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Claims Submission Process

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Claims Submission Process

One does not need a form to submit a claim. Simply submitting a detailed account/statement from the healthcare provider will suffice. The following information needs to be on the account/statement:

  • Healthcare provider’s name and practice number, in the case of a group practice, group practice number and the name of the practitioner who provided the service;
  • If the beneficiary has been referred to a specialist, the referring doctor’s practice number;
  • The beneficiary’s membership number;
  • The name of the Scheme (POLMED) and benefit plan (Marine or Aquarium);
  • The main member’s initials and surname;
  • The patient’s name, other initials and surname (if it is not the main member), as well as the beneficiary code (as it appears on the back of the membership card);
  • Date of service;
  • Account/reference number;
  • Tariff codes(s) – this is a code that refers to the pricing of a medical service/product;
  • ICD-10 codes;
  • Cost of each treatment, item or procedure;
  • In respect of medicine claims, the name, quantity, dosage and net amount payable by the member should be provided; and
  • Proof of payment in the form of a receipt or bank deposit slip if the account has been settled with the provider.

Click below for details about the POLMED claims submission process
How to submit a claim process

Submit your claims correctly:

Claims must be submitted within 120 days of the service date. Claims received after this period will be rejected as stale. Copies of accounts will be accepted for processing or payment.

There are various ways of submitting claims to POLMED for processing:
Email: polmedcurrentclaims@medscheme.co.za
Fax: 011 758 7660
Post: POLMED, Private Bag X16, Arcadia 0007
Visit any of our regional walk-in branches.

Result

Once the claims have been assessed a claims statement will be sent to you that will reflect the outcome of the payment process. You can also view the outcome and your claims statement via the Member zone of this website.

Payment

If a refund is due to a member, POLMED will pay it at the end of the week.