Approved the list of companies, rehabilitation of health insurance claims management, adopted by the Minister of Health, the conclusion of an insurance policy covering risks in respect of professional negligence and negligent and wrong so that the insurance cover of at least one million riyals.
The regulations in 9 chapters contain general definitions of terms used in the regulation and the conditions that must be provided by management companies for the rehabilitation of health insurance claims and exercise of the functions and controls the work of the Department of health insurance claims, and organize all the relations between the parties to the relationship specified in Article I and the sanctions and the dispute settlement mechanism to oversee the claims management companies, health insurance.
The statute to be a fine of not applying at the time of the renewal of rehabilitation than 30 days from the date of expiry of the previous amount of rehabilitation 25 thousand riyals and rehabilitation will be stopped after 60 days from the date of expiry of the previous qualification without having to apply to renew rehabilitation. No less fine in the case of a renewal application after the Rehabilitation Council resolution to halt the rehabilitation, from 25 thousand riyals and not more than 90 thousand riyals, according to the President of the Council in the light of the circumstances leading up to stop the rehabilitation. Does not affect the decision to stop training on the obligations of the company. And doubled the fine owed by the company by 100% if the period of 30 days from the date of signing without penalty paid by the company.
The regulation on the management company that claims to provide health insurance to the insurance company and the service provider all the data required for the completion of claims and the settlement of receivables, and if the management company to provide health insurance claims are reasonable grounds to doubt the validity of this information to the company that can bring the matter to the Board for verification. And be responsible for claims management company health insurance in the event that one of its employees of fraud, abuse or fraud in the exercise of its functions.
And provided a list of items that may not be a management company for health insurance claims U marketing and sale of health insurance, as must the company and the conclusion of the health insurance with health insurance companies eligible for the insurance coverage set forth in the document management company to employees of health insurance claims . The other article stated that the doctors recruited to work for insurance claims management companies health professional independence in their views and are subject only to the medical requirements of the tasks engaged in the control, no right to interfere in the medical treatment, or treatment of beneficiaries. And obliges the regulation of both the service provider and the beneficiary and the insurance company providing medical management company working in the health insurance claims with all information requested and to put at their disposal all the necessary documents to carry out surveillance in accordance with the provisions of Article (34) of these Regulations,
The Secretary-General of the Council of health insurance, Dr. Abdullah bin Ibrahim Al-Sharif (the city) that the start of the Council's role to ensure the rehabilitation of the companies after checking the availability and the completion of the required conditions and consequently the process of supervision and control of claims management companies have to the health insurance system, health insurance and its collaborative operational and to ensure that these companies, as well as parties to the relationship of health insurance implementation of tasks and responsibilities entrusted to them under the regulations adopted.
One of the functions of the claims management companies to do work on health insurance claims and the study of examination of claims that arise on the occurrence and the consequent payment of compensation to the holder of the document from the insurance company and the management of medical programs from health insurance companies with the service provider and are subject to the cooperative health insurance system as a minimum as well as estimating the cost of compensation arising from the emergency service outside the network compared to the value of the actual cost of the health service provided within the network, whether inside or outside Saudi Arabia and to the work of the financial settlements of the claims received and received between the relevant authorities.
The regulations in 9 chapters contain general definitions of terms used in the regulation and the conditions that must be provided by management companies for the rehabilitation of health insurance claims and exercise of the functions and controls the work of the Department of health insurance claims, and organize all the relations between the parties to the relationship specified in Article I and the sanctions and the dispute settlement mechanism to oversee the claims management companies, health insurance.
The statute to be a fine of not applying at the time of the renewal of rehabilitation than 30 days from the date of expiry of the previous amount of rehabilitation 25 thousand riyals and rehabilitation will be stopped after 60 days from the date of expiry of the previous qualification without having to apply to renew rehabilitation. No less fine in the case of a renewal application after the Rehabilitation Council resolution to halt the rehabilitation, from 25 thousand riyals and not more than 90 thousand riyals, according to the President of the Council in the light of the circumstances leading up to stop the rehabilitation. Does not affect the decision to stop training on the obligations of the company. And doubled the fine owed by the company by 100% if the period of 30 days from the date of signing without penalty paid by the company.
The regulation on the management company that claims to provide health insurance to the insurance company and the service provider all the data required for the completion of claims and the settlement of receivables, and if the management company to provide health insurance claims are reasonable grounds to doubt the validity of this information to the company that can bring the matter to the Board for verification. And be responsible for claims management company health insurance in the event that one of its employees of fraud, abuse or fraud in the exercise of its functions.
And provided a list of items that may not be a management company for health insurance claims U marketing and sale of health insurance, as must the company and the conclusion of the health insurance with health insurance companies eligible for the insurance coverage set forth in the document management company to employees of health insurance claims . The other article stated that the doctors recruited to work for insurance claims management companies health professional independence in their views and are subject only to the medical requirements of the tasks engaged in the control, no right to interfere in the medical treatment, or treatment of beneficiaries. And obliges the regulation of both the service provider and the beneficiary and the insurance company providing medical management company working in the health insurance claims with all information requested and to put at their disposal all the necessary documents to carry out surveillance in accordance with the provisions of Article (34) of these Regulations,
The Secretary-General of the Council of health insurance, Dr. Abdullah bin Ibrahim Al-Sharif (the city) that the start of the Council's role to ensure the rehabilitation of the companies after checking the availability and the completion of the required conditions and consequently the process of supervision and control of claims management companies have to the health insurance system, health insurance and its collaborative operational and to ensure that these companies, as well as parties to the relationship of health insurance implementation of tasks and responsibilities entrusted to them under the regulations adopted.
One of the functions of the claims management companies to do work on health insurance claims and the study of examination of claims that arise on the occurrence and the consequent payment of compensation to the holder of the document from the insurance company and the management of medical programs from health insurance companies with the service provider and are subject to the cooperative health insurance system as a minimum as well as estimating the cost of compensation arising from the emergency service outside the network compared to the value of the actual cost of the health service provided within the network, whether inside or outside Saudi Arabia and to the work of the financial settlements of the claims received and received between the relevant authorities.
Tidak ada komentar:
Posting Komentar