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Circular 25 of 2021: Managed Care Organisations Accredited by the CMS Council

The Council for Medical Schemes (CMS) hereby confirms that the Executive Committee (EXCO) of Council considered and resolved to approve the renewal of accreditation of the organisations listed below, during its meeting of 31 March 2021.

Managed Care Organisations: Renewal Applications

  1. Dental Risk Company (Pty) Ltd: Renewal of accreditation was granted for a period of two years from  1 May 2021, in respect of the following services, with no conditions:

Dental Benefit Management Services

  • Basic dentistry
  • Specialised dentistry
  1. ICON Managed Care (Pty) Ltd: Renewal of accreditation was granted for a period of two years from  24 April 2021, in respect of the following services, with the conditions as stipulated on the CMS website:

Active Disease Risk Management Services

    • Oncology

Managed Care Network Management Services and Risk Management

Pharmacy Benefit Management Services

  1. Improved Clinical Pathway Services (Pty) Ltd (ICPS): Renewal of accreditation was granted for a period of two years from 12 April 2021, in respect of the following services, with the conditions as stipulated on the CMS website:

Managed Care Network Management Services and Risk Management

    • Hip and Knee Arthroplasty
    • Cataract surgery
    • Spinal Surgery
  1. Optimal Managed Care (Pty) Ltd: Renewal of accreditation was granted for a period of two years from 10 May 2021, in respect of the following services, with the conditions as stipulated on the CMS website:

Managed Care Network Management Services and Risk Management

    • Cataract surgery

The following managed care organisation applied for renewal of accreditation and does not meet the requirements in terms of Regulation 15B(2)(d) as it does not provide managed care services as defined:

Professional Provider Organisation Services (Pty) Ltd (PPO Serve) – Close scrutiny of the organisation, its business model and services provided confirmed that the organisation does not provided managed care services as defined and therefore need not be accredited as a managed care organisation.

The above-mentioned Managed Care and Administrators conditions and status can be viewed here.

Download the Circular here