FAQ

Upon submission of the claim the patient will be notified via SMS or email that a claim was submitted to their medical scheme on behalf of the service provider, the member is immediately aware of the claim. Once the payment is received from the medical aid the patient will receive an updated statement, should the patient be liable for any shortfall on the account the patient will be requested to make a payment. *A suitable payment arrangement can be entered into or the claim will be submitted to Gap-Cover (should the patient have Gap-Cover) Should the claim be a valid PMB the scheme will be contacted immediately and requested to process the account at PMB rates. Prior to each medical scheme payment run a follow-up to the scheme will be done to ensure the PMB claims are in processing for payment.

We can manage collections as per your practice structure – at, below or above scheme rates or PMB*. *Providing the claim is a valid PMB with valid PMB ICD10 code/s and the authorisation loaded (by the hospital) as a valid PMB.

At Forte Medical our speciality is to ensure your claims are captured and submitted correctly the first time and on time. Membership and dependant codes will be verified with the medical scheme prior to capturing of a claim. Should the claim be rejected for any reason (a daily report will indicate rejected claims), then these claims will be resubmitted to the medical scheme.

Yes – we do require each practitioner to sign a contract that defines the relationship and expectations.

No, there are absolutely no additional or hidden costs and no annual increases.

Yes – A dedicated account administrator that has extensive knowledge of your codes and procedures will be appointed to your practice. Our service gives you a whole team of professional staff making sure your claims get processed quickly and accurately.

Your claims are collected via a courier service at our expense. Electronic options are available via fax or email. Electronic claim submission to Forte Medical ensures that claims are captured and submitted via EDI to the medical scheme on the same day. Couriered claims will be captured and submitted via EDI within 48 hours.

An End-of-day report from our switching house, on-demand reports and month-end reports are provided. You will always be in the know with regards to claims submitted versus payments received.