1. Halaxy Help Guide | South Africa
  2. Finances
  3. Claims & Billing

Set up billing for private health (Medical Aid Scheme)

In Halaxy, the Medical Aid Scheme is available as a preset funder for practices located in South Africa.

The preset Medical Aid Scheme funder includes the correct billing structure for private health, such as the required identification fields for practitioners and patient claims. All you need to do is create appointments with your fees, add your practitioner identification, and set up patient claim details.

In just a few clicks, the appointment invoice automatically configures all the necessary information for you.

The Medical Aid Scheme billing setup checklist

This checklist outlines what you need to do to set up your practice billing.

For step-by-step guides for each of these checklist items, refer to the subsequent sections in this article.

Task

What it does

Details

  • Set up private health fees

  • Adds private health services and their corresponding rebate pricing to your practice group

  • Automatically sets up the correct billing and claim structure in invoices that contain Medical Aid Scheme fees

Where to set up: When creating appointments

You only need to set up each fee once. It can be reused for future appointments and invoices.

  • Set up the patient claim

  • Provides identification of the patient's enrolment with their health fund

  • Automatically adds the patient's claim details with their health fund to their invoice

Where to set up: Calendar appointment

You only need to set up each patient's health fund claim once.

  • Add your required identification

Sets up your required IDs to automatically populate in invoices.

Where to set up: Appointment invoice

You only need to add your identification once per practice location.

When all your requirements are in place, your invoices containing Medical Aid Scheme fees are automatically set up with all relevant information.

Set up your private health fees

This step adds fees and services for your patients with Medical Aid Scheme coverage. This step can be done as needed when creating patient appointments.

  1. On the calendar, click on a timeslot to create a patient appointment.

  2. For Fees, enter the name of the service you are providing, then click it in the dropdown to add it as a new fee.

    Billing-ZA-01.png

  3. In the pop-up, configure your fee.

    Billing-ZA-02.png

    • Funder: Type Medical Aid Scheme, then click Import Medical Aid Scheme. (All private health fees must be set up under this funder.)

    • Amount: Enter the amount you charge for this service.

    • Rebate: You can set this to the same as Amount.

    • (Optional) Configure any other details for your fee as needed. (For a complete guide to fee details, see this article.)

  4. Click Add Fee. This service has now been saved to your practice and can be reused in new appointments.

  5. To add multiple fees to add to this invoice, click Add Another Fee, then repeat Steps 2 to 4.

  6. In the appointment panel, click Save to create the appointment and automatically generate the invoice. (In the newly created appointment, click Invoice to open it.)

You have successfully imported your fee - and also created an appointment, clinical note and invoice.

Tip

If you want to set up all your fees and services without needing to create appointments, you can also import them from the Fees List.

Set up the patient claim

This step adds the patient's claim identification for their enrolment with their private health fund. This step can be done as needed when creating patient appointments.

  1. From the patient's appointment on the calendar, under the claim section, click the Icon-Edit.svg pencil icon.

    Billing-ZA-03.png

  2. In the pop-up, enter the patient's details for their claim:

    • South Africa Identity Number

    • Medical Aid Card Number (card number with their health fund)

    • Expiry Date

  3. Click Save.

  4. If required, click Add Referral to enter the patient's referral details.

The claim is added successfully to the patient's profile and any of their appointment invoices that contain any fees under the Medical Aid Scheme funder.

Tip

If you want to set up your patient's claim without creating an appointment, you can enter their claim in the Funding tab of their profile.

Add your required identification

This step sets up your practitioner identification, which will appear on any invoice containing your Medical Aid Scheme fees.

  1. From the patient's appointment on the calendar, click Invoice.

    Halaxy Invoice

  2. Under the Practitioner Details section, under Identification, click the Icon-Edit.svg pencil icon.

    Billing-ZA-04.png

  3. In the pop-up, enter your identification:

    • HPCSA Registration Number

    • PCNS (Practice Code)

    • Practitioner Code - your provider ID provided by the health fund (if applicable)

  4. Click Save.

  5. (Optional) If you haven't entered your practice address yet, next to Practitioner Details, click Edit to set up your practice details.

You have successfully added your identification for this funder. Whenever you create an invoice with Medical Aid Scheme fees, your identification is automatically displayed on the invoice.

If you've completed all these steps, all you need to do is create appointments with Medical Aid Scheme fees, and your invoices are automatically set up with the correct information. For new patients, don't forget to enter their claim details.

When the patient is ready to pay, you can process their invoice, which you provide to the patient for them to process their claim with their health fund.

Updated

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