| Codes | ICD10 | Description | Qty | Claimed | Pay to provider | Pay to member | Member liable | Member not liable | Comments |
| 0173 |
S91.0 W45.81 | First hospital consultation/visit of an average du | 1 | 771.90 | 369.10 | 0.00 | 0.00 | 402.80 | Show |
- We will only pay a portion of the claim
- The claim will be paid from the member's Medical Savings Account.
- We paid the amount on this line according to the agreed payment arrangement. The member does not have to pay the difference between the claimed amount and the amount we paid. (#391)
- This claim exceeds the Scheme rate. (#45)
- We have paid this claim to the member, as you charged more than the Scheme Rate. (#33)
|
| 0011 |
S91.0 W45.81 | Emergency procedure minute | 85 | 1012.35 | 0.00 | 0.00 | 101.10 | 911.25 | Show |
- Unknown
- We have not paid for the amount claimed as the member has run out of funds in his/her Medical Savings Account. The member is responsible to pay you the outstanding amount. (#274)
- We paid the amount on this line according to the agreed payment arrangement. The member does not have to pay the difference between the claimed amount and the amount we paid. (#391)
- This claim exceeds the Scheme rate. (#45)
- The scheme Rate has been adjusted on this claim line, this is to allow the maximum allowable tariff to be paid out. (#324)
|
| 0147 |
S91.0 W45.81 | For an emergency consultation/visit away from the | 1 | 635.70 | 359.20 | 0.00 | 0.00 | 276.50 | Show |
- We will only pay a portion of the claim
- The claim will be paid from the member's Medical Savings Account.
- We paid the amount on this line according to the agreed payment arrangement. The member does not have to pay the difference between the claimed amount and the amount we paid. (#391)
- We have paid this claim to the member, as you charged more than the Scheme Rate. (#33)
|
| 0304 |
S91.0 W45.81 | Major debridement of wound, sloughectomy or second | 1 | 1406.00 | 794.60 | 0.00 | 0.00 | 611.40 | Show |
- We will only pay a portion of the claim
- The claim will be paid from the member's Medical Savings Account.
- We paid the amount on this line according to the agreed payment arrangement. The member does not have to pay the difference between the claimed amount and the amount we paid. (#391)
- Please note that we have applied modifier 5 calculation to the claim according to industry standards. (#304)
- We have paid this claim to the member, as you charged more than the Scheme Rate. (#33)
- The scheme Rate has been adjusted on this claim line, this is to allow the maximum allowable tariff to be paid out. (#324)
|
| 0010 |
S91.0 W45.81 | Local anaesthetic | 1 | 1235.52 | 698.20 | 0.00 | 0.00 | 537.32 | Show |
- We will only pay a portion of the claim
- The claim will be paid from the member's Medical Savings Account.
- We paid the amount on this line according to the agreed payment arrangement. The member does not have to pay the difference between the claimed amount and the amount we paid. (#391)
- We have paid this claim to the member, as you charged more than the Scheme Rate. (#33)
- The scheme Rate has been adjusted on this claim line, this is to allow the maximum allowable tariff to be paid out. (#324)
|
| 0007 |
S91.0 W45.81 | a) Use of own monitoring equipment in the rooms: | 1 | 421.82 | 238.40 | 0.00 | 0.00 | 183.42 | Show |
- We will only pay a portion of the claim
- The claim will be paid from the member's Medical Savings Account.
- We paid the amount on this line according to the agreed payment arrangement. The member does not have to pay the difference between the claimed amount and the amount we paid. (#391)
- We have paid this claim to the member, as you charged more than the Scheme Rate. (#33)
- The scheme Rate has been adjusted on this claim line, this is to allow the maximum allowable tariff to be paid out. (#324)
|
| 0923 0005 |
S91.0 W45.81 | Removal of foreign bodies requiring incision: Unde | 1 | 674.90 | 317.85 | 0.00 | 0.00 | 357.05 | Show |
- We will only pay a portion of the claim
- The claim will be paid from the member's Medical Savings Account.
- The member is responsible to pay for the rest of the amount on this line. We have paid for a part of this amount as there are no more funds in their Medical Savings Account. (#42)
- We paid the amount on this line according to the agreed payment arrangement. The member does not have to pay the difference between the claimed amount and the amount we paid. (#391)
- Please note that we have applied modifier 5 calculation to the claim according to industry standards. (#304)
- We have paid this claim to the member, as you charged more than the Scheme Rate. (#33)
- The scheme Rate has been adjusted on this claim line, this is to allow the maximum allowable tariff to be paid out. (#324)
|
| 2802 |
S91.0 W45.81 | Procedures for pain relief: Peripheral nerve block | 1 | 703.00 | 0.00 | 0.00 | 396.90 | 306.10 | Show |
- We have rejected this claim
- We have not paid for the amount claimed as the member has run out of funds in his/her Medical Savings Account. The member is responsible to pay you the outstanding amount. (#274)
- We paid the amount on this line according to the agreed payment arrangement. The member does not have to pay the difference between the claimed amount and the amount we paid. (#391)
|
| 0887 |
S91.0 W45.81 | Limb cast (excluding after-care) (modifier 0005 no | 1 | 365.50 | 0.00 | 0.00 | 0.00 | 365.50 | Show |
- We have rejected this claim
- We have not paid for the amount claimed as the member has run out of funds in his/her Medical Savings Account. The member is responsible to pay you the outstanding amount. (#274)
- We paid the amount on this line according to the agreed payment arrangement. The member does not have to pay the difference between the claimed amount and the amount we paid. (#391)
- This claim exceeds the Scheme rate. (#45)
- The scheme Rate has been adjusted on this claim line, this is to allow the maximum allowable tariff to be paid out. (#324)
|
| Totals: | 7226.69 | 2777.35 | 0.00 | 498.00 | 3951.34 | |