Submit a Claim
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.
To ensure speedy service, assessment of your claims & to avoid rejection for late submissions please ensure that queries & claims from your practice are routed to the correct administrator or managed care organisation.
NOTE: If your claims are submitted electronically via EDI your 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.