Managed Care FAQs
Case Coordination
The process of getting prior authorization begins with the patients or service provider and ends with the funder. Prior authorization can be prescription, medical, surgical, or alternative services. It begins with a medical prescription or quotation for procedures to be done to a member by the health practitioner.
The member or service provider then submits to the medical aid for authorization via the following channels:
- Telephone (especially urgent requests)
- Walk-in
Prior authorization helps ensure one gets proper care. It helps us work with your doctor and to evaluate services for medical necessity before you receive treatment or services. It also allows us to ascertain whether a member is eligible for payment coverage for the specific service/s.
Not all healthcare expenses need prior approval before treatment. Let us look at the reasons why one may need to request prior authorization. Your healthcare professional can proceed with the care administration once they get approval.
- High-cost procedures and medication
- Many drug interactions that can be harmful
- Specially prescribed drugs for unique health issues
- Drugs vulnerable to abuse and misuse
- Procedures that can be done for cosmetic or religious purposes
- Foreign treatment
- Ambulance Air/ Road Evacuations
Within 24hr or 48hrs in the case of weekends. For emergency cases we have our team from the Contact Centre on standby. We strongly encourage phone contact for urgent cases.
All foreign treatments require preauthorization and member to submit relevant referral letter from local specialist.
Yes, Cimas reimburse cash payment for foreign treatment at a calculated percentage provided pre-authorization is obtained
YES: this is important to check availability of funds and necessity.
YES: This enables society to safeguard the member’s funds. Done by booking the benefits for the admission in advance to avoid accessing service with depleting funds.
Yes: these are sublimit put in place to control utilization by checking benefit balances and avoid over service.
We are guided by Cimas tariff award. We pay up to tariff.
No: Benefits are not transferable.
No: Benefits cannot be carried forward.
Provider Liaison
Members:
The Bluezone list of service providers is available on our website (https://www.cimas.co.zw/). You can search the providers both by discipline and location.
The Bluezone list of service providers is available on our website (https://www.cimas.co.zw/).
If the provider’s fees are higher than what Cimas pays (Cimas Tariff), the member may be expected to bridge the gap. However, most providers do not charge rates above the Cimas Tariffs.
Any amount charged by a service provider that is over and above what Cimas pays (Cimas Tariff). You may be expected to pay this amount upfront as a co-payment.
Get a correctly completed claim form, attach your receipts and submit via email to claims@cimas.zo.zw. Please note, it is the responsibility of the member to get a properly completed claim form from the provider. Unfortunately, after being paid upfront, some providers do not provide all the required information, which may result in claim rejections. Hence, we strongly recommend looking for alternative provides accepting Cimas Card.
Yes, only if you have been referred to the next level of care (specialist care)
Yes, depending on your package. You can download a Cimas Health Sync App on Google play store and create your account. You will be able to track your benefits and utilisation.
Yes!
Pharmacies now have online platforms where one can send the prescription either on WhatsApp or Email and the medication is delivered at your doorsteps.
Yes, the tariff awards for branded medicines are at the same rate as the generic equivalent
Providers:
Yes, the tariff awards for branded medicines are at the same rate as the generic equivalent
These are providers within our smaller network, who accept the Cimas card with zero to minimum shortfalls. They are part of a bigger network of providers registered with Cimas.
Claims can be submitted electronically in real time via the NH263 platform (strongly recommended), or manually via email. For manual claims, scan the claim together with all necessary attachments into a single PDF file. Send the claim to claims@cimas.co.zw, one claim per email. You will receive an automated response once the claim has been received.
Contact NH263 on support@health263.systems.
No, for security reasons. All biometric fingerprint bypass requests must be initiated by the member.
Disease Management
One should complete and submit a chronic registration form together with a copy of their prescription via the Cimas website, WhatsApp on 0776272744, email on cimascare@cimas.co.zw and physically.
Extensions are not guaranteed but MAY be done on a case-by-case basis depending on various medical conditions and gravities depending on the business’ position at a given time.
If one depletes their benefit and needs assistance for chemotherapy, they should submit a motivational letter from their attending specialist, prescription and quotation which will be attached to the appeal. Approval is not guaranteed, and the extent of assistance cannot be determined.
Members have cover upto tariff awards
Glucometers are given to members for free, but glucose strips are charged deducting from the chronic drug benefit.
BP machines are not a medical aid benefit.
- Help you better coordinate your treatment plan with doctors who have specialized in treating your disease.
- Strengthen your engagement to receiving personalized care during the regular appointments in relation tosettingmilestones.
- Assistyou in finding ways to create a healthier, more balanced lifestyle, specifically designed to your needs, in the presence of your chronic disease in collaboration with Cimas IGO.
- Access to the Chronic Drug Benefit. • Be your Adherence tracking partner for your medication.
- Closelymonitoryour condition with assistance from your attending doctor so that you do not experience any unforeseen complications.
- Reinforce the need for early intervention on complications should they arise.
- Assistyou to join an appropriate peer support group.
- Avail educational material and self-management techniques to empower youand help you by outsourcing medication if your usual dispenser is out of stock.