The Health Insurance Board has issued a notice stating that all organizations must submit details through a real-time system when making claims.
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The Health Insurance Board has directed that the process of reviewing claims payments under the health insurance program be carried out through a review committee.
The health provider has been instructed to follow the claim payment process more strictly. The Health Insurance Board has issued a notice stating that all the institutions must submit details through the real-time system while making a claim.
According to the claim registration and evaluation process set out in the Health Insurance Regulations, 2080, the health provider will have to obtain the board's approval before submitting a claim.
The board has stated that the objective of this arrangement is to make the claim evaluation process scientific, transparent and effective. As mentioned in the notice, it has been stated that claims submitted by providing services without prior approval according to the prescribed criteria and process will not be payable. In addition, it has been stated that the claim payment process will be carried out only as per the decision of the Claims Expense Committee.
The Health Insurance Board has urged all the health providers to fully comply with the prevailing rules, standards and procedures. The Health Insurance Board has stated that it will not be obligated to pay claims that do not meet the criteria or that payment will be rejected.
