Healthcare Provider Information

Enablemed is a Managed Care Organisation accredited by the Council for Medical Schemes, managing the following options:

• Makoti Medical Scheme:
  • Primary Option
  • Comprehensive Option
• Malcor:  Plan D
• Sizwe: Copper Core (Day to Day benefits)
• Essential Employee Benefits (Health Insurance Product)

ENABLEMED 24-hour Call Centre for Pre-authorisations & Enquiries:  0860 00 24 00

EEB 24-hour Call Centre :  010 020 9008 or PEP 011 532 0290

a) Specialist Visits

• Pre-authorisation with GP referral letter a requirement
• Managed Care formulary, Scheme rules & protocols apply to all referrals – refer to Enablemed website / 24 hour Call Centre for any queries
• Back pain protocol to be followed

b) Accounts must be submitted within 4 months after the date of service in one of the following ways:

1. Electronically;
2. Email:  admin@enablemed.com (for non-switching providers); or
3. Fax:  086 660 7023

c)  Chronic Care

• Registration Makoti and Malcor D to chronic@enablemed.com
• Registration EEB:  preauth@mediscor.co.za
• Pharmacy claims electronically (via Mediscor PBM)

d)  Radiology & Pathology approved as per formulary

• Subject to pre-authorisation