Prime Cure Networks

Prime Cure has existing relationships with more than 10 000 healthcare service providers including general practitioners, dentists, optometrists, specialists, pharmacies and private hospitals.

Through its infrastructure and contracted service providers Prime Cure offers its members a well-established, contracted network providing national coverage in both rural and urban areas. Prime Cure is continuously growing and expanding our network in order to provide adequate and reasonable access to member’s home and work. Prime Cure believes that our stable, well managed provider network is crucial for the delivery of cost effective primary healthcare services.

To ensure an informed and compliant network Prime Cure has provider relationship managers whose sole function is to contract and educate providers on the Prime Cure offering, formulary compliance while rendering assistance with queries. Providers are regularly visited by their dedicated relationship manager who remain in close contact with providers at all times. This support team receives ongoing training on all relevant issues such as benefits, operational issues, technology developments and Legislative developments that may impact providers. They attend cyclical training workshops which enables them to assist providers and their staff. They also brief providers on accreditation and profile issues related to a providers practice habits.

In order to respond to the rapid growth currently experienced by Prime Cure and to establish capacity and geographic accessibility the Network process is dynamic and constantly evolving.

Website Information

Service Providers can access important tools such as provider remittances, manuals, forms, formularies and any other pertinent information such as processes and protocols from the Prime Cure website at http://www.primecure.co.za or click on the following link to register and access the Prime Cure Health dashboard - https://live.primecure.co.za/cgi-bin/wspd_cgi.sh/WService=wsb_kxpsys/run.w

Providers are encouraged to register on the website to obtain a user name and password

Update of your Practice contact details

Provider newsletters are sent covering a variety of topics. It is important for both providers and members to be informed about operational matters as well as the managed care principles of their medical scheme.

Prime Cure has relationship managers situated nationally. These qualified staff members regularly interact with providers through personal visits and telephone calls. Providers are requested to inform the relationship managers of any changes that include practice details, contact particulars and professional status. An alternative would be for the providers to contact their allocated Relationship Manager or to communicate any changes by email to the allocated email address Provider.Loading@.primecure.co.za or networks@primecure.co.za or call the Prime Cure call centre on 0861 665 665. This ensures that the database of our contracted providers remains fully up-to-date.

Migration from Paper to EDI submission method

Paper claim submissions are discouraged for various reasons. The main reason being that should claims be lost in the mailing process, there is no means of locating these claims. Also, providers must note that the turnaround for paper claims is longer. Once received, paper claims have to be logged, scanned, pre-assessed and assessed. Only then are the claims sent through for payment. In order to improve timeous payment of claims it is beneficial for claims to be submitted electronically.

Prime Cure encourages providers to submit electronic claims for their mutual benefit. The reason for this is that claims submitted via EDI are processed and paid in less than seven days following receipt thereof. This allows for the provider to immediately detect incorrect details on the claim and to rectify and re-submit these immediately.