| 1. |
All service providers should be registered on the Compensation Fund claims processing system in order to capture medical invoices and reports for medical services rendered. |
| 2. |
Prior to submitting, uploading or switching medical invoices and supporting reports, medical service providers should ensure that the claim is one that the Compensation Fund has accepted liability for and therefore reasonable medical expenses can be paid. |
| a. |
The first medical report (W. CL 4), completed after the first consultation must confirm the clinical description of the injury/disease. It must also detail any procedure performed and also any referrals to other medical service providers where applicable. |
| b. |
All follow up consultations must be completed on a Progress Medical Report (W.CLS). It must also detail any operation/procedure performed and also any referrals to other medical service providers where applicable. |
| i. |
A progress medical report is considered to cover a period of 30 days, with the exception where a procedure was performed during that period then an additional operation report will be required. |
| ii. |
Only one medical report is required when multiple procedures are done on the same service date. |
| c. |
When the injury/disease being treated stabilises a Final Medical Report must be completed (W.CL SF). |
| d. |
Medical Service Providers are required to keep copies of medical reports which should be made available to the Compensation Commissioner on request. |
| a. |
The Compensation Fund allows the submission of invoices in 3 different formats, the use of a switching house,directly uploading the invoice onto the processing application and the receipt of manual invoices by Labour Centre's. The former two are encouraged for Medical Service Providers to use, whilst the last form is for Medical Service Providers who have a small amount of invoices to submit. |
| b. |
Medical invoices should be switched to the Compensation Fund using the attached format or electronic invoicing file layout. It must be noted that the corresponding medical report must be uploaded online prior to the invoice data being switched, to avoid systematic rejections on receipt. |
| c. |
The processing system has an online guide available to guide Medical Service Providers for the direct uploading of invoice on the application. |
| d. |
The status of invoices/claims can be viewed on the Compensation Fund claims system. If invoices are still partially or wholly outstanding with no reason indicated, after 60 days following submission, the service provider should complete an enquiry form, W.CI 20, and submit it ONCE to the Provincial office/Labour Centre. All relevant details regarding Labour Centres are available on the website (www.labour.gov.za) |
| e. |
Manual invoices and their corresponding medical reports must be handed in to the nearest labour centre. |
| 5. |
The progress status of successfully submitted invoices can be viewed on the Compensation Fund online portal/APP. |
| 6. |
If a medical service provider claims an amount less than the published tariff amount for a code, the Compensation Fund will only pay the claimed amount. |
| 7. |
If a medical service provider claims an amount more than the published tariff amount for a code, the Compensation Fund will only pay the Gazetted amount. |
| NOTE: |
Templates of the following medical forms are available on the Department of Employment and Labour website (www.labour.gov.za)
|
First Medical Report (W.CL 4)
Progress/Final Medical Report (W.CL 5 / W.CL 5)
Copyright Act, 1978
