Resources & insights
The administration behind a practice, explained plainly.
Written for the person who has to deal with the claim, not for a marketing audience. General information about how this side of a practice works, with no promises attached.
What is a PMB?
Prescribed Minimum Benefits are a defined set of conditions every registered medical scheme must cover. Here is what that means in practice.
Read itPrescribed Minimum Benefits sit behind a large share of the claims a practice submits, through Diagnosis and Treatment Pairs and the Chronic Disease List. Most rejections in this area are administrative rather than clinical.
PMBs
Claims
Why medical claims are short-paid
Short-payment is quieter than rejection and easier to miss, which is exactly why it costs practices more.
4 minManaging outstanding claims
An age analysis is only useful if something happens because of it. A simple, repeatable follow-up rhythm.
4 minMedical scheme follow-up
Unresolved revenue can disappear into silence when queries are not systematically tracked. Follow-up is the whole job.
3 min
Practice
These articles are general information about healthcare administration in South Africa. They are not legal, clinical or financial advice, and they do not describe the rules of any particular medical scheme.
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.
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