CLAIMS INFORMATION

HOW TO CLAIM

Before submitting your claim, please ensure the following details appear on the account:

• membership number
• principal member’s details (name, address etc)
• supplier’s details (name, address, practice number)
• treatment date
• patient’s details
• details of the treatment (diagnosis, tariff and ICD-10 codes, amounts charged)

Mail the account to Private Bag X1897, Rivonia, 2128.  Please note that only original accounts or accounts submitted electronically by health care service suppliers are accepted. 

Although suppliers may submit claims electronically it remains the member’s responsibility to ensure that the claim reaches the Scheme within four months from treatment date and to check remittance advices for accuracy and validity of the supplier’s claim.

GEMAS has two payment runs per month to suppliers (mid month and at month end) and one to members at month end.

Existing GEMAS members can click here to track the payment of their claims using this website.

ICD10 Codes – a compulsory part of any claim

Legislation requires that claims contain an ICD10 code when submitting it for payment to medical schemes.  Medical schemes are required to reject accounts for payment which do not have these codes.

What is an ICD10 code?

ICD is short for International Classification of Disease.  This means that the code indicates the condition for which you received treatment, for example, I10  indicates that you were treated for hypertension.  Please be assured that this information is handled in the same confidential manner as any of your other medical data.