The National Health Insurance Scheme’s (NHIS) Claims Processing Centre (CPC) in Accra saved the country about GH¢110 million in claims payment last year.
The savings were made by the CPC following its detection of double entries, human errors, wrong diagnosis or wrong medication on the part of service providers
The Director of Claims of the NHIS, Dr Lydia Dsane Selby, made this known when a team of media personnel visited the CPC to acquaint themselves with how the centre operates. The CPC in Accra serves providers from the Greater Accra, Volta and Eastern regions. Dr Selby said the NHIA spent about 80 per cent of its income on paying claims.
She said because claim processing was mainly manual, it took 60 days to process monthly claims from service providers. She said, only 12 per cent of the claim processing was electronic based and called for the whole process to be made fully electronic across the country to help eliminate the dubious claims.
Clean Claims
Dr Selby said although some providers were able to send their claims without any problems to the scheme, others had devised dubious tactics through which they try to “milk” the system.
She said if all claims were “clean”, it would be quick to facilitate payments. However, Dr Selby said due to the nefarious activities of some providers, the scheme went through over 30,000 claims in a month to ensure that errors were minimised to the barest minimum. “Health insurance fraud is big business in many developed countries as the chances of being caught are slim”, she said.
Deliberate Errors
Dr Selby enumerated some of the common “deliberate” errors that providers made on their claim forms to include “no diagnosis, no bio-data, wrong tariffs and fashionable diagnosis. She said every pesewa counted for the tax payer and, therefore, the service would ensure that it scrutinised every claim presented to it. The journalists visited the Fulfilment, Vetting, Data Entry and E-Claims departments.
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