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.
Prime Cure is continuously growing and expanding its network in order to
provide adequate and reasonable access to patients which is in close proximity
to their homes or place of work. Prime Cure believes that a stable, well
managed provider network is crucial for the delivery of cost effective primary
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 remains in close contact with providers at all times.
This support team receives ongoing training on all relevant issues such as benefits,
operational issues and possible technology problems encountered when submitting
claims. They attend cyclical training workshops which enables them to assist and
train providers and their staff. They also brief providers on accreditation and
In order to respond to growth and to establish capacity and geographic
accessibility the Network establishment process is dynamic and constantly
Service Providers can access important tools such as manuals, forms, formularies
and any other pertinent information such as processes and protocols from the
Prime Cure website at http://www.primecure.co.za.
Providers are encouraged to register on the website to obtain a user
name and password. Prime Cure’s website allows providers easy access to their
remittances. To access this information providers can log onto www.primecure.co.za and then click on Provider Login.
After entering the user login and password, the provider selects”View
Advices” which will allow the provider the opportunity of viewing a remittance
advice by date.
Update of your Provider contact details
Provider newsletters are sent quarterly 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 regualarly 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 firstname.lastname@example.org or email@example.com or by sending it
by facsimile to 086 680 6898. This ensures that
the database of our 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
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.