Doctors Online Application Form

Day1 Health Doctors Online Application Form

1Doctor Health (Pty) Ltd (1Doctor Health) wishes to identify any willing and able providers to render quality and cost-effective services as non-exclusive designated service providers on behalf of all our clients to members on the 1Doctor Health Options.

Practice Details
Physical Address
Postal Address
Practice Contact Details
Banking details
Supporting Documents
Acknowledgement
 
Copyright 2015 Day1 Health (Pty) Ltd | All Rights Reserved
Day1 Health (Pty) Ltd is an authorised Financial Services Provider. FSP No: 11319
Hospital Plan Underwritten by African Unity Life Limited (FSP 8447)
Day1 Health is a B-BBEE level contributor: Level Two (125% B-BBEE procurement recognition level)(1)(2)
Day1 Health complies with the principles of open enrolment, community rating and cross-subsidisation and does not discriminate or refuse membership on the basis of
race, age, gender, marital status, ethnic or social origin, sexual orientation, pregnancy, disability, state of health, geographical location or any other means of discrimination.

1Doctor Health agrees to the following:

  1. To reimburse claims submitted electronically in the required format within a period of 30 days from date of receipt of claims;
  2. To reimburse you according to our approved rates and procedures;
  3. To endeavor to move towards seamless, effective, and efficient interactions with your practice;
  4. To follow a fair/equitable process in the establishment of the 1Doctor Health network, with an ethos of creating and maintaining sustainable partnerships;
  5. To follow a communication strategy to ensure that service providers are regularly communicated to and provided with any relevant updates with regards to any network related requirements and processes;
  6. To confidentially discuss and resolve any queries, complaints, and concerns that you might have as our valued service provider;
  7. To promote your practice (this may include listing your practice on the website or lists to be distributed to these client scheme members).

The Service Provider hereby agrees to the following:

  1. To be appropriately registered with the HPCSA and have medical indemnity cover;
  2. To provide clinically appropriate and cost-effective treatment to members;
  3. Where clinically indicated, to operate within the relevant scheme's protocols, formularies and referral processes, and scheme benefit structures;
  4. To treat all patients with dignity and respect, and to put their interests first;
  5. To maintain a clean, safe, and appropriately equipped facility;
  6. Submit all claims in the prescribed format electronically to the prescribed destination code on the relevant tariff codes, ICD-10 codes as per the applicable legislation;
  7. To formally verify that the patient's ID matches his/her membership details;
  8. To bill per the agreed fee and to undertake not to balance bill or charge members any additional fees outside this agreed fee structure for the services covered by the 1Doctor Health option benefits;
  9. To timeously communicate any changes in practice or relevant information to 1Doctor Health prior to any change;
  10. To obtain the necessary authorisation where applicable per the 1Doctor Health protocols;
  11. To prescribe medication within the 1Doctor Health unless prior authorisation has been obtained from 1Doctor Health and to inform any member requesting any medication or benefits that fall outside the applicable benefits that it will be for his/her personal account;
  12. Both parties agree to a written termination notification of one calendar month.

1Doctor Health reserves the right to terminate this agreement with immediate effect if a provider makes him/herself guilty of unprofessional conduct in terms of the relevant applicable rules, if there is any disciplinary inquiry into his/her conduct instituted by the HPCSA, if a provider commits fraud, theft or abuses his/her rights in terms of this agreement.