THE Brong Ahafo Regional Claims Manager of the National Health Insurance Scheme (NHIS), Mr James Adu-Bona, has admonished service providers to submit claims that will leave no traces of doubt or suspicion to avoid the rejection and delay for payment of bills.
“Service providers must follow due diligence since the vetting process would not spare any one who might fail to conform to laid down rules,” he said.
Mr Adu-Bona, who is also the Nkoranza Scheme Manager, gave the admonition at a day’s workshop to update the skills of officers responsible for the preparation of claims in all Health Insurance Service providing facilities in the Dormaa Municipality at Dormaa Ahenkro.
The workshop, organised by the Dormaa Municipal Mutual Health Insurance Scheme in collaboration with the Dormaa Presbyterian Hospital, was on the theme: “Effective claims administration: A tool for efficient and credible transaction”.
The workshop was also designed to prepare the participants to adequately handle information on the NHIS forms with ease and to promote minimal rejection of their claims during vetting.
Topics treated at the workshop included features on the Health Insurance Membership Identity Cards, attendance of Health Insurance Card Bearers and medicines captured under the scheme and diagnosis.
Mr Adu-Bona stated that one of the goals of the NHIS was to keep within the scope of the World Health Organisation (WHO) treatment guidelines and protocols by guiding the service providers to observe best practices.
He, therefore, appealed to billers to stick to prescriptions offered by doctors and use specific and generic names of drugs instead of lumping drugs under brand names and making them unacceptable in the approved NHIS drug list.
Mr Adu-Bona said clinical auditing had revealed that hospitals encouraged clients to go for scheduled mandatory visits even where they were not ready to do so, while clients also visited hospitals every week because the insurance covered them.
He also bemoaned the situation where clients jumped from one health facility to another even without exhausting their drugs at the previous visit.
The Dormaa Municipal Health Director, Madam Florence Iddrisah, appealed to the scheme to grant same bills for all categories of service providers to cut down on public discrimination and insinuation to staff of some of the facilities.
She urged the government to provide for recruitment of separate staff to work on claims as health workers had to spare part of their time, stressing that could make them to make mistakes.
The Municipal Health Insurance Manager, Mr Martin Amponsah, called on service providers to work hand-in-hand with the scheme to ensure its sustenance.
He advised billers to desist from engaging in any dubious practices since the vetting process was capable of identifying them with ease.