Kathmandu. The Health Insurance Board has further clarified the work of claim management.
Issuing a letter to all the service providers and health institutions associated with the health insurance program, the Insurance Board has further clarified about the claim management work. “Letters have already been sent in the past to make the claim management work of the Insurance Board more scientific and effective,” reads the letter. ’
Now, the Insurance Board has directed the health institutions providing the service to process the claim accordingly.
Clarity on claims management
In the Insurance Management Information System (IMIS) of the Health Insurance Board, the health institutions providing the service should mandatorily mention the IPD in the column of OPD/IPD in the care type in the case of referral/emergency/OPD admission.
If you have to take service from the OPD, there will not be a different claim code for the OPD service on the same day, so provide the service by keeping the OPD in the same claim code.
In case of OPD service and emergency services on the same day, and in case of emergency services on the same day, different claim codes can be made.
If a child is born within the period of the insured membership, the child should be provided with the necessary documents using the mother’s claim code for the period of the insured membership, and in the case of providing the service only to the child, the necessary documents of the child should be provided by using the claim code from the mother’s insurance number and the necessary explanation should be mentioned in the IMIS system.
