{"id":9043,"date":"2024-08-30T11:31:53","date_gmt":"2024-08-30T11:31:53","guid":{"rendered":"https:\/\/botsogo.reviewdevelopment.net\/?page_id=9043"},"modified":"2024-10-25T13:13:53","modified_gmt":"2024-10-25T13:13:53","slug":"submit-a-claim","status":"publish","type":"page","link":"https:\/\/botsogohealthplan.co.bw\/new\/submit-a-claim\/","title":{"rendered":"Submit A Claim"},"content":{"rendered":"\t\t
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Submit A Claim<\/h1>\t\t\tHome<\/a>\t\t<\/div>\r\n\t<\/div>\r\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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How to Claim<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\t\t\tProcess<\/strong>

\n\nMost service providers submit their claims directly and are paid directly, which means you do\nnot have to submit your account to the scheme.

\n\nA claim can be submitted through the below platforms.

\n\n– Electronic Submission (EDI)-for service providers only<\/strong>
\n\n– At our offices (Paper Claims)
\n\n– Mobile App- (Add Link)- for members only<\/strong>
\n\n– Member portal- (Add link)- for members only<\/strong>

\n\nPlease note that every claim should be submitted with the following information:

\n\n– Patient\u2019s Full Name
\n– Main Member\u2019s Full Name
\n– Membership Number
\n– Date of Service\/treatment date
\n– Procedure\/Treatment Codes
\n– Diagnostic Codes
\n– Nappi codes for Medication\/Drugs
\n– Original Receipt
\n– Original Invoice
\n– Referral Letter
\n– Medical Report\/Motivation

\n\nWhere a member has paid an account, he shall, in support of his claim, submit a detailed invoice\nand receipt as proof of payment (Reimbursement will only be done to a KYC compliant\nmember<\/strong>)

\n\nThe Scheme shall, where an account has been rendered, pay any benefit due to a member, either\nto that member or to the supplier of the relevant health service who rendered the account, within\n30 days of receipt of the claim pertaining to such benefit.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\t\t\tWhen must I submit a claim?<\/strong>

\n\nYou must submit a claim as soon as possible after receiving the service. If you submit a claim\nlater that the last day of the 4th month<\/strong> from the date on which medical treatment was provided,\nyour claim will be stale and your account will not be paid

\n\nNOTE: A CLAIM IS VALID FOR ONLY 4MONTHS FROM THE DATE OF SERVICE<\/strong>

\n\nHow will the scheme reimburse me for accounts already settled?<\/strong>
\nThe account will refund you through EFT

\n\n\nCan I claim for medical expenses incurred outside Botswana?<\/strong>
\n\nFor services rendered outside Botswana and South Africa, ONLY<\/strong>\u00a0emergency claims will be\ncovered. Members will pay upfront for all the medical services and claim back from the scheme.A retrospective authorization will be required within 24h of receiving the claim.

\n\nClaims will be paid subject to the Botsogo set tariffs and in the Botswana currency (BWP).

\n\nPoints to remember<\/strong>
\n\n– Keep a copy of your records
\n\n– It is your responsibility as a member to ensure that your claims have been submitted to\nthe scheme and to check whether they have been paid by the Scheme, even if your\nservice provider submits the claim on your behalf.
\n\n– If your claim is rejected, you have 60 days<\/strong> in which to submit the correct claim or raise a\nquery.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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    Attach Documents ( signed invoice and proof of payment)\n<\/p>\n

    <\/span>\n<\/p>\n

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    <\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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      Attach signed Invoice\n<\/p>\n

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      Attach proof of payment\n<\/p>\n

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      Submit A Claim Home How to Claim Process Most service providers submit their claims directly and are paid directly, which means you do not have to submit your account to the scheme. A claim can be submitted through the below platforms. – Electronic Submission (EDI)-for service providers only – At our offices (Paper Claims) – […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor-template.php","meta":{"footnotes":""},"class_list":["post-9043","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/botsogohealthplan.co.bw\/new\/wp-json\/wp\/v2\/pages\/9043","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/botsogohealthplan.co.bw\/new\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/botsogohealthplan.co.bw\/new\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/botsogohealthplan.co.bw\/new\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/botsogohealthplan.co.bw\/new\/wp-json\/wp\/v2\/comments?post=9043"}],"version-history":[{"count":52,"href":"https:\/\/botsogohealthplan.co.bw\/new\/wp-json\/wp\/v2\/pages\/9043\/revisions"}],"predecessor-version":[{"id":9770,"href":"https:\/\/botsogohealthplan.co.bw\/new\/wp-json\/wp\/v2\/pages\/9043\/revisions\/9770"}],"wp:attachment":[{"href":"https:\/\/botsogohealthplan.co.bw\/new\/wp-json\/wp\/v2\/media?parent=9043"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}