The Managing Director of Anambra State Health Insurance Agency, ASHIA, Dr. Simeon Onyemaechi, says that in order to reflect the current economic realities in Nigeria, the agency will increase the fee-for-service paid to its accredited healthcare providers for surgical services like Caesarean Section, among others.
He made this announcement during quarterly meeting with Chief Medical Directors and Administrators of ASHIA-accredited health providers held at the ASHIA office in Awka.
Dr. Onyemaechi further said that a new fee- for-service rate for other surgical and medical procedures will be deliberated on and circulated on their WhatsApp platform.
The ASHIA boss expressed displeasure that despite the agency operating a digitalized system that allows end-to-end users to send and receive data at the comfort of their homes, some HCPs still have not submitted up-to three months of enrollee encounter forms to the agency.
He reminded them of their service level agreement which has a clause on non-submission of enrollee encounter forms, and which states that the agency has the right to give any defaulting hospital either a fine of one hundred-thousand-naira, suspension or delisting of such hospital, depending on the magnitude of the offense.
Dr. Onyemaechi urged the defaulting HCPs to compile and submit their up-to date enrollee encounter forms on or before the 7th of May 2024 or face the consequences.
According to him, despite the increased capitation and drug expansion which was geared towards eliminating inappropriate out-of-pocket charges on ASHIA enrollees, it has come to his attention that some HCPs still charge enrollees for services and drugs already capitated.
The ASHIA MD reiterated the need for such HCPs to desist from the act or face being delisted from ASHIA, and revealed that all the increments in ASHIA services are to avoid enrollees being subjected to unnecessary out-of-pocket charges by the hospitals.
Dr Onyemaechi explained that enrollees should not pay more than ten percent for drugs, and enjoined them to refer enrollees to ASHIA pharmacies if the prescribed medicines are not available at their hospitals.
Speaking on services rendered to enrollees, the MD announced that ASHIA has produced a Standard Medical Treatment Guidelines, which will serve as guide on the right treatment process for every medical service rendered to enrollees, even as he noted that this will help reduce code denial if followed correctly.
The CMDs at the meeting appreciated the ASHIA boss for his timely and swift response to their complaints and plights, and pleaded with him to also look into the increment of fee-for-service for other residents surgical procedures.
Be the first to write a comment.