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OMG / PRIME CURE GLOBAL FEE CONTRACT FOR CATARACT SURGERY: 2009

We refer to our notice dated 25 February 2009 in which we informed you that OMG has concluded a global fee contract for cataract surgery with Prime Cure.

You have signed and returned the Option form in which you indicated that you want to participate in the contract.

Prime Cure has provided us with the following process flow information:

1) Designated Service Provider (DSP) GP refers scheme member to contracted ophthalmologist (DSP ophthalmologist) - GP/Member must obtain authorisation from Prime Cure for specialist consultation;
2) DSP ophthalmologist consults member and if cataract surgery is indicated, DSP ophthalmologist must complete the OMG Cataract Surgery Authorisation form (Attached);
3) DSP ophthalmologist must add at the bottom of the form the name and practice number of the hospital in which the procedure would be done;
4) DSP ophthalmologist must then fax the Authorisation form to 0865207980 (preferred route). DSP ophthalmologist may also contact Prime Cure on telephone number 0861 665 665 to obtain an authorisation number;
5) Prime Cure undertakes to provide feedback within 8 -16 working hours to the DSP ophthalmologist via fax/e-mail/phone.
6) A fax/e-mail will also be generated by MSO/MHS with the authorisation details to the practice. (Practice must ensure that correct fax/e-mail details are captured on the Prime Cure system);
7) Where cataracts are not diagnosed, but another eye disease is diagnosed, then the DSP ophthalmologist must request hospital authorisation on 0861 665 665 and press the option for hospital authorisation. The specialist authorisation number will be reference number required by MSO/MHS.

Additional Notes:

1. The DSP GP or member must obtain the necessary referral number to refer the scheme member to an ophthalmologist. In terms of their plan options the members do not have direct access to a specialist;
2. Prime Cure prefers that claims are submitted electronically, in which event payments are expedited. Their EDI destination codes are via QEDI or Healthbridge 642P and via Mediswitch PCUR0001;
3. Prime Cure will only refer to a non contracted ophthalmologist where there is no DSP ophthalmologist in the area;
4. Members of the Purehealth Purenetwork benefit option will only be entitled to the contractual benefits until 31 May 2009;
5. Where authorisation has been granted, the DSP ophthalmologist must inform the hospital/clinic that he will be liable for payment of the fee that he has negotiated with the hospital/clinic – the hospital/clinic must not submit a separate account to Prime Cure.

Please contact us should you require any clarification on the contents of this notice.

Regards

Ernst Ackermann
HealthMan – Administrators of OMG
Tel: 021 864 2542
Fax: 021 873 7440
Cell: 083 625 4782