Medihelp


 

Important Information about Payment of Claims

  • Dental benefits and cover differ between the medical schemes and options under administration; the Denis Benefit Guide shows detailed benefit tables for each scheme.
  • Denis reserves the right to request clinical records and radiographs to process and assess claims.
  • Payment of claims is subject to and governed by the registered scheme rules. In the event of a dispute, the registered scheme rules will prevail.
  • Payment of valid claims is subject to the membership contributions being up to date on receipt of the claim. Payment of these contributions is regarded as acknowledgement that the member and beneficiaries are bound by the registered rules of their scheme.

WHAT DOES DENIS NEED IN ORDER TO PROCESS A CLAIM?

​When submitting a claim to Denis, please ensure the following information is clearly stipulated on  the claim. Missing and/or inaccurate information will result in your claim being rejected.

We need the following information from you:

  • Medical scheme
  • Membership number
  • Practice name
  • Practice number
  • Treatment date
  • Dependant name
  • Dependant code (please use the code as per the patient's membership card)
  • The relevant ICD-10 code per claim line
  • Valid procedure codes
  • Tooth numbers (if applicable)
  • Authorisation number (if applicable)
  • Assistant's name and practice number (if applicable)
  • Referring practitioner's name and practice number (in the case of a dental laboratory claim)

Dental technician registration number (required on laboratory claims)

STALE CLAIMS

​In terms of the Medical Schemes Act, all claims must be submitted within four months from the last day of the month in which the service was provided. Claims that are not submitted and received within this period will be regarded as stale and ineligible for benefit. Payment of such a claim will be the member’s liability. 

CLAIMING

​Please submit your claim through one of the electronic claim clearing hubs (EDI)

Email: claims@denis.co.za or fax: 0866 770 336

Alternatively, post the original claim to:

Denis Claims Department
Private Bag X1
Century City
7446

Or deliver the original claim to our offices at:

Block D
The Forum
Northbank Lane
Century City
Cape Town
7441

terms and conditions | Copyright Dental Information Systems (PTY) Ltd. ( Reg. no 1996/000371/07),(FSP No 36026 )