SAOPA Member Issue/Incident Report

Please complete all relevant sections to ensure your request is handled effectively. Kindly note that SAOPA does not have the mandate or infrastructure to facilitate individual funder claim enquires, however, we will address trends in funder and reimbursement issues where appropriate and within our mandate.
1. Member Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
SAOPA Membership Number*
O&P Centre/Practice Name:
2. Issue Category (Select One)
Type a question*

Specific Funder Related IssuesGeneral Billing and CodingMembership Benefits/Membership PlatformGeneral Assistance/Support RequestOther
3. Issue Details
3.1 Description of the issue or incident: (Please provide a concise and detailed description and timeline of the issue you are experiencing. Include any relevant dates, parties involved, and specific examples if applicable. It is suggested to use bullet points to focus thoughts and information)*
3.2 Impact of the issue: (Describe the impact of the issue or incident on you, your practice or patient)*
3.3 Steps taken so far: (Have you attempted to resolve this issue on your own? If so, please describe the actions taken, timelines and the outcomes, including reference to CMS and/or HPCSA complaints.)*
3.4 Desired outcome or support requested: (What do you hope to achieve or what specific assistance are you requesting from SAOPA?)*
3.5 What solution/s would you suggest based on own insight? (Please share any ideas or possible solutions you have in mind)*
4. Attachments
Please attach any relevant documents, correspondence, or evidence that may support your issue.(Attach files or indicate if you will send these separately via email. Please do not include any patient identifiable information in line with the POPI Act and protection of private information. It will be helpful if any attachments are referenced in point 3. Only attach most relevant information as to not obscure the important detail.)

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5. Urgency Level
It is understood that referral to the appropriate committee and investigation may result in response delays. Some issues may also require a general response to the wider SAOPA community.*

Routine/Not time sensitiveImportant (Needs attention within 10 working days)Urgent (Needsimmediate attention)
6. Additional Comments or Information:
Include any other information you feel is relevant to your submission.
Acknowledgment
By submitting this form, you acknowledge that the information provided is accurate to the best of your knowledge and that SAOPA may use the details provided to address the issue effectively.
Should be Empty:

1. Member Information

2. Issue Category (Select One)

3. Issue Details

4. Attachments

5. Urgency Level

6. Additional Comments or Information: