Submit claims/accounts as soon as possible and include all relevant information within four months of date of service – these are the golden rules for achieving prompt settlement of your medical claims/accounts by Platinum Health. This will assist the scheme to pay the provider before the account becomes overdue and members are threatened with legal action or held accountable for claims/accounts. Platinum Health has an agreement with designated service providers (DSP’s) to submit claims/accounts directly to the scheme in order to streamline the payment of claims/accounts. A remittance advice will be sent to the service provider on a monthly basis confirming payments made. Members are also kept informed as Platinum Health emails or posts statements of claims paid to members on a monthly basis.

It is very important that Platinum Health has your updated contact details which include your residential, – postal and e-mail addresses as well as your telephone number. To update your contact details, download the “Request to change membership details, scheme option or card request” form below or collect one from your local Client Liaison Officer and complete the relevant contact detail changes. The next step is to forward the form to Platinum Health via either fax or hand in to your local Client Liaison Officer.

Please note: It remains the member’s responsibility to ensure that the scheme receives all claims/accounts in time for prompt payment.

Medical service providers are required to include the following information on all accounts:

• Member’s initials, surname and address;
• Member’s medical scheme number;
• The date and the service or supplies provided, and the tariff code for the service or suppliers;
• The name and date of birth of the patient who received the service or supplies;
• Platinum Health authorisation number, where applicable.
• Platinum Health authorisation number, where applicable.

In addition, state other information which will help Platinum Health process claims timeously:

• Verify that the member or a dependant did receive the service or supplies by signing the account submitted.

• Members who pay cash for services and then claim from Platinum Health must attach proof of payment, together with the account, as the scheme processes the tariff codes used by the provider for the refund to the member. If the refund documentation does not reach Platinum Health in time, the provider will be paid and the member must request the refund from the provider.

• The only acceptable proof of payment is a receipt of the money paid (such as a credit card transaction slip), a receipt or a zero-balance statement from the provider.

Submit claims within four months of treatment date to prevent the claims from becoming stale, thus resulting in non-payment. Details to be confirmed by the member:

• Membership number
• Dependant code;
• Authorisation number, if the account is from a specialist; and
• Treatment date

Submit all claims and refunds to Platinum Health Claims at:

• Email to: ZZGPlatinumHealthClaims@platinumhealth.co.za
• Rustenburg Client Liaison Office at your operation
• Mail to Platinum Health, Private Bag X82081, Rustenburg, 0300

Claims Statements

Once the claim has been processed, full details will be printed on the member’s claims statement, which will be distributed on a monthly basis.
Members may contact Client Liaison at 080 000 6942 from 08:00 to 16:00, Monday to Friday, to obtain their claims advice.