Claims Process

What you need to check before sending your claim to Libcare

  • The claim must be clear, detailed and easy to read.
  • If you have settled the account, please submit proof of payment in the form of a receipt or proof of Electronic Funds Transfer (EFT).
  • Make a copy of the above documents for your own records.
  • Proof of payment must be submitted with any refund that needs to be paid to a member. A written note indicating "paid by member" or a "paid" stamp will no longer be accepted. If the correct proof of payment is not attached, the account will be rejected.

Ensure that the following information is on the claim

  • The correct membership number
  • Member's last name and initials
  • Full name of patient (as indicated on your membership card, not a nickname)
  • The correct dependant code
  • Date of birth of the patient
  • Treatment code (Tariff/Nappi)
  • The applicable ICD 10 diagnostic code on every claim line
  • The amount charged
  • The service provider's name and practice number

Sending claims to Libcare

Electronically: Most service providers have the ability to send claims to us electronically, ensuring a very short processing time.

Post: PO Box 653418, Benmore, 2010.

Basic claim guidelines

  • We need to receive claims within at most four months following the month in which the services were provided. After that time, a claim becomes a stale claim and will not be paid
  • It is ultimately your responsibility - not your healthcare provider's responsibility - to ensure claims are submitted for payment.
  • If your healthcare provider has claimed electronically and you receive a copy of the claim (for your information), you do not need to send the copy to Libcare.

Stale claims

  • If you submit a claim after the end of the fourth month following the month in which the services were provided, as stated on the claim, Libcare will regard it as stale and will not pay the claim.
  • If you submit a claim within the four-month period and it is partially paid, or rejected as incorrect or unacceptable for payment, it is your responsibility to check your statement(s) and resubmit a correct claim within 60 days following the date of notification.
  • If not, the claim will be regarded as stale and no payment will be made.
  • Libcare will not cover any interest or legal fees that are levied on a claim that is submitted late.
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