Kathmandu. KATHMANDU: The Health Insurance Board (HIB) has issued a 7-point directive to the health providing health institutions to make the claim management process of health insurance more scientific and systematic.
The Insurance Board issued a circular in the name of all service providers in the name of health. The Insurance Board has issued these directives to systematize the claim payment that the health institutions receive in the health insurance program in recent period.
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In the Insurance Management Information System (IMIS) of the Health Insurance Board, the health institutions providing the service should clearly mention the visit type of emergency/OPD/referral while entering the claim.
In case of emergency admission, IPD must be mentioned in the column of OPD/IPD in the care type.
In case of admission from OPD, IPD must be mentioned in the column of OPD/IPD in Care Type.
While taking services from referrals, the insured department (OPD or IPD) should be clearly mentioned in the column of OPD/IPD in the care type.
Since there are no different claim codes on the same day in case of emergency OPD service, the OPD service should be provided in the same emergency claim code.
If a child is born within the period of the insured’s membership, the child should be provided the service using the mother’s claim code for the duration of the insured membership and the necessary explanation should be mentioned in the IMIS system.
According to the provisions of Clause 2 (c) and Section (3) of the Work Procedure Related to Claiming Real Time in Health Insurance, 2080, the documents related to claim entry should be uploaded in real time as per the procedure.
