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Understand Claims Statement

Understand your claims statement

Your claims statement will be emailed to you. Please ensure that you update your email records.

Tips to read your statement
Go to the pay code column

  • In the column will be a code and an explanation of the code at the end of the statement
CODEREASON/EXPLANATIONWhat does it mean?
28Claim paid to provider at Scheme rates - member to pay differenceThe provider claimed more than the 100% Momentum Medical Scheme contracted rate and the difference is now due Only portion paid - member needs to pay balance
65No day to day funds available to pay this claimThe benefit requires pre-authorisation and must contact us only if they have not previously claimed.
252Savings depletedThe benefit is not covered on the option and you do not have HealthSaver to fund the claim Not paid - member needs to pay account in full
293Medicine or item not covered by the SchemeRefer to benefits of your option. Go to "tools" on the website to access more information on your healthcare benefits Not paid
521Paid from Momentum Primary CareAlthough the amount reflects R 0.00 under payment and benefit sections - it is paid in full as you consulted a network provider - doctor, dentists or optometrist No payment due
529Claim from a non-network provider. Member liableYou did not request authorisation and must contact us for a late pre-authorisation if you have not used your out of network / casualty benefits before Not paid
531Referring doctor is not a network provider. Member liableThe specialist you consulted was not authorised and must contact us for a late pre-authorisation if you have not used your specialist benefits for the year before Not paid
545Tariff billed is not part of the agreed list of tariffs for this optionRefer to benefits of your option. Go to "tools" on the website to access more information on your healthcare benefits Not paid