Glossary & Guidelines: Hospital Patient Administration

Medical Aids tend to update their tariffs during price season (January every year) and to tweak prices throughout the year. It is therefore important to keep your GoodX up to date with the newly released tariffs by importing the new tariffs via the internet into your GoodX Software's PostgreSQL database.

If your facility is registered with NHN they will provide price updates at the beginning of the year as well as throughout the year.

GoodX Standard Rates: (What GoodX/NHN provides)

• Standard set of tariff codes.
  
• Standard set of pricelists per Medical Aid
  
• Standard prices per code per pricelist
  
• Standard general pricelist Medical Aid linking
  
• Standard Billing Groups
  

Practice Custom / Specific / Private Rates: (What Clients provide)

• Any custom codes not supplied as part of the standard code set
  
• Custom pricelist not part of standard pricelist set
• Custom values/prices to be applied to standard or custom billing codes 
• Custom general pricelist Medical Aid linking
  
• Custom Billing groups for specific percentages or balanced billing

GLOSSARY

Standard Rates

• The Standard Medical Aid tariffs as provided by the Medical Aids through NHN.

Custom Rates

• Any Ward/Equipment/Theatre code or pricing that is not standard from the Medical Aid Price Tariffs. 
• Eg 77007A instead of 77007 or an R20 difference in price.

Linking

• Each Medical Aid gets linked to their specific Pricelist.
• Eg Discovery gets linked to Discovery Rates and Bestmed to Bestmed Rates etc.

Custom Linking Profile

• The Facility can decide what prices to link with which Medical Aid. 
• Eg All Medical Aids get linked to Discovery Rates and any shortfall will be Patient Liable.

Medical Aid Contracts (Special Rates Agreements)

• These are rates that are negotiated between Clients and Medical Aids.
• The Client signs a Network Agreement with specific Rates that the Doctor can charge above the standard Medical Aid rates. Specific rules from the Medical Aids apply.
• Take Note: Registration with a medical aid is not the same as signing a special rates agreement with that medical aid.

• Indication at what percentage the Patient will be billed
• Eg 100% Scheme Rate or 200% above the Medical Aid Scheme Rate

Medprax

Medprax is a data interface containing medical aids, medicines, and materials information.

Medprax is updated once a week if a practice is registered with Medprax.

Medprax updates the following information for medical aids:

• plans
• discontinued plans
• rules
• routing codes
• administrator information and changes

Medprax updates the following information for medicines and materials:

• Nappi codes
• the list price per item
• descriptions (name, strength, size, volume, and presentation)
• discontinued items
• new items
• updated items

IQest

IQest is a data interface containing medicines and materials information. Stock file for hospitals and NHN signed clients. 

IQest is updated once a day if a hospital is registered with IQest.

NAP (Stock Prices)

Net acquisition price - Applicable at hospitals and NHN clients. This is the price the hospitals are allowed to be charged on a patients account.

NHN

National Hospital Network (NHN) was founded in 1996 with the prime objective of bringing together leading independently owned private hospitals and medical facilities under one umbrella; to gain synergy, cost-effectiveness, and to collaborate on best practice patient care.