CPC Qualicare / DocWeb | Doctor's Online resource for South African Doctors CPC Qualicare / DocWeb | Doctor's Online resource for South African Doctors
The official website of CPC/Qualicare IPA

February 2014 Newsletter

ENHANCED FEES OFFERED TO IPAF AND THEIR CONTRACTED DOCTORS

Most of you are aware that IPAF has received a variety of enhanced payment offers from major medical aids in return for you, our members entering into a contractual relationship with those funders, VIA IPAF. The enhancements acknowledge:

  •  the ease with which we can, and the funders can, contact you ,
  • discuss your outcomes, and
  • perform peer review on your profiles, and
  • your contribution to limiting downstream costs especially related to PMBs.

IPAF regularly receives a variety of prices offered to our contracted doctors and we thought it wise to list these enhanced fees so that you can charge the offered price which is often more than the price which your computers or PMA systems have defaulted to.

IPAF emphasises that we do not negotiate these prices with any schemes but merely offer them the enhanced services of IPAF and our doctors, and in return, accept their offerings for enhanced fees via a “Pay for Performance” (P4P) exercise.

Please amend your PMA’s urgently, lest you lose well deserved monies for service excellence. You should therefore discuss these fees with your PMAs and bookkeepers regularly and visit the IPAF website for regular updates.

Medical Aid Fund AGILITY

 

Medical Aid Doctors Enhanced Fee

Fees for consultations & procedures for: Progressive Flex, Classic, Millennium & Supreme Options

Acute Consultations plus procedures excluding medicine

311.00

Chronic Consultations plus procedures excluding medicine

384.00

Medical Aid Fund BESTMED

 

Medical Aid Doctors Enhanced Fee

BESTMED

CATEGORY I

CATEGORY II

CATEGORY III

IPA

380.00

354.00

327.90

NON-IPA

354.00

340.00

327.90

Non-contracted

N/A

N/A

295.70

Medical Aid Fund BANKMED

 

Medical Aid Doctors Enhanced Fee

(Core Saver, Traditional, Comprehensive & Plus)

NON-CONTRACTED

IPA

NON-IPA

CONSULTATION

289.00

342.50

315.00

Medical Aid Fund DISCOVERY

 

Medical Aid Doctors Enhanced Fee

DISCOVERY  HEALTH

GP NETWORK

NON-NETWORK

DISCOVERY

345.00

310.00

Medical Aid Fund LIBERTY HEALTH

 

Medical Aid Doctors Enhanced Fee

Liberty

335.70

Medical Aid Fund MEDIHELP / STRATA

 

Medical Aid Doctors Enhanced Fee

 

PROFILING
CATEGORY

 

Non-CONTRACTED PROVIDERS

FOUNDATION CONTRACTED PROVIDERS

Prescribing Doctors

Dispensing  Doctors

IPA Provider

Non-IPA Provider

IPA Provider

Non-IPA Provider

Category 1

No Benefit

250.00

220.00

325.00

295.00

Category 2

No Benefit

225.00

215.00

300.00

285.00

Category 3

No Benefit

Scheme Rate
200.00

Scheme Rate
195.00

Scheme Rate
295.00

Scheme Rate
280.00

Medical Aid Fund POLMED

 

Medical Aid Doctors Enhanced Fee

GP NETWORK

NON-NETWORK

310.00

287.00

IPA Foundation CDE

 (Centre for Diabetes & Endocrinology)

Medical Aid Doctors Enhanced Fee

Reimbursement rates (Doctors belonging to IPAF and a participating IPA:

Healthcare Provider Grade

CDE Reimbursement Rate for code 0190

A

340.78 per consultation, including VAT

B

313.01 per consultation, including VAT

C

290.29 per consultation, including VAT

Reimbursement rates (Doctors belonging to IPAF and not to IPA:

Healthcare Provider Grade

CDE Reimbursement Rate for code 0190

A

319.32 per consultation, including VAT

B

290.29 per consultation, including VAT

C

271.36 per consultation, including VAT

Retainer Fee Rates:

Healthcare Provider Grade

CDE Retainer Fee Rate

A

67.00 per month, including VAT

B

47.00 per month, including VAT

C

34.00 per month, including VAT

Last modified on Thursday, 13 March 2014 14:55

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Contact Information

Postal Address: Physical Address :
CPC QUALICARE
P.O.BOX 15633
VLAEBERG
8018
Suite 501
Boland Bank Building
18 Lower Burg Street
Cape Town
8000

TEL.:  021 -  4264777
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