MEDISHARE
MEDISHARE Medical Providers Newsletter
November 2014
Crash Response and Claims Management Process
When a crash occurs, it is expected to be reported to the MVA Fund Call Centre (0819682). The Call Centre team promptly dispatch the nearest police and ambulance service to the crash scene. The injured persons are triaged, stabilized and then transported to the nearest health facility based on sustained injuries. Upon arrival at the hospital, the receiving doctor decides on admission or referral of the injured person to another facility. In case of referral, the doctor in consultation with the Case Coordinators at the Call Centre will arrange an inter-hospital transfer with a referral letter. The MVA Fund Case Management team ensures that persons injured receive quality care in the hospital. In addition, the Case Managers issue a purchase order to the respective hospital and the treating team. The treating medical providers must provide a discharge report to the Fund. Whilst in hospital, injured persons should complete the MVA Fund Claim Form 1, based on future medical treatment advice from the doctor. In lodging a claim with the MVA Fund, the following documents are required for submission:
Injured person • ID/ Passport/ Namibian Voter’s card and/ or a birth certificate if claimant is a minor • Bank statement • Poll 66 • Claimant statement from NAMPOL • Driver’s license (where applicable) • Medical reports including X-rays (where applicable) • Fully completed claim Form 1 Medical providers • Detailed invoice with purchase order number If claimant submitted a claim, the MVA Fund’s payment policy entails that all claims shall be paid within 60 days of claim submission. Remittances are distributed to the medical providers about three days after each pay run. Most importantly, medical providers should ensure that invoices are submitted to the MVA Fund within one year of the crash date, else the claim prescribes.
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MEDISHARE MVA Fund Medical Provider Management Team The Medical Provider Management Unit is responsible for the analysis of lodged medical claims and payments to medical service providers. The Unit further undertakes intelligence by gathering and analyzing claims data through appropriate and enabling technologies to identify any patterns. In short, medical claims are subjected to audits and assessments before payment is made to the service providers. The team is managed by Mr. Lebby Mbekele, Manager: Medical Provider Management, assisted by Mr Mikael Akafingo, Head: Medical Provider Management, and Ms Helen Shikongo, Head: Medical Provider Relations, as well as a Medical Assessor, Hertlinda Munkanda. Furthermore, there are three Medical Provider Management Officers (Mr Enzo Jossobs, Mr Jason Jason & Mr Thabo Uirab) and two Medical Claims Officers (Ms Elina Muronga & Ms Salome Kaulinge). Please feel free to enquire with the Medical Provider Unit: Tel.: 061 289 7000
Medical Expenses The MVA Fund has implemented a triaging system and only the treating doctor at a given hospital has the authority to refer injured persons to any other relevant health care facility. As depicted in the below figure, the total expenditure for the financial period, April to 31 October 2014 amounts to N$ 77,798,206.51 compared to a similar period in 2013 being to N$ 64,503,298.37, which indicates a 20% increase.
Mr. Lebby Mbekele Manager: Medical Provider Management
Medical Cost: April - October 2013 & 2014 14, 000,000,00 12, 000,000,00 10, 000,000,00 8, 000,000,00 6, 000,000,00 4, 000,000,00 2, 000,000,00 0,00 April
Ms. Helen Shikongo
Mr. Mikael Akafingo
Head: Medical Provider Relations
Head: Medical Provider Management
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Claimed 2013 Monthly Total Claimed 2014 Monthly Total Accepted 2013 Monthly Total Accepted 2014 Monthly Total
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September
October
MEDISHARE Treatment Latest News and Transfer Protocols of MVA Fund Patients The MVA Fund team is greatly concerned about the increase of medical costs emanating from treatment of patients. The Fund’s limited financial resources is under immense pressure thus necessitated the following protocol: 1: To manage the length of stay for MVA Fund patients at private medical facilities, similar to private medical insurers. The treatment of patients with Spinal Cord Injuries (SCI) and severe Traumatic Brain Injuries (TBI) in private facilities, will be granted authorization for fourteen (14) days only, whilst all other injuries warranting transfers, will be authorized for five (5) days. 2: Upon reaching the five (5) and fourteen (14) days respectively, and further treatment at the said facility is still medically warranted, a written motivation from the treating doctor, must be provided to the attending hospital Case Manager, upon which the purchase order (PO/authorization) will be amended for a further one to five (1-5) days depending on the situation.
3: Patients that may require an operation at private facilities will only be transferred on the said date of the procedure. The provider will be required to provide a motivation in case of a need for 2-3 days pre-operatively in a facility where the operation will be performed. Should co-morbidities be the reason for pre-operation monitoring, it will be done in the initial facility until such time a patient is stable to be transferred to the operating facility on the day of the said operation. 4: The MVA Fund will ONLY pay for generic medication if available as from the 16th September 2014 and should the trade medication be prescribed due to any medical reason, such a service provider should submit a written motivation to the attending MVA Fund Case Manager. Please do not hesitate to contact: Ms. Helen Shikongo Head: Medical Provider Relations Tel.: 061 289 7035 E-mail: helen@mvafund.com.na
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MEDISHARE Examination of Persons Injured in Road Crashes
As per standard procedures, all persons involved in vehicle crashes are subjected to a full bodily examination by medical doctors. The importance on this is that, many a times, persons involved in car crashes who may have sustained minor or no injuries are not always taken care of and this may have implications on their future medical interventions. In order to minimize the occurrences of people coming
back with medical related complications due to road crashes, we request that the treating doctors perform a thorough examination with the aim of detecting any possible injuries or any expected future injuries that the person may encounter.
Status on Medical Claims Payment
FEEDBACK
As reported during September, MVA Fund extends sincere apologies to all its medical service providers for the delayed payments. The technical challenges that made it impossible to effect payments on time has now been restored and we are working towards clearing the backlog by end November 2014. Once again, please bear with us as we exert all efforts to ensure that all outstanding invoices are settled.
We aim to improve by encouraging our stakeholders to please contact us at niita@mvafund.com.na and make suggestions on how we can streamline our processes.
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