Medical aid glossary
ICD-10 code
The international diagnosis coding standard used on every South African medical claim. The ICD-10 code tells the scheme what condition was treated, and it is what determines whether a claim is assessed as a Prescribed Minimum Benefit. An incorrect or missing ICD-10 code is one of the most common causes of a rejected claim.
Where you will see this term
Terms like this appear on claims statements, remittance advices, authorisation letters and scheme rules. Understanding the exact wording your scheme used is usually the first step in working out whether a rejected or short-paid claim can be disputed.
Related terms
Claim review
Not sure what your scheme's wording means for your claim?
Send us the rejection letter, the itemised account and the clinical notes. We translate the scheme's reasoning into plain English and tell you whether the decision stands up against its own rules and the Prescribed Minimum Benefit regulations.
Start a claim reviewLandlodz (Pty) Ltd, trading as ClaimIQ SA
Registration No.: 2024/615543/07
ClaimIQ is a product of Landlodz (Pty) Ltd (Reg. No. 2024/615543/07).
Contact: info@claimiq.tech
ClaimIQ SA is an independent medical aid claim review and dispute service. We are not a medical scheme, a broker or a financial services provider.