Medical-aid claims

Submit medical-aid claims electronically, for R0 per claim

Many practices pay a fee every time they send a claim. On Cliniweb, claim submissions are zero-rated. You bill the visit, add the ICD-10 code and submit the claim from the same screen, then follow it through to the scheme’s response.*

Register your practice How claims work
  • R0 per claim, no batch limits
  • Rejection reasons on the invoice*
  • Built by South African GPs
The cost of per-claim fees

What do claim fees cost your practice?

Enter roughly how many claims you send each month and what you pay per claim now, whether to your software or a claims switch.

Per-claim fees per monthR2,500
Per-claim fees per yearR30,000
Per-claim fees on CliniwebR0

The starting numbers are an example, not anyone’s actual prices. Cliniweb still has a daily access fee and data storage (about R250 a month for most practices) plus pay-per-use messaging. See pricing. Not sure what you pay now? Read claim switching fees explained or how medical-aid claims work.

How it works

From the consult to the remittance

Procedures and dispensed medicine from the visit are already on the patient’s record, so nothing is typed twice.

Bill the visit

Tick the procedure codes and dispensed items for the date and add them to a new or open invoice. Medicine cost and dispensing fee show separately.

Add the ICD-10 code

An invoice without a diagnosis shows ICD required. Reuse codes from an earlier visit or add the patient’s chronic conditions in one click.

Submit the claim

One click sends it to the scheme or administrator. There’s no fee per claim and no batch to wait for.

Follow its progress

Watch it go from queued to sent to the scheme’s response, on the invoice itself.*

Fix and resend

A rejection or part-payment shows the reason. Retry the claim, reverse it, or send a paper claim as a PDF to the scheme.

Reconcile and collect

Remittances are matched to invoices.* Fully paid claims close themselves, and any patient portion comes back as work to do.

* Remittances and claim status are available on some schemes only.

Before you claim

Authorisations and benefit checks

Fewer rejections start with the right details on the claim.

  • Benefit check for patients on GEMS, Discovery, POLMED and Fedhealth, run from the patient’s record.
  • Membership details compared with the scheme’s own record, so you can see when the patient’s plan, number or dependant code needs updating.
  • Authorisation numbers saved once are added to that day’s invoices automatically.
  • Confirmed funds from the check fill in the form for you to review before saving.
When a claim comes back

See the reason, not just “rejected”

Every attempt is logged on the invoice with its status, date and time.

  • Rejection and partial-approval reasons shown on the invoice card.*
  • Retry, reverse or paper claim, offered depending on what the scheme said.
  • Submitted invoices are locked. Changes are added to the record, never written over it.
  • Cash-only invoices stay out of claims without affecting the patient’s other invoices.

An approved amount is not a payment. Always check what the scheme actually paid on its remittance.

After the claim

Accounts that show what’s still owed

“Accepted” by the scheme and “collected” are kept apart, so promised income isn’t counted as cash.

  • Age analysis from 0–14 days to over 120 days, with a work state on each account so your team knows what’s been looked at.
  • Today at a glance: billed, received, accepted by medical aids and still unresolved.
  • Cash by staff member, so a shortfall at cash-up can be traced.
  • Statements, receipts and reports by day, month or year, with CSV export.
Schemes and administrators

Claim from the medical aids your patients use

Claims go electronically to the scheme or its administrator.

  • Discovery
  • GEMS
  • Medscheme
  • Momentum
  • KeyHealth
  • Profmed
  • Affinity
  • and more

Not sure about a scheme? Email info@cliniweb.co.za before you register.

Questions

Medical-aid claims: common questions

Is it really R0 per claim?

Yes. Electronic claim submissions on Cliniweb are zero-rated, so there is no fee per claim and no batch limit. You pay the daily access fee, data storage and the messages you send. See the full fee schedule in our terms.

Which medical aids can I claim from?

Claims go electronically to the scheme or its administrator, including Discovery, GEMS, Medscheme, Momentum, KeyHealth, Profmed and Affinity. Ask us about a specific scheme before you register.

Will I see why a claim was rejected?

Yes. The scheme’s response shows on the invoice, including the reason for a rejection or a partial approval. From there you can fix the invoice and retry, reverse the claim, or send a paper claim.

Do I get remittances and claim status?

On some schemes only. Where a scheme supports it, the response and remittance come back into Cliniweb and are matched against your invoices. On other schemes you work from the scheme’s own remittance.

Do I have to add an ICD-10 code?

Yes. Medical aids need a diagnosis code on the claim, so Cliniweb asks for an ICD-10 code before it lets you submit. You can reuse codes from earlier visits and add a patient’s chronic conditions in one click.

Can I still bill cash patients?

Yes. Any invoice can be marked cash only, so it never goes to a medical aid, and you can take payment and print or email the invoice from the same screen.

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