The National Health Insurance Scheme in the Sunyani Municipality has organized stakeholders meeting with a call on healthcare providers to ensure that the claims they submit to the scheme are clear, specific and submitted on time to avoid claims deduction and late payment. The Acting Deputy Director of the Claims Processing Centre in Kumasi, Isaac Gideon Akonde made the call at the stakeholders meeting in Sunyani. According to Mr. Akonde, the NHIS Claims Processing Centre (CPC) is usually confronted with challenges during processing of claims such as doubled cost, misapplication of tariffs, subscriber duplication, over billing and over prescription of medicines. He said inappropriate filling of claim forms such as illegible handwriting, unclear diagnostic, use of abbreviations and alteration on claim forms as some of the practices that can lead to claim deductions. Mr. Akonde who was delivering a paper on, â€œmajor reasons that account for claims adjustmentâ€, said when filling the claims the specific problems people bring for treatment must be stated and not generalized as this leads to claim deductions. Again, there must be diagnostic evidence in order to prescribe the specific medicines to enhance claims. He urged healthcare providers to check and authenticate the validity of clientsâ€™ cards to ensure claims are raised for active card holders. The Sunyani Municipal Manager of the NHIS, Patrick Koku Kuagbenu outlined some challenges the scheme is facing such as rising cost of claims, prescription forms not bearing names of prescribers, operating without key health professionalâ€™s thereby compromising quality of care and non-display of credential documents at facilities. Mr. Kuagbenu took the stakeholders through information the Scheme requires from the healthcare providers and advised doctors and medical assistants not to stamp prescription forms and leave them lying around as people could use them without their knowledge and incur cost for the scheme.
Source: Biiya Mukusah Ali/newspaper.developghana.com