2019-04-28 PossibleHealth-GIZ Nepal meeting

Date

28 Apr 2019

Participants

• laxman manandhar

• Dipak Thapa

• Purushottam Sapkota

• Members from Nepal insurance board

Discussion points

• Insurance policies or schemes

  • old age scheme

  • family insurance scheme

  • Old people can use benefit of both above schemes

• Packages

  • OPD package : 200
    registration
    Haemoglobin
    Valid upto 7 days
    Followup visit should not be claimed

  • ER package : 400

  • IPD package
    Diagnosis based package : Pneumonia : 8000, criteria : 48 hrs admitted
    Surgery package : 18000 : stay, medicine, labs
    Per day stay: General hospital: 2000 , If not 48 hrs criteria not met

  • ICU per day : 3000

  • IPD and ICU can be combined

• Renewed cases : time and balance updated

• Insurance claim location
  single government hospitals : First service point
  If not in first service point then in others cant be claimed unless referred

• Dose assessment changes
  if changed dosage then need to adjust previous claims
  Refill dates within prescribed time period

• Free packages/ medicines : location wise

  • Needs to be claimed with amount 0

• PHC and hospital : price differences (Bedded categories )

  • Different bedded systems can have different drugs prices, free and caps

• Private hospital can claims as well in case of referenced case

  • Hospital can claim only government rates

• Monthly reimbursement till now unless some problems in evidence document

• If used two schemes :
  old age and family have two ids then it may have complexities like previous id and changing id next visit
  All family members have same insurance id ?

• claim code numbers list to be provided during claiming
  organisation wise ids : prefix claim codes to be provided which can be incremented within range
  claimcode should include all the IPD charges

• Extra claims can be done for USG, CT scan

• RST codes for resubmission

  • R : resubmit

  • S : second

  • T : Third

• Yearly changes in prices/schemes

Action items

• Nepal based list of medical items and services with details codes, rates etc. Purushottam Sapkota
• Claim code numbers format and auto generation information Purushottam Sapkota
• Information about the insurance schemes packages, caps etc. Purushottam Sapkota
• List including the cost differences for PHC and Hospitals (#Bedded categories) Purushottam Sapkota

Decisions