| 1. | All service providers should be registered on the Compensation Fund claims system in order to capture invoices and medical reports. |
| 1.1 | Medical reports should always have a clear and detailed clinical description of injury and related ICD 10 Code. |
| 1.2 | In a case where a surgical procedure is done, an operation report is required |
| 1.3 | Only one medical report is required when multiple procedures are done on the same service date |
| 1.4 | A medical report is required for every invoice submitted covering every date of service. |
| 1.5 | Referrals to another medical service provider should be indicated on the medical report. |
| 1.6 | Medical reports, referral letters and all necessary documents should be uploaded on the Compensation Fund claims system. |
NOTE: Service providers are required to keep original documents (i.e medical reports, invoices) and these should be made available to the Compensation Commissioner on request.
| 2. | Medical invoices should be switched to the Compensation Fund using the attached format. - Annexure D. |
| 2.1. | Subsequent invoice must be electronically switched. It is important that all requirements for the submission of invoice, including supporting information, are submitted. |
| 2.2. | Manual documents for medical refunds should be submitted to the nearest labour centre. |
| 2.3 | Service providers may capture and submit medical invoices directly on the Compensation Fund system online application. |
| 3. | The status of invoices/claims can be viewed on the Compensation Fund claims system. If invoices are still outstanding after 60 days following submission, the service provider should complete an enquiry form, W.CI 20, and submit it ONCE to the Provincial office/Labour Centre. All relevant details regarding Labour Centres are available on the website www.labour.gov.za. |
| 4. | If an invoice has been partially paid with no reason indicated on the remittance advice, an enquiry should be made with the nearest processing labour centre. The service provider should complete an enquiry form, W.CI 20, and submit it ONCE to the Provincial office/Labour Centre. All relevant details regarding Labour Centres are available on the website www.labour.gov.za. |
| 5. | Details of the employee's medical aid and the practice number of the referring practitioner must not be included in the invoice. |
If a medical service provider claims an amount less than the published tariff amount for a code, the Compensation Fund will only pay the claimed amount and the short fall will not be paid.
| 6. | Service providers should not generate the following: |
| (a) | Multiple invoices for services rendered on the same date i.e. one invoice for medication and a second invoices for other services. |
| (b) | Cumulative invoices Submit a separate invoice for every month. |
* Examples of the new forms (W.C1 4/W.C1 5/W.C1 5F) are available on the website www.labour.gov.za.
