Page 25 - C.Journal 3rd edition

Claims Journal 3rd Edition Claims Journal 3rd Edition

Claims channel Claims channel

Technical Updates Providers with issues

Reconciliation and Quality Update- New process

As a requirement of the Internal Audit department to have a provider claim physical checks and
reconciliation processes. Technical team has created a new process called “Physical Checking” to
meet this requirement.

The objectives of this new process are:

• To ensure that all requirements are properly submitted by the providers based on Bupa submis-
sion and invoicing protocol.
• To ensure that the amounts claimed by the providers in the General summary statement are cor-
rect based on the physical claims and data.
• To avoid delay in processing due to missing documents and incorrect billing.
• To inform and orient those providers who are frequently not following the protocol.
List of Providers Complied after sending communications

February 2017 Report

Since this new process has kicked off, we have checked 85 providers and identified 28 providers
which are not Bupa submission and invoicing protocol compliant, 40 compliant providers, 12 pro-
viders who complied after sending communications and 5 providers still on process.

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