Important PCNS Notice

LATEST NEWS

PCNS IS EVOLVING

Technology has seeped into almost every aspect of our day-day-to-day lives. We bank, shop and even invest online. Yesterday’s pen and notebook have made way for tablets & smartphones. This wave of technological advances has also swept across the healthcare landscape – so why not register or update your PCNS online?

We are experimenting to enable you to register and update your practise code number online.

This will allow you access to the PCNS from anywhere and at any time. You can now co-manage the progress of your request.

The PCNS online portal will revolutionise the way that you register or update your practise code number.

With this exciting evolution, comes some changes:
• The PCNS premises will operate from 11h00 – 15h00
• The Call Centre remains available from 08h00- 16h30
• Applications may be couriered or posted
• We will have increased self-service terminal
• As we value your input, please complete our VOC survey

Click here to access our VOC survey

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Benefit and Risk

The overall focus of the Benefit and Risk department is on minimising risks to which schemes are exposed in providing benefits for their members. It ensures that benefits are designed, worded and coded in such a way that there is little or no opportunity for misuse or abuse.

Three panels support the work of the Benefit & Risk Department: the Clinical Advisory Panel (CAP), the Coding and Hospital Panel (CHEP) and the Criteria Committee.

The CAP researches and compiles funding recommendations relating to:

Recommendations emanating from this committee would be regularly reviewed and updated and provided as guidelines to schemes to assist them in offering greater consistency in benefit design and claims adjudication, as well as to assist members to understand the limitations of less expensive options.

The CHEP focuses on specific problems with hospital codes and descriptors, the consumable (non-chargeable) list and new equipment billing practices. It also examines hospital "baskets" for theatre time, ward days, maternity and the like and the development of a zero-based costing document for these fees. While the focus of this panel is on hospitals, they also attend to the schedules of other disciplines.

The Criteria Committee examines requirements for facilities to qualify for PCNS allocation. In consultation with various professional associations, it also gives guidance to schemes about applicable tariff codes chargeable by different categories of facility.

Strategically the department is moving towards initiatives to create more value for medical schemes. The implementation of managed care will become a focus, particularly in assisting medical schemes to determine issues such as surgeons' qualifications, the relative benefits of one surgical method as opposed to another, guidelines for the use of therapies relative to side effects, cost, age of patient and the like. Recommendations and guidelines which reflect industry standards need to be established to enable medical schemes to make informed decisions for each individual case.

The strategic focus for this department for 2006 is as follows:

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Corporate Communications

As a knowledge based organisation, the effective dissemination of information to industry stakeholders is critical. This is done through the media, seminars and workshops, newsletters and other communication modalities to four key industry stakeholder groupings, namely; medical schemes and administrators; medical scheme members and consumers; regulatory authorities and relevant government departments; business and labour organisations.

BHF Annual Southern African Conference

The annual conference showcases the sector, drawing people not only from the medical scheme sector, but many other related organisations including government departments, actuaries, switching houses, insurance brokers and various provider associations. The conference is seen as a unique opportunity to network and hear of latest trends and developments both locally and internationally. The focus is generally on issues of a more strategic nature.

The 15th Annual BHF Southern African Conference was held at the Durban International Conference Centre, from the 24th to 27th of August. The theme for this year’s conference was “Waves of Change. Oceans of Opportunity"

Opened by former president, Nelson Mandela in 1997, the Durban ICC was South Africa’s first International Convention Centre and has played a pioneering role in attracting international events to our shores since its inception.
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BHF Trustee Training: 2014:

This focused, comprehensive, one-day course provides in-depth information on the key areas relating to good governance of medical schemes. Highly relevant to trustees and those working within the private funding sector.

The topics are presented by industry experts and all delegates receive a CD with resource manual containing relevant information as well as a bound copy of the Medical Schemes Act and Regulations.

Two Trustee Training sessions were held in Botswana on the 16th of September. Trustee Training sessions were held in Johannesburg on the 25th of March and 30th of September; as well as in Cape Town on the 27th of March and the 14th of October. All sessions were well attended and we received positive feedback from the delegates.

Click here to view the typical agenda.
Please contact laurab@bhfglobal.com for information regarding future Trustee Training sessions, as well as customized sessions.

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HFMU division

The Healthcare Forensic Management Unit (HFMU), a division of BHF, essentally provides a collaborative platform and a unique service to alert the HFMU participants to potentially fraudulent acitivity within the private healthcare industry.

The HFMU utilises various platforms to engage with industry stakeholders such as the HFMU Group (members only).

HFMU Participation

Workshops and seminars at which pertinent areas relating to potentially fraudulent activities are discussed by leading industry experts (both local and international), as well as membership outreach initiatives were undertaken by the HFMU and this will continue during 2013.

An HFMU Bytes newsletter is distributed quarterly. Relevant news articles (local as well as international) are also published in an effort to keep the HFMU particpants informed.

Those considering participating within the unit are encouraged to read the HFMU Policies and Procedures document. Should you require any further information, please contact Chelesile Mtshiya by utilising one of the following methods - HFMU feedback form, electronically (email) or telephonically on 011 537 0200, Fraud Hotline 080 TIP HFMU (080 847 4368)

HFMU and related Meetings and Events

Relevant industry events can be viewed here.

International Relationships

The HFMU is also recognised by various international organisations. On 6th October 2011, the Chairman of the HFMU, Mr Herman Havenga, signed a Memorandum of Understanding on behalf of the HFMU participants in Krakow, Poland with the European Healthcare Fraud & Corruption Network (EHFCN), the Canadian Healthcare Anti-fraud Association (CHCA), the National Healthcare Anti-fraud Association (NHCAA) and Health Insurance Counter Fraud Group (HICFG).


Signing of MoU in Krakow, Poland - 6/10/2011

Click here to join our Group. Members only.

PCNS division

The Practice Code Numbering System (PCNS) of BHF is a list of unique practice billing codes for providers of healthcare services in South Africa, Namibia and Lesotho.

The practice number, allocated to all registered healthcare providers is a legal requirement for the process of reimbursement of a claim to either a medical scheme member or service provider. This is in accordance with the requirement of the Medical Schemes Act 131 of 1998 wherein it is stated that a medical scheme may only reimburse a member or a provider of relevant healthcare services for services rendered against a valid practice code number.