How to Claim
Important information about payment of claims
- Please refer to the Enablemed dental benefit tables for a summary of the dental benefits offered by your selected benefit option.
- 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.
- Payment of claims will only be made when DENIS has the member's valid bank details on our system, as cheque payments have been phased out.
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)
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.
Please submit your claim through one of the electronic claim clearing hubs (EDI).
Email: claims@denis.co.za
Alternatively, post the original claim to:
DENIS Claims Department
Private Bag X1
Century City
7446
Or deliver the original claim to the DENIS offices at:
Block D
The Forum
North Bank Lane
Century City
Cape Town
7441