Internal PMB Worskhop

Tshegofatso Tlhong
Mind Map by Tshegofatso Tlhong, updated more than 1 year ago
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Internal PMB Worskhop
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Internal PMB Worskhop
1 Funding Of PMB's?
1.1 Claims
1.1.1 route PMB claims where there is no hospital authorisation?
1.1.2 Decline any claim related to treatment that falls outside PMB level of care
1.1.3 Route a declined auth where a claim is PMB
1.2 Where there are no DSP's across the country will we fund at cost?
1.3 Automated or PMB Application?
1.4 Definate PMB only?
1.5 OH Auths =PMB ICD Code, Procedure and Within the date range
2 How would the benefit accumulation be calculated?
2.1 Dual Accumualtion?
3 How will we manage the subilmits?
3.1 Our concern is that claims have never been able to pay through the sublimit
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