By Kofi Ahovi
The National Health Insurance Authority (NHIA) would soon commence a nationwide operation of the electronic vetting and receipt of claims made by the scheme operators.
The format would be rolled out in zonal claims processing centres across the country.
The authority started a pilot of the process in partnership with the Mamobi Polyclinic in Accra late last year and was very successful.
The electronic receipt of claims is being introduced into the system to address corruption and abuse of the scheme by certain operators, a recent audit into the scheme, since it was introduced in 2005, revealed very serious corrupt practices.
According to the authority, the pilot project was very successful hence the implementation of the nationwide project.
To this effect, staff from all the 145 District Mutual Health Insurance Schemes in the country have been trained in the use of the new financial and operational reporting tool developed by the Authority. The new reporting format is designed to streamline and standardize the electronic recording and timely transmission of accurate data by the Schemes to the Authority for efficient planning.
It is expected to improve financial and operational discipline at the Schemes, and ensure prompt processing and payment of claims to service providers. Trends in the data would also be useful for evaluation and monitoring purposes.
Furthermore, the NHIA is implementing a common Information, Communication and Technology (ICT) platform to enhance portability, standardization, member authentication, finance and supply chain and claims administration.
A total of 870 sites have so far been hooked up, comprising all 145 district schemes, 714 provider sites and 11 NHIA sites.
The government is also reviewing the NHIL to improve efficiency and effectives of the implementation of the scheme. This is due to the stiff implementation challenges facing the authority.
A total of 13,840,198 persons have registered with the scheme, representing about 67% of the total population of the country. The scheme has also produced about 12,146,526 ID cards to 87.8% of registered members. In addition, a total of 4,500,000 ID uniform cards have been produced.
The National Health Insurance Scheme (NHIS) was established by the NHIA Act 2003 (Act 650) and the National Health Insurance Regulation 2004, (LI1809).
The National Health Insurance Authority (NHIA) would soon commence a nationwide operation of the electronic vetting and receipt of claims made by the scheme operators.
The format would be rolled out in zonal claims processing centres across the country.
The authority started a pilot of the process in partnership with the Mamobi Polyclinic in Accra late last year and was very successful.
The electronic receipt of claims is being introduced into the system to address corruption and abuse of the scheme by certain operators, a recent audit into the scheme, since it was introduced in 2005, revealed very serious corrupt practices.
According to the authority, the pilot project was very successful hence the implementation of the nationwide project.
To this effect, staff from all the 145 District Mutual Health Insurance Schemes in the country have been trained in the use of the new financial and operational reporting tool developed by the Authority. The new reporting format is designed to streamline and standardize the electronic recording and timely transmission of accurate data by the Schemes to the Authority for efficient planning.
It is expected to improve financial and operational discipline at the Schemes, and ensure prompt processing and payment of claims to service providers. Trends in the data would also be useful for evaluation and monitoring purposes.
Furthermore, the NHIA is implementing a common Information, Communication and Technology (ICT) platform to enhance portability, standardization, member authentication, finance and supply chain and claims administration.
A total of 870 sites have so far been hooked up, comprising all 145 district schemes, 714 provider sites and 11 NHIA sites.
The government is also reviewing the NHIL to improve efficiency and effectives of the implementation of the scheme. This is due to the stiff implementation challenges facing the authority.
A total of 13,840,198 persons have registered with the scheme, representing about 67% of the total population of the country. The scheme has also produced about 12,146,526 ID cards to 87.8% of registered members. In addition, a total of 4,500,000 ID uniform cards have been produced.
The National Health Insurance Scheme (NHIS) was established by the NHIA Act 2003 (Act 650) and the National Health Insurance Regulation 2004, (LI1809).
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