Circular 15 of 2021: Revised Healthcare Utilisation Annual Statutory Return
The Council for Medical Schemes (CMS) hereby publishes the updated technical guideline document for completing the Utilisation section of the 2019/2020 Annual Statutory Return (ASR).
The implementation of the Medical Schemes Act (No. 131 of 1998) needs to be monitored to evaluate its impact on the industry and beneficiaries, and where necessary, to recommend legislative reforms. Submission of good, quality and credible data is important to achieve this objective. By reviewing data specification documents, the CMS ensures that the latest developments and best practices are incorporated for the collection of good quality data.
The following updates and changes have been made in the current technical guideline document:
| Part | Field | Amendment |
| B1 to B13 (Excluding B12) |
|
Two additional fields |
| B4 |
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| B14 |
|
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| C4 |
|
|
| C5 |
|
Additional field to capture comorbidity |
| Updated CdRef Tables | ||
|
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This latest version of the technical guideline document should be read in conjunction with the following updated documents.
- ASR Data Specification v9.0: This workbook contains the layout and field type definitions for the data tables.
- ASR Valid Codes v9.0: The reference workbook containing tables with valid values for certain key columns specified in the ASR Data Specification v9.0
- ASR Data Specification Appendix v9.0
- Guidelines for the Identification of Beneficiaries with Risk Factors in Accordance with the Entry and Verification Criteria Version 14.1
- It should just be noted that there was a typo in Section 6 the DM1 table. The ATC code should be A10AB and not A10AB, and
- The ICD-10 code H36.0 was incorrectly placed under Table 14 DM2 while it should have been placed under Table 13 DM1
The Healthcare Utilisation ASR system will go live on 9 March 2021 and the deadline for the submission of the 2019/2020 Healthcare Utilisation ASR will be on 14 May 2021.
Details of schemes’ Data Officers should be updated and access to the Healthcare Utilisation Annual Statutory Returns must be authorised by the Principal Officer of the scheme, a request in this regard should be send to Ms Busisiwe Khuzwayo (b.khuzwayo@medicalschemes.co.za).
Officials from the CMS will be at hand to address all technical queries relating to the updated Healthcare Utilisation Data specification document.
Your cooperation will be highly appreciated.
Download the Circular here.