POLMED Submit a Claim
IMPORTANT INFORMATION ABOUT PAYMENT OF POLMED CLAIMS
- Please refer to the POLMED dental benefit tables for a summary of the dental benefits offered for the 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.
To ensure speedy service and assessment of claims, and to avoid rejection for late submissions, please ensure that POLMED queries and claims are routed to the correct administrator or managed care organisation.
NOTE: If POLMED claims are submitted electronically via EDI, the claims will be routed correctly by the various switching houses as long as the scheme details and options are correct on the claim.
- 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.
Out-of-Hospital Claims (Basic and Specialised Treatment)
- All claims to be submitted to DENIS.
- If not submitted via a Claims switching house by the service provider, these claims must be sent to:
POLMEDcustomerservice@denis.co.za
Sedation and In-Hospital Claims
- Treating dental practitioner claims submitted to DENIS.
- If not submitted via a Claims switching house by the service provider, these claims must be sent to:
POLMEDcustomerservice@denis.co.za
- Hospital and anaesthetist claims for authorised in-hospital treatment and sedation events to Medscheme.
Medscheme will be responsible for the receipt, processing and payment of these claims. - If not submitted via a Claims switching house by the provider, these claims must be sent to:
- Hospital Claims: claimsmanagement@medscheme.co.za
- Anaesthetist Claims: specialist@medscheme.co.za