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NHIA Director of Claims downplays Service Providers’ nine months unpaid claims |3/9/2020


The National Health Insurance Authority (NHIA), Acting Director for Claims, has downplayed assertions that the Authority owed its  credentialed Service Providers nine months claims.

According to Mr. Nicholas Afram Osei, technically, the NHIA owed the Service Providers six months.He has accordingly advised them to follow laid down procedure in addressing their concerns.

In an exclusive interview, Mr. Nicholas Afram Osei accused some of the service providers of late submission of claims and in some cases detected falsification of claims, which often require extra vigilance in the vetting process.

He advised the Service Providers to ideally submit their claims on time for fulfillment, vetting and for prompt payments.

“There is no need for you to delay your claims. Once it is ready submit it so that it can be vetted in time for you to get your money as well.”

 “The Providers  have a period to submit their claims. So, assuming that the claim is submitted within one month, this means that from the time that the claim was submitted,  up to the time it is vetted makes the total duration roughly three  months.

  Some delay the claims and the moment they submit the next day they are on radio saying that they have submitted their claims and have not been paid.”

According to him, the NHIA is compelled to do deductions from claims submitted for payments because of some  service providers’ do not  adhere to protocols regarding tariffs and the certified medicines price list.

“It takes about one week  to work on claims report received at the Secretariat  before sending them to the Finance Directorate at the Head Office for payment.

"Generally , it takes 4weeks to 6 weeks to vet claims We do first come first serve vetting. So once the claims come in, the one that is brought in first we look at that one first." 

There may be problems with claims at fulfillment, and in that case the provider may have to return the claims, correct  them  and resubmit.”

According to Mr. Nicholas Afram Osei, the CPCs receive between 1,500,000 to 2,000,000 claims in a month nationwide He said the CPCs needed adequate Clinicians to augment their work saying, “Each CPC should have a minimum of 3 Clinicians.”He added that the Electronic Claims Infrastructure needed to  be upgraded to enhance the claims management system and make it more efficient.


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