Benefit Management


General Practitioners

  • By joining our primary care network, we would like you to be the primary caregiver to Momentum Medical Scheme Ingwe Option members, as well as Momentum Health4Me members. In return we have a seamless integration of benefits, regardless of the member's option, reducing the administration burden on your practice. You will receive weekly payments for all valid claims correctly submitted within 4 months of date of service.
  • Your practice will be subject to our profiling system on a quarterly basis and based on the profiling results, you may be upgraded to a higher level which would result in higher reimbursement for consultations, or you could be downgraded, which would affect the reimbursement for consultations negatively. This excludes providers on the Momentum CareCross primary care network.
  • Kindly note that dispensing practices cannot give members a prescription to take to the pharmacy, as these prescriptions will reject. Should this occur, it could have a negative impact on your practice's profile.
  • If you are part of a group practice, you need to supply us with the practice numbers of all the group practice members, in order for us to capture the necessary detail on system. This will enable these practitioners to use their practice number as a referring practice number. It must be noted that billing must be done under the group practice number.
  • We would also like to encourage you to make use of our specialist network when you need to refer members. We have agreed scheme rates with these specialists for in-hospital treatment and by referring to them, our members will not be negatively impacted by paying above scheme rates.
  • We will send you regular statements, showing your payments, etc.

Dental Practitioners

  • The dental network is managed by Momentum Dental Risk Management.
  • This network is specifically for Momentum Medical Scheme Ingwe Option members, as well as Momentum Health4Me members. As a designated service provider you need to adhere to certain protocols, i.e. rates, list of tariffs, and explaining to a patient if certain codes are not covered before procedures are performed. The objective is to direct members to compliant providers to prevent any out-of-pocket expenses for members.
  • Contact Momentum Dental Risk Management for any dental benefit queries.
  • Contact details:
    Phone no: 0860 11 78 59
    Fax to mail: 086 547 6599
    Email:[email protected]

Optometrists

  • The optometry network is managed by Opticlear.
  • Their contact number is 011 4616337
  • This network is specifically for Momentum Medical Scheme Ingwe Option members, as well as Momentum Health4Me members. As a designated service provider you need to adhere to certain protocols, i.e. rates, list of tariffs, and explaining to a patient if certain codes are not covered before procedures are performed. The objective is to direct members to compliant providers to prevent any out-of-pocket expenses for members.
  • Contact Opticlear for any optical benefit queries.
  • Contact details: Phone no: 011 461 6337

Specialist visits

  • If you need to refer members to a specialist, please use a specialist referral form for Momentum Medical Scheme Ingwe Option members, as well as Momentum Health4Me members.
    Note: Only members on the Momentum Health4Me Gold and Titanium options are entitled to specialist visits.
  • We have an Associated Specialist network that can be used. By making use of these network specialists, members will not experience any out-of-pocket expenses for in-hospital treatment.

Pharmacy network

  • Please make use of the pharmacy network to dispense medication according to the applicable formularies.