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Circular 21 of 2021: Update to Healthcare Utilisation Annual Statutory Return

The Council for Medical Schemes (CMS) published the updated technical guideline document (Healthcare Utilisation Annual Statutory Return Technical Guideline for the preparation of data Version 9.1) for completing the Utilisation section of the 2019/2020 Annual Statutory Return (ASR).

The system is live and schemes are encouraged to familiarise themselves with it well before the deadline for submission. No extension on deadlines will be granted. Schemes should note the following important data submissions dates aimed at giving schemes enough time to work through changes, ensuring accurate and complete submissions.

Deadlines Description Due date
Electronic data submission The deadline for electronic submission of schemes data 14 May 2021
Feedback reports Feedback to schemes on data submission and possible resubmission of data 21 May 2021
Resubmission of data Resubmission of data due to errors identified in feedback reports 28 May 2021
Final signed off report Final report signed off by Principal Officer and Trustees 11 June 2021

The following changes were effected to version 9.0 of the technical guideline.

Part Field Amendment
A5, B6 and B13 ·       Co-payment by member

·       Other payment by member

Two additional fields
B14 ·       Number of unique beneficiaries admitted Number of unique beneficiaries admitted was extended to include beneficiaries treated out of hospital
C5 ·       CoMorbidity Additional field to capture comorbidity
Valid codes
CDRef5 ·       pkMCIndicator 154 (MC_ASP Number of unique beneficiaries on aspirin) is a duplicate of 153 and was removed from the list

·       Number of COVID related hospitalisations (MC_COV)

·       Removed 154 (MC_ASP)

·       Removed MC_COV

CDRef 10 ·       COVID-19 codes Separated ICD10 codes into virus identified(U07.1) and virus not identified (U07.2)
CDRef 27 Data should not be duplicated under various DIS groupings in table B14, If you have captured ICD10 A00 under DIS 1.5 it should not be duplicated for any other DIS grouping, example DIS 1.7


This version of the technical guideline document should be read in conjunction with the following updated documents.

The final report can be electronically signed, if the scheme has the option available, however schemes can submit the scanned signed document to the CMS by 11 June 2021 to 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.