Psemas: Registered suppliers’ claims rejected
Henriette Lamprecht
WINDHOEK
Thousands of members of the Public Service Employee Medical Aid Scheme (Psemas), the state's medical aid fund, could be seriously affected by the rejection of claims from healthcare providers since 1 May.
According to the Namibia Private Practitioners Forum (NPPF), approximately 360 000 Psemas benificiaries and more than a thousand suppliers could be affected.
Speaking on behalf of the NPPF, Eben de Klerk said according to reports received by the forum’s members, a significant portion of suppliers – “if not the majority” – is currently affected by claims rejected by the fund’s administrator, Methealth.
This despite the fact that these suppliers fully comply with Psemas requirements.
"We received complaints from service providers that their Psemas claims have been rejected because they were allegedly removed as registered providers at Methealth without any notice. This despite their documents being up to date,” De Klerk said.
Written guarantee
The NPPF is now insisting on a written guarantee – by this Friday – from both Psemas and Methealth that all health service providers registered on 30 April will have their claims paid out for services provided since 1 May.
Methealth has, however, informed the forum that it cannot give a guarantee of payment because that does not fall within its mandate.
"We accept this because it seems that the problem lies with Psemas. Methealth is fully dependent on both data and payment from Psemas, ” De Klerk said.
Meanwhile, De Klerk said the situation “exposes service providers and Psemas beneficiaries to unsustainable financial risks”.
"Suppliers run the risk of millions of dollars in damage should claims for several months be rejected," he said.
The only way to manage this risk in the absence of a guarantee of payment is not to provide services to Psemas members, he added.
Virtual meeting
In response to service providers’ complaints, finance ministry executive director Ericah Shafudah promised to respond in writing by Friday.
She also undertook to have a virtual meeting with De Klerk today as "partners in Psemas" to "thoroughly discuss" the refusal of claims as well as any other complaints by service providers.
However, according to De Klerk, the planned meeting – which would also be attended by Methealth – had not been confirmed by yesterday. Shafudah also did not respond to questions by the time of going to press.
– [email protected]
WINDHOEK
Thousands of members of the Public Service Employee Medical Aid Scheme (Psemas), the state's medical aid fund, could be seriously affected by the rejection of claims from healthcare providers since 1 May.
According to the Namibia Private Practitioners Forum (NPPF), approximately 360 000 Psemas benificiaries and more than a thousand suppliers could be affected.
Speaking on behalf of the NPPF, Eben de Klerk said according to reports received by the forum’s members, a significant portion of suppliers – “if not the majority” – is currently affected by claims rejected by the fund’s administrator, Methealth.
This despite the fact that these suppliers fully comply with Psemas requirements.
"We received complaints from service providers that their Psemas claims have been rejected because they were allegedly removed as registered providers at Methealth without any notice. This despite their documents being up to date,” De Klerk said.
Written guarantee
The NPPF is now insisting on a written guarantee – by this Friday – from both Psemas and Methealth that all health service providers registered on 30 April will have their claims paid out for services provided since 1 May.
Methealth has, however, informed the forum that it cannot give a guarantee of payment because that does not fall within its mandate.
"We accept this because it seems that the problem lies with Psemas. Methealth is fully dependent on both data and payment from Psemas, ” De Klerk said.
Meanwhile, De Klerk said the situation “exposes service providers and Psemas beneficiaries to unsustainable financial risks”.
"Suppliers run the risk of millions of dollars in damage should claims for several months be rejected," he said.
The only way to manage this risk in the absence of a guarantee of payment is not to provide services to Psemas members, he added.
Virtual meeting
In response to service providers’ complaints, finance ministry executive director Ericah Shafudah promised to respond in writing by Friday.
She also undertook to have a virtual meeting with De Klerk today as "partners in Psemas" to "thoroughly discuss" the refusal of claims as well as any other complaints by service providers.
However, according to De Klerk, the planned meeting – which would also be attended by Methealth – had not been confirmed by yesterday. Shafudah also did not respond to questions by the time of going to press.
– [email protected]
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