Got a claim?

CLAIMS

Submitting your claim is super simple! Just follow the four quick and easy submission steps and Old Mutual Staff Medical Aid Fund (Claims) undertakes to settle the account within 30 days of receipt.

Claim Submission Steps

All it takes is these four easy steps:

1

Sign all original accounts, invoices and prescriptions

2

Make sure that the following information appears on the account:

  • The name of the Fund and Plan, e.g. Traditional or Savings Plan
  • Your membership number
  • Surname and initials of member
  • The patient’s first name(s) and date of birth as it appears on your membership card
  • ICD-10 code
  • The date of service
  • Valid provider practice number
  • Valid attending provider practice number
  • Tariff code(s)
  • Quantities

3

Submit them directly to the Old Mutual Staff Medical Aid Fund (Claims):

  • Email: claims@omsmaf.co.za
  • Internal mail: Old Mutual Staff Medical Aid Fund (Claims) Mutualpark
  • Post office: Old Mutual Claims, P O Box 1411 Rivonia, 2128
  • All claims for services rendered outside the borders of RSA: foreignclaims@omsmaf.co.za

4

Keep a copy for your records

Important note

  • Claims that are faxed or submitted as scanned documents will only be processed if legible and received within the four-month claiming period.
  • The payment run is every Thursday and it includes all claims to members and providers that were processed the previous week up and until Friday 12h00.
  • Members on the Network (including SELECT) Plans do not need to submit accounts for any service received at a Universal Healthcare Network practice as the practice will submit its accounts directly to Universal Healthcare. However, you can submit a claim for any medical costs not submitted by the practice, to Universal Healthcare, so that the claim can be processed for tax purposes.

1

Sign all original accounts, invoices and prescriptions

2

Make sure that the following information appears on the account:

  • The name of the Fund and Plan, e.g. Traditional or Savings Plan
  • Your membership number
  • Surname and initials of member
  • The patient’s first name(s) and date of birth as it appears on your membership card
  • ICD-10 code
  • The date of service
  • Valid provider practice number
  • Valid attending provider practice number
  • Tariff code(s)
  • Quantities

3

Submit them directly to the Old Mutual Staff Medical Aid Fund (Claims):

  • Email: claims@omsmaf.co.za
  • Internal mail: Old Mutual Staff Medical Aid Fund (Claims) Mutualpark
  • Post office: Old Mutual Claims, P O Box 1411 Rivonia, 2128
  • All claims for services rendered outside the borders of RSA: foreignclaims@omsmaf.co.za

4

Keep a copy for your records

Important note

  • Claims that are faxed or submitted as scanned documents will only be processed if legible and received within the four-month claiming period.
  • The payment run is every Thursday and it includes all claims to members and providers that were processed the previous week up and until Friday 12h00.
  • Members on the Network (including SELECT) Plans do not need to submit accounts for any service received at a Universal Healthcare Network practice as the practice will submit its accounts directly to Universal Healthcare. However, you can submit a claim for any medical costs not submitted by the practice, to Universal Healthcare, so that the claim can be processed for tax purposes.