OFFICIAL ACCEPTANCE AS MICARE PANEL - … · Panel clinics that offer services to clients under the...

MiCare Sdn Bhd (a member of Zuellig Pharma Group) (formerly known as Metronic iCares Sdn Bhd)

Block A, No. 22 Jalan Astaka U8/84, Section U8, Perindustrian Bukit Jelutong, 40150 Shah Alam, Selangor Darul Ehsan, Malaysia Tel : +603-7839 7200, +603-7843 9459 Fax : +603-7847 4304, +603-7846 1664 Website: www.micaresvc.com Email: [email protected]

YOUR ONE STOP MEDICAL CLAIMS ADMINISTRATOR

ATTN.: GP PANEL MANAGEMENT TEAM DATE: …………………………….

OFFICIAL ACCEPTANCE AS MICARE PANEL 21-03-2018

(By fax: 03-5590 5208 or 03-7846 1664 / 3595)

I, the undersigned hereby confirm have read through, understand and accept of the following: -

1 - PROTOCOL as described under the FCS and FFS schemes

2- TERMS AND CONDITIONS duly set by MiCare. 3- List of services that are EXCLUSIONS. 4 - To submit all claims through MICARE PORTAL on REAL TIME basis. 5 - To REFER to MICARE for any concerns that may arise from time to time. 6- To ABIDE by all PROCEDURES AND PROTOCOLS as laid down by MMC in the practice of medicine. …………………………………………………..…………. (NAME AND IC NO) as (DOCTOR IN – CHARGE / CLINIC OWNER) agree to abide by the above. Attached herewith are the: -

a) Clinic information form duly filled up.

b) Clinic services.

c) Update of price list of services provided by clinic COMPULSORY, please complete the next page. Thank you.

SIGNATURE OFFICIAL CLINIC STAMP

NAME OF DOCTOR IN - CHARGE

NAME OF CLINIC OWNER

TEL

FAX

EMAIL ADDRESS




Duly completed by (OFFICIAL CLINIC STAMP)

CHARGES Consultation Fees : _______________________________________________

Average Medication Cost : _______________________________________________ Percentage Use of Generic Drugs in Clinic : _______________________________________________

Percentage Use of Patented Drugs in Clinic : _______________________________________________ Average Treatment Cost : _______________________________________________ Any Surcharge (Only for 24-hr clinic, Applicable after 11pm) : _______________________________________________ COMPUTERIZATION Currently Computerized : Yes / No

Currently using any Clinic Management software : Yes / No

Subscribing to Internet Service : Yes / No

Please indicate Type of service subscribed : _______________________________________________

Kindly SPECIFY : Individual or *group practice (delete non applicable)

*If under group practice Please list Head Quarter (HQ): _______________________________________________

Remarks (if any) : _______________________________________________ Thank you.




CLINIC INFORMATION FORM

To: Doctor / Clinic Administrator Date: ……………………….. Kindly assist us in filling up the following information for our record purposes, thank you.

PLEASE AFFIX OFFICIAL CLINIC STAMP

IMPORTANT - PAYEE NAME

CLINIC REGISTRATION NUMBER (BORANG B / BORANG F- whichever applicable)

OPERATING HOURS, PLEASE INDICATE ALL SESSIONS OF THE DAY: -

MONDAY TO FRIDAY

SATURDAY

SUNDAY

PUBLIC HOLIDAY/S

24 HOURS CLINIC

OTHERS, PLEASE SPECIFY: -




MEDICAL FACILITIES AVAILABLE

PARTICULARS REMARKS (IF APPLICABLE)

PAP SMEAR

Yes / No

ULTRASOUND (IF ANY)) Yes / No

X-RAY MACHINE

FILM ILLUMINATOR (X-RAY READER)

NEUBULIZER Yes / No

FEMALE DOCTOR Yes / No if yes, please specify number of female doctor/s

LOCUM ON DUTY WHEN DOCTOR IN-CHARGE AWAY Yes / No

ABLE TO CARRY OUT MINOR SURGERY Yes / No

BLOOD TEST FOR GLUCOSE, PLATELET COUNT ETC. Yes / No

ECG Yes / No

PHYSIOTHERAPY FACILITIES Yes / No

ENT EQUIPMENTS Yes / No

ANTE-NATAL CHECK-UP Yes / No

URINE FEME Yes / No

EMERGENCY ROOM WITH: -

1) PORTABLE CARDIAC DEBRILATOR Yes / No

2) IV DRIPS Yes / No

3) OXYGEN Yes / No

4) CPR TRAINED Yes / No

OTHERS, PLEASE SPECIFY: -

1)

2)




PAYMENT REGISTRATION FORM FOR DIRECT CREDIT TO BANK ACCOUNT

Please (√ ) where applicable (IMPORTANT) New Panel Existing Panel - Change of Bank Details Only Refresh Panel Existing Panel - Change of Clinic Management If yes, please state effective date for claims to be paid to new Management :__________________________

Name of bank

Complete bank address

Payee Name (IMPORTANT)

Bank account number

Clinic GST registration no.

Email address (to notify details of payment)

Please PRINT clearly

MiCare Clinic ID (for MiCare use only)

Clinic name

Clinic address

Telephone no

I / we confirm that the above details are correct and that the bank account belongs to me / us: -

Signature Official clinic stamp

.................................................................... ...............................................

Name : Date : NRIC No :

Condition: It is expressly agreed between the applicant and MiCare Sdn. Bhd. that in the event of wrongful payment and/or overpayment into the account of applicant, it is bound duty of the applicant to inform and refund the wrongful payment and/or overpayment to MiCare Sdn. Bhd. within seven (7) days of the acknowledged receipt of payment. Failure to do so will allow MiCare Sdn. Bhd. to take legal action against the above applicant.




MiCare Clinic Recruitment - Terms and Conditions (Kindly

initial at the bottom right corner of each page & return the original document of this contract to MiCare for record)

1) Panel Clinics - Professional Requirements Panel clinics shall be duly licensed by the Ministry of Health, Govt. Of Malaysia and registered with the Malaysian Medical Council. Any change in the status must be communicated to MiCare promptly.

The practicing doctor in the clinic should be duly licensed by Malaysian Medical Council and posses a valid Annual Practicing Certificate. Any locum doctor must satisfy the above requirements. The doctor who has the agreement with MiCare will be responsible for all transactions by the clinic.

Additionally, you are also required to submit the photocopy of the following approval documents to MiCare (Clinic Team): -

a) Annual Practicing Certificate b) Ministry approval document for the premises of the clinic c) Any other relevant documents for special services (e.g. X-ray facility, physiotherapy etc)

Panel clinics will provide all covered treatment that the clinic is able. There will be no treatment provided that is of a questionable nature by the prevailing practice protocol of the medical community as governed by the Malaysia Medical Council guidelines.

2) Panel Clinics - Members All panel clinics are advised to display MiCare decal prominently to assist members to identify panel clinics clearly. A decal will be sent to all clinics that comes onboard MiCare.

Panel Clinics shall accept an eligible MiCare member as a patient when he/she has identified himself / herself with a MiCare card or the IC. MiCare CARDS MAY VARY IN APPEARANCE DEPENDING ON THE CLIENT WE SERVE.

First Logo (currently in use, will phase off within 1 year)

Please identify MiCare logo either in front or at the back of the medical card. In case of any doubt, please call MiCare for verification before turning away patient. Please check the eligibility on line and if in case of further doubt please call MiCare toll free helpline 24/7 at 1-800-88-2678 for clarification.




Panel Clinics shall not: -

1) Discuss any business terms of the services provided with the member. 2) Attempt to contact the client company to comment on services or to solicit business. 3) Pass any disparaging remarks about MiCare to members with regards to business

arrangement.

All concerns should be addressed directly to MiCare and we will attend to panel clinics concerns directly.

To avoid inconvenience to members, any change in operating hours of the clinic must be communicated to MiCare before being implemented.

3) Panel Clinics - Exclusions Panel clinics must request MEMBERS TO PAY FOR SERVICES THAT ARE NOT COVERED by the plan they are eligible for. These exclusions vary from client to client and a guideline list is provided by MiCare. These exclusions are in line with the insurance industry standards. If in doubt, please contact MiCare via our toll free helpline for clarification before requesting members to pay.

4) Panel Clinics - Medications used (for FCS Program ONLY) Panel clinics that offer services to clients under the FCS scheme agree to utilize the drug list provided. MiCare will update this list from time to time.

Medication that the patient absolutely needs but not in the list can be prescribed by the attending physician. To facilitate smooth reimbursement for medication not on the list the doctor needs to obtain a code from MiCare via our 24/7helpline at 1-800-88-2678.

5) Register of Attendance and Consent for Release of Information The clinic shall keep a completed and signed Register of Attendance Form (ROA) as proof of a visit and of consent for release of medical information and provide the ROA Form to MiCare when requested.

6) Data Privacy The clinic shall manage, safeguard and process MiCare member’s data in a manner that is in compliance with the provisions of the Personal Data Protection Act (PDPA) 2010 in so far as it is applicable to the clinic.




7) Panel Clinics - Services Clinics are expected to provide medical services that are considered as accepted standard protocol by the Malaysian Medical Council guidelines and the ethical standards expected of a registered practitioner. This will include providing the doctor’s best expertise and intentions.

MiCare strongly discourage practices that may compromise patient safety and adversely affect the clinics’ relationship with us. These include prescribing excessive medication,frequent visitation, providing medication for non covered members of the family under the name of card carrying members, inclusion of services not provided by listing them under different headings etc.

MiCare clinic audit team will be highlighting these to the individual clinics confidentially if there are such situations. MiCare as a responsible Third Party Administrator will have no choice but to take into confidence the company concerned for further advice on clinics that repeatedly resort to the above practices.

Our corporate clients will not be able to tolerate the above situation and MiCare will have no choice but to cease arrangements with such establishments. Clinics that have come under such actions are a small number. We shall also submit appropriate reports to the relevant authorities like MMC for their further action.

8) Panel Clinics - Transfer of Ownership

This agreement, being intended to secure the services of and be personal to the Panel Clinics, shall not be assigned, sublet, delegated or transferred by the panel clinic without the prior written consent of MiCare.

The agreement shall be governed by and construed in accordance with the law for the time being in force in Malaysia. The parties hereby agree to submit to the non exclusive jurisdiction of the courts in Malaysia.

9) MiCare - Administrative Procedures MiCare will make available to panel clinics different protocol of identification of the members from various plans. This is to make sure that eligible services are provided without hassle.

10) MiCare - Reimbursement MiCare will assist doctors to make their claims for services via a web based protocol. MiCare may, from time to time, request for additional documentation from Panel clinics in order to process such claims.

MiCare encourages doctors and/or administrators to enter claims online real time to

avoid non payment of claims.




11) MiCare - Payment The closing date for the claims of a particular month is the 7

th of the following month. MiCare

shall make payments to clinics within 45 working days from the closing date provided that there is no dispute over the said claim. Please note that client corporations join MiCare at various times of the year. Hence, any late submission of claims runs the risk of non payment due to the following reasons: -

1) Corporate client account has been terminated. 2) Closing period for existing clients may vary and payment account may be closed. 3) Corporate client who have insured their programs may have completed their insured

period.

Due to the above reasons, submission of claims beyond submission deadline (7th of the following month from actual consultation date) WILL NOT be payable.

All concerns with regards to payments should be directed to MiCare. Please refrain from any comments, casual or otherwise, to client members on payment matters. MiCare will consider any such discussion with client members a serious breach of agreed confidentiality which may result in termination.

12) Notice of Termination

Either party can terminate this agreement by giving 30 DAYS NOTICE in writing of such intention WITHOUT HAVING TO PROVIDE ANY REASONS WHATSOEVER.

In case of insolvency of either party this agreement can be terminated without notice by the solvent party.

In case of termination, the relevant parties hereby agree to abide by all the terms and conditions of this agreement till the last day of the notice period.

MiCare reserves the right to suspend or terminate panel clinic without notice if MiCare has reasonable grounds to suspect that information provided by the panel clinic is untrue, inaccurate or incomplete or MiCare believes that the panel clinics’ action may cause financial loss, breach of agreed terms or legal liabilities.




EXCLUSIONS LIST for GENERAL PRACTITIONERS (SERVICES NOT COVERED) 19-02-14

Programs administered by MiCare are insured programs and the industry regulations on services that are not covered under the medical scheme offered by MiCare are listed below.

Theses services may be required by the patient. However doctors who offer these services or prescriptions must request the patient to bear the cost. MiCare will not reimburse the clinic for these items.

Private nursing, rest cures or care in a sanitarium

Treatment for erectile dysfunction or treatment related to impotence or sterilization

Treatment for infertility

Family planning methods including mechanical or chemical contraceptive means

Pregnancy, child birth including surgical procedure for delivery, miscarriage, abortion, pre-natal, post-natal care, pregnancy tests and routine pregnancy check-ups

Treatment for Venereal diseases including HIV and all their sequelae

Treatment for congenital, hereditary diseases/deformities

******

Psychiatric conditions including any neuroses and their physiological or psychosomatic manifestations

Suicide or conditions arising from attempted suicide




Any treatment for self-inflicted injuries regardless whether the patient is sane or insane at the time of commission

******

Any surgery of a cosmetic nature including plastic surgery of any kind unless as a corrective surgery for injuries covered by the insurer

******

Consultation, investigations or procedures primarily for preventive, investigative, experimental, diagnostic or otherwise not incidental to treatment of diagnoses of a covered disability

House calls by GP clinics are not covered

******

Dental conditions including treatment or surgery except as necessitated by accidental injuries to sound natural teeth occurring during the period of coverage

******

External prosthetic devices and appliances such as artificial limbs, crutches, hearing aids, aero chambers, nebulizer, implanted pace makers, knee guards, pressure stokings

******

Eye examination for correction of vision and corrective glasses, procedures and surgery (e.g. radial keratotomy) for the same

Treatment for obesity, smoking cessation programs, drug addiction or intoxication, educational classes for covered medical conditions, nutritional services, group support services unless authorized by the plan

Investigation and treatment of sleep disorders, snoring disorders and insomnia




Alternative medical therapies including but not limited to hormonal, nutritional, chiropractic services, acupuncture, acupressure, reflexology, bone setting, herbalist treatment, massage, aromatherapy, ozone therapy etc except Chinese Traditional Medicine by medical practitioner registered and licensed by KKM

Immunizations for travel or prevention except those recommended as mandatory by Ministry of Health, Government of Malaysia except as specified by plan

Dietary supplements, vitamins, anabolic steroids and weight loss programs are not covered unless specified by the members’ coverage. Supplements such as iron preparations for anemia are covered

Treatment for Acne, facial cleansers, cosmetic shampoos, soaps, hair tonic

Sickness or injury arising from hazardous sports such as (but not limited to) skydiving, water skiing, underwater activities requiring breathing apparatus, winter sports, professional sports and flying (other than as a fare paying passenger in a licensed passenger carrying commercial carrier over established routes)

Treatment for injuries or conditions arising from any act of war, declared or undeclared, criminal or terrorist activities, active duty in armed forces, participation in strikes, riots or civil commotion or insurrection

Ionizing radiation or contamination by radioactivity from any nuclear fuel or nuclear waste from process of nuclear fission or from any nuclear weapons material

Radiology: Only X-rays for chest, upper and lower limbs will be covered (X-rays for skull, spine and abdomen must be referred).

Ultrasound, MRI and CT scan

Treatment by modalities which have not become part of mainstream medicine e.g. Sonotron therapy

Treatment for cancer and chronic renal failure

Date post:	29-May-2018
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