentumhealth.co.za.
** Login or call us on 0860 102 493 to follow-up on whether the account has been paid.
The following claims have to be submitted to us :
** In-hospital claims
** Authorised casualty / emergency consultations
** Specialist claims.
** Most suppliers of medical services and medication have an electronic link to Momentum Health, which allows claims to be submitted directly by the supplier to Momentum Health. In such a case, you are entitled to receive a copy of the account from the service provider, which you should use together with your statements to check the processing of these claims.
** It is still your responsibility as the member to check if your claims are submitted within 4 months of treatment. If we do not receive a claim by the last day of the 4th month following the month in which the service was rendered, the claim will be stale and you will need to pay any outstanding amounts to the provider.
Information needed on an account / claim :
Before you submit a claim, please check that the following information is on the account :
** your membership number
** the principal member’s surname, initials and first name
** the patient’s surname, initials and first name
** the treatment date
** the amount charged
** the ICD–10 code, tariff code and / or nappi code
** the service provider’s name and practice number
** proof of payment if you have paid the claim.
If you have already paid the account and are requesting a refund, the claim has to be accompanied by :
** a copy of the receipt
** your bank account details
** a copy of your passport or identity document.
How To Send the claim
Email : claims AT momentumhealth.co.za
Fax : 031 580 0480
Post :
Momentum Health,
Claims Department,
PO Box 2338,
Durban 4000
** Direct payment into your bank account for claims refunds is most convenient.
** Please ensure that we have your correct banking details – contact 0860 102 493 to update your information.
Outstanding claims following membership termination :
** Claims for expenses incurred during your membership of Momentum Health will be accepted up to 4 months after treatment as long as you received the service / treatment on or before the date your membership ended, subject to all contributions being up to date and benefits being available.
** Claiming for third party injuries and motor vehicle accidents
Third party injuries are where a third party was responsible for the injury and therefore may be liable for medical expenses :
** Any amount recovered from a third party or from the Road Accident Fund (in the case of motor vehicle accidents) for hospital and medical expenses must be refunded to Momentum Health, if these expenses were paid on your behalf by us.
Please remember to :
** Report the incident to the police and obtain a case number
** Phone our member call centre on 0860 102 493 for authorisation.
Information needed when phoning us :
** your membership number
** the principal member’s surname, initials and first name
** the full name(s) of the person(s) involved in the accident
** the date of the accident/incident
** the case number for the police report.
** In the case of a motor vehicle accident, you will be asked to sign an undertaking whether or not you will be claiming from the Road Accident Fund
** If you acknowledge that you will be claiming from the Road Accident Fund, details of this are sent to our appointed Road Accident Fund attorney
** If you have your own attorney, then our attorney would liaise with your appointed attorney
** If you need an attorney, you can use our attorney.
** Your attorney will liaise with the Road Accident Fund and settlement will be made to your attorney, who will in turn liaise with us to pay the refund of any medical expenses that we covered.