Fred van Deventer

Medihelp – How do I claim?

In Medical Insurance, Medihelp on June 2, 2010 at 9:08 am

This process is valid for all options except Necess.

Claims can be submitted in one of four ways:

  1. Electronically – by sending an email with your claim to medihelp@medihelp.co.za
  2. The account can be posted to Medihelp (see below for the address)
  3. The account  can be handed in at Medihelp’s head office in Beatrix street, Pretoria (see below for details)
  4. The account can be handed in at any of Medihelp’s regional offices (see below for details)

Click here to read more about ICD-10 codes.

If you do submit an account to Medihelp, keep the following in mind:

  • Claims for dental and optometry services cannot be submitted directly to Medihelp.
    • Dental claims: Dental Information Systems (Denis) – Claims Department
      Private Bag X1
      Century City
      7446
    • Optometry claims: PPII
      PO Box 12450
      Centrahil
      6006
  • Claims must reach Medihelp within four months following the month in which the service was rendered.
  • Accounts can be submitted to Medihelp in electronic or printed format.
  • A fully specified account must be submitted to Medihelo – a statement showing a balance only is not a valid claim.
  • Printed and electronic accounts must contain at least the following information:
    • Your surname and initials
    • Your Medihelp membership number
    • Your benefit option
    • The treatment date/s
    • The name of the patient
    • The applicable codes
    • The amounts charged, and
    • The service provider’s practice number.
  • Sign the specified account and remember to always indicate your membership number on all correspondence to Medihelp. If you have already paid the account please attach your receipt and clearly mark the account as paid.
  • Electronic accounts must comply to the following:
    • No Word or Excel documents will be accepted.
    • Documents can be submitted in pdf, tif, jpg or any other scanned format.
    • The date on which Medihelp receives the email, will serve as the receiving date of the claim.
    • Incomplete or unreadable accounts and accounts on which changes have been made will not be accepted.
  • Electronic accounts can be sent via email to medihelp@medihelp.co.za
  • Post the account to Medihelp at the following address:
    Medihelp
    PO Box 26004
    ARCADIA
    0007
  • If you are in the vicinity of Medihelp’s offices, you can hand in your account at our Head Office at Beatrix Street, Arcadia, Pretoria. Members are welcome to hand in their individual claims at one of our regional offices at the following addresses (please note that service providers should still send the bulk of their claims to Medihelp’s Head Office in Pretoria):
    • Cape Town:
      Block 4
      De Tijger Office Park
      Cnr Hannes Louw and McIntyre Ave
      PAROW
    • Port Elizabeth:
      First floor
      Fairview House Building
      66 Ring Rd
      Greenacres
      PORT ELIZABETH
    • Bloemfontein:
      The Office Park
      Number 6
      Cnr President Reitz & 3rd Ave
      Westdene
      BLOEMFONTEIN
    • Durban:
      Ground floor
      Unit 1
      Sasfin House
      7 The Boulevard Str
      Westway Office Park
      Westville
      DURBAN
  • Remember to keep proof of the submitted account and, most importantly, to follow up on the claim by checking your summarised statements.
  • Claims that were rejected by Medihelp due to incorrect or insufficient information must be resubmitted to Medihelp within 60 days. It is your responsibility to ensure that all accounts for services rendered to you and/or your dependants are finalised.
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