NHIS to introduce new claims system | 12/22/2016

The National Health Insurance Authority (NHIA) will, from January 2017, start implementing a new claims system dubbed: “Claim It”, for healthcare providers.


Beginning with 38 public health facilities in the Wa municipality in the Upper West Region, the system, which will be rolled out in the rest of the country gradually, is a claims submission software application developed by the NHIA to help tackle inefficiencies in claims generation, collation and storage for both providers and the NHIA.


Launching the software in Accra yesterday, the Chief Executive Officer of the NHIA, Mr Nathaniel Otoo, said the system was a claims entry software application that would allow the submission of clean and complete claims by healthcare providers to the NHIA. 



Already, the system has been piloted in 15 public health facilities, including pharmacies and diagnostic centres in the Greater Accra and Eastern regions.

The “Claim It” service will see service providers submitting their claims electronically to the NHIA.

The implementation of the system will reduce cost of generating claims and submitting them to the NHIA by service providers, as well as improve on their claims processing time.

It will also ensure a reduction in errors and inconsistencies associated with generating claims and further ensure a reduction in cost of claims storage, as well as the ability to track claims during the vetting and adjudication processes.

Mr Otoo said it would also ensure improved communication between the NHIA and health providers concerning claims generation and processing.

He said as part of the benefits of “Claim It”, the NHIA was in agreement with Pharm Access, a private company, to provide cash advance for computers and accessories for service providers who needed computers to work with.

The new system, he said, would also help the health service generate credible data on some most prevalent diseases, as well as medicine use in the country.


Claims reforms

Mr Otoo said over the years, the NHIA had tried to make the claims process efficient by establishing claims processing centres (CPCs) in Accra, Cape Coast, Kumasi and Tamale to improve efficiency in claims management.


Presently, he said, the CPCs received nearly 70 per cent of all claims generated by NHIS-accredited facilities.


He said after establishing the CPCs, the NHIA introduced electronic claims management (dubbed E-claims) for bigger health facilities such as the Korle Bu and the Komfo Anokye Teaching hospitals, the Ridge and the 37 Military hospitals, as well as some Christian health facilities and regional hospitals.

The Director General of the Ghana

Health Service (GHS), Dr Ebenezer Appiah-Denkyira, commended the NHIA for the innovation, saying it would help improve healthcare delivery in the country and also reduce over-payment to some service providers.


The Greater Accra Regional Director of Health, Dr Linda Vanotoo, who chaired the launch, called for more education on the system for service providers to ensure efficiency.


She said the system was another opportunity to deepen the relationship between the NHIA and service providers.