For nursing and home-based care
Billing and medical-aid claims for nursing practices
NetPractice submits nursing and home-based care claims to South African medical schemes in real time, using the 88-prefixed five-digit tariff codes nursing and home-based care actually bills — so a procedure printed as 303 on your schedule goes out as 88303, not 0303. The accepted or rejected outcome comes back in seconds, so a coding rejection is a two-minute fix on the day rather than a surprise at month-end.
The code-form trap
Nursing is the one case where the discipline number itself is a decision. Registered nurses bill under 88 and home-based nursing care under 80, and a claim submitted under the wrong one is rejected regardless of how correct everything else on it is.
South African tariff codes come in two billed forms, and which one applies depends on your discipline. Medical specialists bill the bare four-digit code — a GP bills 0190 as 0190. Allied and paramedical disciplines bill their BHF discipline number followed by the three-digit procedure. Nursing and home-based care is discipline 88:
| Discipline | BHF number | Billed code form |
|---|---|---|
| Occupational therapy | 66 | 66nnn |
| Podiatry | 68 | 68nnn |
| Physiotherapy | 72 | 72nnn |
| Audiology | 82 | 82nnn |
| Dietetics | 84 | 84nnn |
| Psychology | 86 | 86nnn |
| Nursing and home-based care | 88 | 88nnn |
| Biokinetics | 91 | 91nnn |
This is invisible on a tariff schedule, because the schedule prints the short procedure number and leaves the form to you. It is the most common structural coding error in allied practices, and it does not fail politely: codes come back unknown or priced at zero across the board rather than case by case. If that is what your rejections look like, check the form before you check anything else.
Each scheme’s own tariff schedule is the authority on its rates and codes. Where a scheme’s schedule disagrees with anything here, follow the schedule. Clinical technology is deliberately absent from the table above: its numbering is not consistent between schemes, so no single pattern would be correct.
What a nursing practice gets
- Registered nursing at 88 and home-based nursing care at 80, billed separately.
- Visit and hour-based care, commonly requiring authorisation up front.
- Longer episodes of care, where authorisation runs out before the care does.
- Wound care and dispensed materials, which carry product codes rather than procedure codes.
Plus everything every practice gets: real-time claim submission with the scheme’s verdict in seconds, invoices and monthly statements, patients and visits, clinical notes, and reports on aged debtors, daily collections and turnover.
Two things worth reading next if claims are the problem: why medical aid claims get rejected and how to read a remittance advice, which is where short-paid nursing and home-based care lines usually show up first.
Nursing and home-based care billing questions
What is the difference between discipline 88 and 80 for nursing claims?
Registered nurses bill under discipline 88; home-based and home nursing care bills under 80. They are different disciplines to the scheme, so a claim under the wrong number will not pay whatever else is right about it.
Does home-based nursing care need authorisation?
Usually, and it is commonly granted for a set number of visits or hours. The recurring problem is care continuing past the authorised amount, so track what has been used rather than what was approved.
Do nursing and home-based care claims need an ICD-10 diagnosis code?
Yes. Every claim to a South African medical scheme needs a valid ICD-10 code, coded to the most specific level the record supports. For an injury the scheme also expects an external-cause code, and that cause code has to be a billable five-character code rather than a category heading.
What does billing software cost for a nursing practice?
On NetPractice it is R9.50 per claim with the first 10 claims each month free, and no monthly fee or contract. A practice submitting 200 claims a month pays R1,805.
Start with 10 free claims
R9.50 a claim after your first 10 each month, no monthly fee and no contract. Set up within 24 hours.