Lemayian David

Attachment in Accounts

NATIONAL HOSPITAL INSURANCE FUND

2023 - 2023

Ensure that all payments made in accordance with financial regulations and approved budget. Oversee the management of petty cash accounts. Assist in analysis of claims and preparations of claims settlements. Process settlement claims. Assist in all matters pertaining to contributions. Verify member’s fingerprints to be captured in the system. E-claim connectivity for the members to access the facilities.

CREDIT/ INSURANCE CONTROL (NHIF AND JUBILEE)

CITY EYE HOSPITAL

2024 - 2024

Verification of NHIF/Insurance card at the department and if legible for services they are direction for registration at the front office with the outpatient forms. Triage. Filling out of the forms and medical report. Biometrics done for billing in processing claim form. Preauthorization forms sent to NHIF/Insurance for approvals. The surgical top ups and rejected cases for surgical and procedures are called by the client’s department and informed of the same. For the optical cases the optical department calls the clients directly. Inpatient (Procedures and Theatre). Clearance of clients by the use of biometrics and filling of the claim form signed. Raised e-claims are forwarded to accounts department for batching after claiming. SMART CARD BILLING PROCEDURE (JUBILEE INSURANCE). On arrival of a patient inquire for the card. Open smart and ensure the card reader and finger print reader are connected. Place the card on the reader to ascertain the patient has benefits and the insurance card is amongst the ones we take. Select outpatient or inpatient depending on type of visit. On confirming okay, ask the patient to fill the insurance form, confirm form is filled correctly and signed. Put the form in the patient’s file for the doctor to fill when seeing the patient. When the patient is leaving the doctors room they are given the already filled form and bring back to the department for billing. To run the bill: Place the card on the reader. Input the patient file no. and reconfirm as per the instructions. This will then allow for billing. On selecting the benefit description i.e. outpatient overall, Input the invoice number. Select relevant field i.e. consultation/medication/procedures/others. Input the diagnosis and amount. Confirm the amounts billed. Select save all claims and ask the patient to place their finger to authorize for payment. Confirm saved before discharging the patient. Open a visit under the slade 360 to scan all the documents and submit to the insurance. For inpatient bills admission has to be done before billing. For non-smart bills: Outpatient. Patient enquiring about their insurance. Ask the patient for the insurance card if it’s on the panel. Send an email to the insurance to confirm the validity of the card if in question (cannot see the benefits or the client has arrived without the smart card). Ask the patient to fill in the Insurance form if its valid or pay cash if otherwise. Once confirmed okay the patient can go ahead to see the doctor. Print out the email confirmation and attach to the insurance form already filled by the doctor and forward to the accounts departments after attaching the invoice from the cashier. Inpatient. Once the patient is confirmed to have inpatient cover, the patient is asked to sign on the preauthorization form. Ask the doctor to fill the medical part and fill out the cost. Scan and send the preauthorization request to the insurance for approval. On confirmation call the patient to inform them of the same. In case of a decline or co pay notify the patient of the same as well. The patient is called by the counselling team and given a surgical/procedure date. When the client arrives on the given date they sign the claim form and run the smart card. If still legible the client is cleared at the department and; Sent to the cashier for clearance. They are then sent to the clinic to proceed to theatre or procedure room. After theatre patients are sent to the department with the discharge summary which is then attached to the claim form and preauthorization form which is then submitted to the accounts department.