NHIA Cautions Service Providers Over Illegitimate Claims

The National Health Insurance Authority (NHIA) has expressed concern that some Service providers in both public and private health institutions continued to accept invalid and inactive membership cards and process claims for reimbursement.

Some of them have also resorted to referring basic laboratory requests which were supposed to be done at their facilities to ‘stand-alone’ laboratories that went beyond their limit to render services they have not been accredited to render.

These were being done against numerous measures put in place by the management of the Authority to ensure that only legitimate clients were served by the various service providers to improve efficiency.

Ms Abena Asiaw Donkor, Senior Claims Processing Officer of NHIA, who made the observation during a stakeholder engagement in Cape Coast, said such practices were having a toll on the finances of the Scheme.

The meeting which was on the theme “Ensuring the sustainability of National Health Insurance Scheme (NHIS), the role of stakeholders” offered an opportunity to the Cape Coast District office of the Scheme to take stock of its operation in the year under review.

The stakeholders included owners and managers of health facilities that were registered with the NHIS as service providers, health personnel in-charges of Community Health and Planning Services (CHPS) compounds, traditional leaders and the media.

Ms Donkor encouraged the service providers to ensure that officers who worked on their claims were well trained.

She also advised them to establish small sub-committees within their facilities to go through the claims before sending them to the Claims Processing Centre (CPC) for processing.

In this vain, she said simple errors that were often detected at the CPC would be taken care of and ensure that the claims were worked on time for payment to be done promptly.

Ms Donkor pointed out that the sustainability of the NHIS was a collective responsibility of all stakeholders and urged all to collaborate to ensure that only legitimate claims were processed and submitted for payment.

Mr. Francis Oti-Frimpong, Central Regional Director of the NHIA, said the over 3,500 and 330 accredited service providers of the Scheme respectively across the nation and the Region, clearly showed how enthused people were to come on board.

He said the NHIS was doing creditably well in relation to its main objective of granting financial access to its large subscriber base.

This, he said was as a result of effective structures that have been put in place but indicated that more effective stakeholder collaborations were needed to make the Scheme financially and institutionally sustainable.

Mr William Braku, Cape Coast District Manager of the NHIS, said the District could boast of more than 88,800 active members as at October this year.

He said although the Scheme encountered numerous challenges of delayed and irregular payment of claims to service providers, with innovative initiatives by management and commitments from Government, arrears were being cleared to the excitement of providers.

He added that measure had been instituted to ensure sustainable and regular reimbursement to its cherished service providers while steps were being taken to eliminate fictitious claims.

Source: GNA