PROFILE OF HEALTH INSURANCE UNIT – KATH

The Health Insurance Unit is under the Finance Department of the Hospital. It was set up in 2005 to facilitate the implementation of the NHIS, process NHIS claims and also ensure that revenue from NHIS is duly collected on behalf of the hospital. 

We operate in two offices; main office at the Polyclinic and the annex at the A & E Disaster block.

The transition from manual processing of claims to an electronic one is almost complete. The hospital is currently running two software applications, the Health Administration and Management system (HAMS) and the Lightwave Health information management system (LHIMS) to aid in the processing and submission of all Outpatients (OPD) and Inpatients (IPD) claims. With the implementation of the new software (LHIMS) on 1st January, 2019, the hospital hopes to fully migrate from the HAMS to the LHIMS by the end of the year.

Meanwhile, the in-patient claims is currently submitted manually to the NHIA Claims Processing Center (CPC). However, there is the intent of migrating the processing of in-patient claims electronically using the LHIMS by the end of the year. 

The work schedule of staff is based on directorate level of which we have sub-units. For example, we have Surgery Directorate, Obstetrics and Gynecology, Child Health, Medicine, Oncology, Family Medicine, Trauma and Orthopaedics, Emergency Medicine, ENT and Eye etc. the diagram below depicts the unit/sub-units and their services.

MANAGEMENT TEAM MEMBERS

This is the Health Insurance Unit Management Team Members. It is made up of the Head of the Unit, the Accountant, the In-patient Head, the Family Medicine Head, the Tertiary Out-Patient Heads and the Head of Complaints and Quality Assurance

KEY FUNCTIONS

The key functions of the Unit are outlined as follows:

  • Staff education
  • Daily collection of data on health insurance from service points
  • Out-patient claims processing and vetting of in-patient claims
  • Claims submission
  • Reconciliation
  • Preparation of Directorate report
  • Preparation of the unit budget
  • Interactions with the directorate management team members on arising issues

Other priority activities of the Unit includes timely submission of claims, reducing rate of claims rejections, training of staff on documentation, organizing training on the NHIS tariff for staffs and daily collection of insurance data from service points including consulting rooms .

BREAKDOWN OF CURRENT STAFF STRENGTH

The Unit is made up of Administrative Managers, Accounting Staffs, Pharmacy Technicians and Secretaries.

NUMBER OF STAFF

RANK

1

DEP. CHIEF ADMINISTATIVE MANAGER

1

ACCOUNTANT

7

PRIN, ADMINISTATIVE MANAGER

1

SNR. ADMINISTATIVE MANAGER

4

PRIN. ACCOUNTS OFFICER

2

PRIN. FINANCE OFFICER

1

PRIN. EXECUTIVE OFFICER

1

PRIVATE SECRETARY

1

SNR. RECEPTIONIST

1

STENOGRAPHER SECRETARY

1

SNR. PHARMACY TECHNICIAN

21

 

Table 1 Current Staff Strength and Rank

 

CONTACT ADDRESS

Health Insurance Unit

Komfo Anokye Teaching Hospital

Kumasi

03220 – 22301-4 ext 1109

Email: KathInsurance@Kathhsp.org

UNIT WORKING HOURS

Our offices are opened Mondays to Fridays from 0800hrs – 1700hrs

 PARTNER ORGANIZATION

National Health Insurance Authority: www.nhis.gov.gh

Premier health insurance:   www.premierm  utualhealth.com

Nationwide mutual healthcare: www.nationwidemh.com

Acacia health insurance:  

Apex Mutual Health:  www.apexmutualhealth.com