How to submit your claim
Our Call Centre team has noticed an increase in the number of questions around the claims submission process.
Do you know which information to send and where to send it to?
Who submits the claim to the Scheme?
Your healthcare professional can submit the claim to the administrator directly - in this case you don't have to send us a copy. In some instances you may have to settle the account first and then submit the claim to the administrator. If you settle the account, please insist on an accurate invoice that reflects your payment. You can send the account and your receipt to the administrator and you will be reimbursed according to your benefits.
Who is responsible for payment?
Whether you or your healthcare provider submit the claim, you remain responsible for payment of the healthcare services.
How can I send the claim to the Scheme?
Email: Scan and email your claims to claims@angloms.co.za.
Post: Send your claims to Anglo Medical Scheme P.O. Box 746,
Rivonia, 2128.
Fax: Fax your claims to 011 539 1008 (please only use this option if you don't have other communication channels. Fax is often illegible which might result in your claim not being processed).
Upload: We have just launched a claims upload tool on the Scheme website. Once logged in as a member, go to 'how to claim' and upload your claim directly from your computer or device.
Checklist: Information needed for claims submission
Ensure that your claim is valid, you have received the treatment or services you have been charged for and that the following details are correct and complete:
- full name of main member
- membership number
- name of patient (main member or registered dependant)
- treatment date
- details of the service (tariff code, CPT code)
- the diagnosis code (ICD-10)
- proof of payment if you have settled your account
If any of the above information is not correct or missing, the claim cannot be processed and the administrator will reject the claim. You might not receive notification if membership could no t be verified.
For information on the full process of claims submission please visit > your plan > how to claim.