Claims submission - what we need from you
Our administrator's claims experts have asked us once again to remind our members what the Scheme needs to process claims. If any of the below is missing, illegible or incorrect we might not be able to process your claim and, in some cases, we might not even be able to get back to you to ask for more information. It is also insufficient to send us only the proof of payment or a receipt.
Please always ensure the following information is clear and complete:
- Membership number
- Patient's name
- Healthcare provider's name
- Healthcare provider's practice number
- Account number
- Treatment date
- Tariff or procedure or NAPPI codes
- Amount claimed
- Diagnostic code (ICD-10 code/s for each line billed).
Important, if you have paid for the services upfront, submit the proof of payment with your claim. Email the claim to mailto:claims@angloms.co.za, upload it in the member login area of the Scheme website or in the Anglo Medical Scheme app.
We process claims within two to three working days. For more information, search 'how to claim' on www.angloms.co.za.
Published: August 2022.