To streamline our claims payment processes, we have agreements with designated service providers (DSP’s) to submit claims directly to the Scheme. This also ensures that you don’t have to submit claims to us.

But what if I receive an account or tax invoice from a service provider?
What should I do?

Call us on 014 590 1700 or 080 000 6942 to confirm whether we have received the account or tax invoice.

If Platinum Health hasn’t received the account or tax invoice yet, what should I do?

Please submit the invoice to us within four months from the date of services or supplies you received. This will prevent it from becoming stale, which could also result in non-payment.

What is a stale claim?

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 medical scheme benefits.

Here is a step-by-step guide on how you can submit claims to us:

1. First make sure the following details appear on the tax invoice or account:

• Tax invoice or account number.
• Your initials, surname, and address.
• Your membership number.
• The dependant code of the patient who received the services or supplies.
• The date, tariff code and detail of the services or supplies you received. (Your doctor can help you with the tariff code if you don’t have it).
• The authorisation number, if the tax invoice or account was for a specialist consultation.
• Verify that you or your dependant received the service or supplies, by signing the tax invoice or account.

2. The next step is to submit the claim to us, using any of the following channels:

• E-mail: phclientliaison@platinumhealth.co.za
• Mail: Platinum Health, Private Bag X82081, Rustenburg, 0300
• Face-to-face: Submit it at a Client Liaison Office near you.

3. Once we receive your claim, we will process it in accordance with the Medical Scheme Rules, Rates and Tariffs.

4. Once we have processed the claim, it will be paid.

5. We will then inform you that the claim has been paid via e-mail. You will also receive an SMS notification and a member statement with full payment details.