Internal PMB Worskhop

Internal PMB Worskhop

1. Funding Of PMB's?

   • Claims
     • route PMB claims where there is no hospital authorisation?
     • Decline any claim related to treatment that falls outside PMB level of care
     • Route a declined auth where a claim is PMB
   • Where there are no DSP's across the country will we fund at cost?
   • Automated or PMB Application?
   • Definate PMB only?
   • OH Auths =PMB ICD Code, Procedure and Within the date range

2. How would the benefit accumulation be calculated?

   • Dual Accumualtion?

3. How will we manage the subilmits?

   • Our concern is that claims have never been able to pay through the sublimit