Hospital Utilisation Management

This programme is managed by PROVIDENCE Healthcare Risk Managers and provides a comprehensive hospital risk management programme which includes pre-authorisation, case management, clinical audit and, in some cases, specialist programmes.

HOW DO YOU OBTAIN PRE-AUTHORISATION?

You can either Phone: (041) 395 4545 or 0860 08 08 88
Fax: 086 686 5503 or 086 686 4113
E-mail: specauth@suremedhealth.co.za

hospauth@suremedhealth.co.za

Should pre-authorisation not be obtained, a co-payment of R1000 will be applied.

Information you must have ready for pre-authorisation:

  • Patient’s membership number;
  • The patient’s full name, age and dependant number;
  • Surname and initials of the attending doctor (plus practice number if available);
  • Date and time of admission to hospital;
  • The reason for admission to hospital;
  • The associated medical diagnosis;
  • The planned procedures as well as the tariff codes that the doctor intends to use. Your doctor will assist in providing the above information.

What happens if you stay in hospital longer the initial approved length of stay?
Should you require extra days in hospital, your doctor or the hospital’s case manager must immediately inform PROVIDENCE to ensure continued benefits. If there is a clinical reason for the stay, PROVIDENCE will approve the extra days, subject to benefit parameters. It is important to remember that there must be a clinical indication or medical reason for the extra stay.

What happens in the event of an emergency hospital admission?
In the event of an emergency, admission over a weekend, or on a public holiday, PROVIDENCE must be notified of admission to hospital on the next working day.