PMB claim payment

Good Day <br> <br> The Dr completes the PMB app form, an amended form is submitted. Numerous calls email requests to have claims reprocessed, various excuses various delays no resolution. <br> <br> The patient presents with a # of the right clavicle. The patient is taken to Milnerton Medi Clinic for first treatment. Xray reports sent to the Scheme. You say the ER unit needs to complete a PMB app form??? since when? They are not responsible for the management of the #. Thus the orthopaedic surgeon completes the form. The POP's sent the claims sent yet no resolution. Stupid responses complete avoidance of resolving this query dating from November 2015. <br> <br> I ask why. This is a PMB condition and the member needs to be reimbursed for the claims paid. <br> <br> We need this resolved asap and complete resolution or we would need to revert to laying a complaint with CMS