National Health Insurance Authority to ensure effective claims management

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Mr Joseph Yieleh Chireh, Minister of Health said on Thursday that the National Health Insurance Authority (NHIA) has embarked upon reforms to facilitate effective claims management.

The reforms also aims at removing the waste and inefficiencies identified in the operations of the scheme.

Mr Chireh said key challenges identified in the current claims management included the lack of human and technical capacity to properly vet the large volumes of claims the NHIA receive, the manual paper based claims, vetting errors and inability of the Authority to effectively detect fraud.

He noted that the vetting process was slow resulting in delay in payment to providers, incidents of up coding, irrational prescription and abuse of the gatekeeper system through rampant undetected misapplication of funds involving claims payment at the scheme level as a result of weak financial management system.

Mr Chireh said to overcome the challenges, the NHIA has set up a claims processing centre to handle claims from secondary and tertiary hospital throughout the country.

The centre will operate through the state- of- the- art technology to ensure speedy payment of claims.

Mr Chiereh said plans were underway to decentralise the consolidated claims system to designate zones within the country.

He said strategies were being pursued rigorously by the NHIA including identification of clinical and financial audits at the scheme and accredited health facilities.

Source: GNA

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