Emergencies: 082 800 8727  |  Questions: 080 000 6942
phclientliaison@platinumhealth.co.za

SPECIALIST REFERRALS PROCESS

    • PlatComprehensive/PlatCap members need to obtain authorisation from Case Managegment to consult specialists.
    • PlatFreedom members do not need authorisation to visit a specialist, however members still need to request authorisation from Case Management for Managed Care Programmes such as Maternity, Oncology, Renal Dialysis etc

SPECIALIST REFERRALS PROCESS

    • PlatComprehensive/PlatCap members need to obtain authorisation from Case Managegment to consult specialists.
    • PlatFreedom members do not need authorisation to visit a specialist, however members still need to request authorisation from Case Management for Managed Care Programmes such as Maternity, Oncology, Renal Dialysis etc

SPECIALIST REFERRALS PROCESS FOR PLATCOMPREHENSIVE AND PLATCAP MEMBERS:

 

FIRST VISIT

1. General Practitioner issues a request for referral

Member has to visit GP with a specific condition or problem. The General Practitioner will refer member to a specialist.

The GP issues a request for referral and gives it to the member. PlatComprehensive/Platcap members should use this request to obtain authorisation for the visit from Case Management.

The referral request from the GP should contain the following detail:

  • The patient’ name, date of birth, medical scheme number, contact details
  • The specialist’s details and practice number
  • A detailed clinical referral letter (as well as whether or not the visit is related to an MVA or an IOD.
  • The referring GP’s details and practice number

2. Submit the referral letter to Case Management

Tel: 014 590 1700 or 080 000 6942 OR
Fax: 086 247 9497 or 086 233 2406 OR
Platinum Health facilities OR
Email: plathealth@platinumhealth.co.za (specialist authorisation)

Authorisation will be valid for only the date of treatment.

3. If referral request is approved

  • Case Management evaluates the request with the assistance of the Medical Advisor.
  • PlatComprehensive/Platcap member receives an authorisation number via SMS, email, and telephone or from Platinum Health facility.
  • Copy of referral letter, X-rays, blood results and all related documentation to be taken with to the specialist.
  • member to give authorisation number to specialist.

4. If referral request is rejected

  • Case Management evaluates the referring request with the assistance of the Medical Advisor and reject referral.
  • If PlatComprehensive/PlatCap members’ authorisation is rejected, the member will receive notification via SMS, email, telephone or from Platinum Health facility; stating the reason why authorisation request was declined.
  • PlatComprehensive/PlatCap members can contact Case Management and Platinum Health facilities at their sites with regards to follow-up queries.

FOLLOW-UP VISIT

1. Specialist issues a request for follow-up visit

Specialists will be required to write a feedback report to the referring GP to ensure that he/she has clarity on the condition/treatment of his/her patients.

The letter requesting the follow-up visit should contain the following details:

  • The reason for the follow-up visit or frequency of visits, with a full clinical report on diagnosis and treatment, required from treating specialist.
  • The patient’ name, date of birth, medical scheme number, contact details

A copy of the required documentation should be submitted to Case Management for approval prior to the follow-up visit.

Case Management will capture the motivation/diagnosis and issue a follow-up authorisation number to the patient. This number is valid for only the date of treatment.

  • Follow-up visits to specialists after hospitalisation/surgery have to be authorised by Case Management.
  • On discharge, the specialist will inform the member when follow-up visits are required.
  • This is usually two or six weeks after discharge.
  • Contact Case Management with this information for approval and an authorisation number

2. Submit the referral letter to Case Management

Tel: 014 590 1700 or 080 000 6942 OR
Platinum Health facilities OR
Email: plathealth@platinumhealth.co.za
(specialist authorisation)

3. If referral request is approved

  • Case Management evaluates the request with the assistance of the Medical Advisor.
  • Member receives an authorisation number via SMS, email, and telephone or from Platinum Health facility.
  • Copy of referral letter, X-rays, blood results and all related documentation to be taken with to the specialist.
  • Member to give authorisation number to specialist.

4. If referral request is rejected

  • Case Management evaluates the referring request with the assistance of the Medical Advisor and reject referral.
  • If a member’s authorisation is rejected, the member will receive notification via SMS, email, telephone or from Platinum Health facility; stating the reason why authorisation request was declined.
  • Member can contact Case Management and Platinum Health facilities at their sites with regards to follow-up queries.

REQUEST AUTHORISATION

EMERGENCY/AFTER-HOURS SPECIALIST REFERRALS

 

Applicable to PlatComprehensive/PlatCap members:

  • Emergency specialist referrals can be arranged telephonically between referring GP and the responsible Case Manager, but the documentation still needs to be finalised afterwards.
  • After-hours specialist referrals should be arranged with the Case Manager on call and submitted to Case Management on the first working day after the consultation.

PLATINUM HEALTH REFERRAL LETTER

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PLATINUM HEALTH SPECIALISTS FEEDBACK FORM

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CASE MANAGEMENT CONTACT DETAILS

 

After-hours and emergencies contact number may not be used for general account and membership queries.

TELEPHONE

014 590 1700 or 080 000 6942

AFTER-HOURS & EMERGENCIES

082 800 8727

EMAIL

Specialist authorisation: plathealth@platinumhealth.co.za
Hospital pre-authorisation and authorisation: hospitalconfirmations@platinumhealth.co.za

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