PMB support
Prescribed Minimum Benefits, administered properly.
PMBs are governed by their own rules and claims are assessed against those rules. When the coding, the supporting documentation or the scheme correspondence does not line up, a claim that should have been considered under PMBs is often processed as an ordinary benefit, or declined outright.
You will recognise some of these.
- A claim you believe is a PMB was paid from day-to-day benefits
- A scheme has asked for supporting documentation you do not have time to compile
- Nobody in the practice is certain which conditions fall under the Chronic Disease List
- PMB-related claims are being declined and the reasons are not being read
What this covers
The work itself
Reviewing whether PMBs apply
Going through the claim and the scheme's response to establish whether the condition and treatment fall to be considered under Prescribed Minimum Benefits at all.
Preparing supporting documentation
Assembling and checking what the scheme requires for a PMB claim before anything is submitted, so avoidable rejections are caught early.
Submitting and re-submitting
Lodging PMB-related claims correctly, and correcting and re-submitting where the original submission is the reason for the outcome.
Scheme follow-up on record
Following up with the scheme and keeping the correspondence, references and dates so the position is always documented.
Explaining the assessment
Setting out in writing why a claim was assessed the way it was, so the practice can make an informed decision about what to do next.
Where this stops
HealthAdmin administers the PMB claim process. Whether a claim is funded is decided by the medical scheme, applying the Regulations and its own rules to the facts of the case. No outcome is promised or guaranteed.
Questions practices ask first.
How many conditions are PMBs?
Prescribed Minimum Benefits are set out in the Regulations to the Medical Schemes Act as Diagnosis and Treatment Pairs, each linking a diagnosis to the treatment that goes with it, alongside a Chronic Disease List with its own treatment algorithms. The current conditions, pairs and algorithms are published by the Council for Medical Schemes, and whether PMB rules apply to a particular claim is assessed on that claim's own facts.
Do you need our patients' clinical records?
Not through this website, ever. Where clinical documentation is genuinely required for a PMB claim, it is requested directly from your practice under an agreed written mandate.
Can you guarantee a PMB claim will be paid in full?
No. Funding decisions rest with the scheme. What HealthAdmin controls is that the claim is correctly prepared, correctly submitted and properly followed up.
Read more on this
The rest of what HealthAdmin handles
All servicesClaims & Revenue Recovery
Rejected and short-paid claims are rarely abandoned deliberately.
Learn moreAuthorisations & Motivations
HealthAdmin supports the administrative and funding process around clinical motivations.
Learn moreMedical Scheme Liaison
Medical scheme queries, escalations and correspondence take a practice's front desk out of the room.
Learn moreRemote Practice Support
Not every practice needs another full-time administrator.
Learn more
Remote support for practices across all nine provinces. Call 084 301 6520.
Where is your practice losing time or revenue?
Tell us where the administrative pressure sits. PMBs, claims, authorisations, scheme queries, or a backlog nobody has time to work.
Please do not submit patient medical information through this website.