Pre-authorisation requests and Case Management processes

We recently launched our Healthcare Providers Online Pre-authorisation Tool, designed to give you access to pre-authorise and track treatment authorisations.

We are in the process of modifying the tool over the next few months to give you access to authorise other requests such as hospital, prosthetic and chronic medication authorisations.

In the meantime, we have listed the process to follow for all other Pre-authorisation and authorisation requests and Case Management below:

All hospital admissions in Acute phase to be authorised with RMA within 72 hours of admission via rmahospitalauthorisation@randmutual.co.za if request is sent from the hospital.
Pre-authorisation to be requested prior to Hospital admission via Medihelp@randmutual.co.za if request is sent from the treating doctor’s rooms, including Prosthetic and Chronic Medication requests.
Out of Hospital consult to be requested via RMA online auth portal.
Emergency admissions in ICU and High Care following injury will be considered automatically authorised subject to authorisation being sought within 72 hours of such admission to enable RMA to issue an authorisation and manage such admission further.
Retrospective authorisations will not be considered.
Turnaround time for Pre-authorisations and clinical updates is 3 working days provided liability has been accepted for the claim.
Any escalations for Pre-authorisations for which feedback has not been received from RMA after the 3 days, an original email initially send to the respective email address should be forwarded back to the same address with Follow-up clearly indicated in the subject line to enable RMA to escalate accordingly.
If a request is escalated for Medical advisor, an additional 3 working days need to be added for feedback in total 6 working days.
For any authorisation requests where feedback has been received that liability is pending, follow up should be done via the contact center as authorisation will not be possible until liability has been accepted on the claim.