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First Training
How to log into myMPSOrientation of myMPS How to add a new user in myMPS How to add a new providerHow to add patients to myMPS How to capture an invoice Managing Patient AccountsAdding an appointment to the CalendarHow to conduct a Benefit CheckCustomizing calendar display settingsHow to capture additional claim information in myMPSNetwork Pricing contractsTransfer from Medical Aid liable to Patient liable How to create Templates and Favorites
Second Training
How to follow up on claims in myMPS Working with the myMPS inboxUsing myMPS ReportsHow to manage electronic remittances (eRAs)How to handle claim rejections via myMPSModifiersHow to transfer from Medical aid to patient liable Liability

Network Pricing contracts

What are Network Pricing contracts?
This is a Fixed price contract between the medical aid and a Doctor/Service Provider, which stipulates what the medical aid will pay for procedures performed. In most of the contracts, the medical scheme will provide the procedure codes and how much they pay when you are part of that specific contract.

On myMPS we have a feature that caters to different medical scheme contracts so that our providers comply with the medical aid contracts they have signed. 

To access this feature, follow the steps below: 

  • Step1: go to www.mymps.co.za  and log in with your username and password
  • Step 2: Click on the Admin Tab
  • Step 3:  Under Practice, click on Network pricing contracts
  • Step 4: On the list of medical aid contracts, you can tick the box next to the scheme that the provider has a special payment arrangement with, and click save.

 

Understanding capitation payment arrangements

 Capitation is a fixed amount of money per patient per unit of time paid in advance to the service provider for the delivery of health care services. When the service provider signs a capitation agreement, a list of specific services that must be provided to patients is included in the contract.

The amount of the capitation will be determined by the number of patients involved and will vary from health plan to health plan, but most capitation payment plans for primary care services include consultation, consumables, medication, and some in-room procedures.Most schemes will require the service provider to be contracted in order to see their clients and some will pay ‘fee for service’. Some schemes will require their clients to nominate their preferred GPs.

Some practitioners may be put off by the low payment amount on these schemes but miss out that perhaps in the area that they are practising in, there might be a concentration of members who are on these plans which will boost the revenue. Also, some of these schemes are by invitation only and may need a motivational letter if not invited but the doctor desires to see patients on these plans. 

Medical schemes with capitation payment arrangements include:

  • Discovery keycare
  • Bankmed basic plan
  • Bonitas boncap
  • Gems beryl and tanzanite one
  • Affinity Health insurance
  • Momentum health4me
  • Universal administered schemes
  • All Carecross and Primecure schemes


 

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