The National Health Insurance Authority has started training it staff on the new software on financial reporting in the various municipal and district health schemes.
The training is targeted at train Scheme Managers, Accountants, Claims Officers and Information Systems Officers of the various schemes.
The project is to ensure improvement in financial discipline at the schemes and to ensure timely release of accurate data by the schemes to the authority for efficient planning. It is also to ensure quick processing and payment of claims to service providers, effective planning and decision making.
The schemes are now required to electronically submit monthly financial reports and data to the Authority. The reports must cover reimbursement status which will be determined by total amount of claims submitted by service providers, deductions for rejected claims, claims payments received from NHIA head office and outstanding balances, if any.
The schemes are to indicate their monthly revenue status from total premium payments, processing fees, other amounts collected from subscribers, as well as subsidies, reinsurance and administrative support received from the Authority. They are also to indicate their expenditure status from the total claims paid and administrative expenses made.
Sanctions including outright dismissal of the officer would be meted out to any District Mutual Health Insurance Scheme that failed to submit its monthly financial reports and data. Poor or non-reporting of financial status of the schemes on timely basis had been the bane of the NHIS and contributed to the huge indebtedness to providers. This was because the Authority lacked accurate data on the financial status of the schemes to enable financial discipline and the timely release of accurate data to the Authority for efficient planning.
NHIA has also announced its intentions to soon roll out 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.
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 training is targeted at train Scheme Managers, Accountants, Claims Officers and Information Systems Officers of the various schemes.
The project is to ensure improvement in financial discipline at the schemes and to ensure timely release of accurate data by the schemes to the authority for efficient planning. It is also to ensure quick processing and payment of claims to service providers, effective planning and decision making.
The schemes are now required to electronically submit monthly financial reports and data to the Authority. The reports must cover reimbursement status which will be determined by total amount of claims submitted by service providers, deductions for rejected claims, claims payments received from NHIA head office and outstanding balances, if any.
The schemes are to indicate their monthly revenue status from total premium payments, processing fees, other amounts collected from subscribers, as well as subsidies, reinsurance and administrative support received from the Authority. They are also to indicate their expenditure status from the total claims paid and administrative expenses made.
Sanctions including outright dismissal of the officer would be meted out to any District Mutual Health Insurance Scheme that failed to submit its monthly financial reports and data. Poor or non-reporting of financial status of the schemes on timely basis had been the bane of the NHIS and contributed to the huge indebtedness to providers. This was because the Authority lacked accurate data on the financial status of the schemes to enable financial discipline and the timely release of accurate data to the Authority for efficient planning.
NHIA has also announced its intentions to soon roll out 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.
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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