South Africa National Health Insurance Act 20 of 2023
Chapter 8: operation of the Fund, medical schemes, procurement, accreditation, information and payment – South Africa National Health Insurance Act 20 of 2023

South Africa National Health Insurance Act 20 of 2023 39-5: Submit the prescribed clinical and administrative information to be accredited and reimbursed

What does 39-5 require?

To be accredited and paid, a provider or establishment has to lodge data on the Fund's prescribed platform, including the user's identity number or, for foreigners, permit and visa details, diagnosis and procedure codes in the prescribed coding systems, details of treatment given including medicines dispensed and equipment used, diagnostic tests ordered, inpatient length of stay, the facility a user is referred to, why any treatment was withheld or rationed, and whatever else the Minister, after consulting the Fund, requires for monitoring national health outcomes (section 39(5)). Section 40(2) imposes the same duty generally, having regard to the Protection of Personal Information Act.

Maintained by Gerard Blokdyk

Other controls in Chapter 8: operation of the Fund, medical schemes, procurement, accreditation, information and payment – South Africa National Health Insurance Act 20 of 2023

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