In the up-coming Bhela meeting on October 30, we will talk about a feature in the health insurance context, the pre-authorization of claims before health care services are carried out. By obtaining a pre-authorization from the health insurance, both health care provider and patient know in advance how much of a specific procedure will be covered by the health insurance. This is especially relevant for high-cost and individualized procedures which have a risk of substantial co-payments. Pre-authorizations must be managed efficiently to avoid delays in carrying out the health care services and reduce administrative overheads. This is exactly where openIMIS comes in.
In the context of the KADCHMA scheme in Nigeria, the openIMIS implementation for the Kaduna State Health Insurance, respective functionality has been developed by 2M Corp which allows for pre-authorization of claims and also to manage the referral of patients from one facility to a higher-level facility. This feature has been sought by many implementations as they envision their schemes introducing such requirements soon. Therefore, we would like to invite to an exchange on experiences from any on-going implementation projects.
Prof. Jens Geissler / FOM University in Hamburg, Germany, will facilitate the discussion. In his input, he will explain the benefits and possible challenges of pre-authorization from the perspective of health insurance, health care provider and patient. He will also show criteria for which types of procedures pre-authorization is relevant, and a generic business process for the management of pre-authorizations.
Yolande Goswell / 2M Corp will introduce their work for KADCHMA in Nigeria.
Resources:
Idea: Claims pre-authorisation - openIMIS - openIMIS Wiki (atlassian.net)
Nigeria - openIMIS - openIMIS Wiki (atlassian.net) + Nigeria / Implementation Details - openIMIS - openIMIS Wiki (atlassian.net)
Yolande Margaret Goswell, 2M Corp –openIMIS implementation in Kaduna State, Nigeria (youtube.com)
Co-ordinates
Date: 30.10.2024
Time: 10.00 AM Central European Time (CET)
Room: https://meet.jit.si/openIMISImplementers - (jitsi claims to support Chrome, Chromium & MS Edge and Firefox browsers only. You might also want to try the jitsi app)
Participants: (kindly only add yourself, not others):
Schedule
When (CEST) | Duration | Who | Topic Slides (PDF) & Link to recording |
|---|---|---|---|
10.00 | 15 Min | openIMIS Coordination Desk / Jens Geißler | Introduction |
10.12 | 15-20 Min | Yolande Goswell / 2M Corp + …. Represantative KADCHMA scheme (tbc) | Presentation: Recording: |
10.40 | 15 Min | All | Q&A, Discussion |
10.55 | 5 Min | openIMIS Coordination Desk / Jens Geißler | Wrap-up & outlook on upcoming Bhela topics |
Q&A
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Summary
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