Claims Processing

Due to an error in the software administered by NCS Pte Ltd., about 7,700 individuals received inaccurate healthcare and intermediate and long term subsidies, said the Ministry of Health (MOH) on Feb. 16, 2019. The individuals affected were those who had their Community Health Assist Scheme (CHAS) card applications and renewals processed from Sept. 18 to Oct. 10, 2018. CHAS enables Singapore citizens from lower to middle-income households and all Pioneers* to receive subsidies for medical and dental care at participating GP and dental clinics near their home. Specifically, the error occurred in the computer system when it calculated means test results. MOH said it is working with healthcare service providers and scheme administrators to reach out to the affected individuals. About 1,300 of them who received lower subsidies will have the difference reimbursed to them and another 6,400 individuals received higher subsidies due to the error. However, they do need to return the additional subsidises disbursed. The means-test system calculates the healthcare subsidies which individuals are eligible for, based on their income information. Timeline of key events (as stated by MOH and NCS) Sept. 24, 2018 : First means test discrepancy was detected by CHAS processing team and incident reported to NCS. Oct. 10, 2018 : Software version issue detected was fixed. Oct. 10 to Nov. 29, 2018 : 5 more cases of inaccurate means-test results were detected, NCS applications support team investigated since Sept. 24 but could not pinpoint the root cause. MOH was informed. Nov. 29 - Dec. 5, 2018 : MOH and NCS worked together to assess the impact to individuals and the extent of impact was assessed to be thousands of individuals, and scheme beside CHAS. Jan. 14, 2019 : Correct subsidy tiers for each scheme were generated and provided to MOH. Jan. 18, 2019 : Measures were implemented to contain impact on non-CHAs schemes. Feb. 10, 2019 : Number of unique individuals affected all schemes were determined. Feb. 16, 2019 : Subsidy tiers of affected individuals were fully corrected and affected individuals were to be progressively informed. Reimbursements to commence. MOH expects all the affected individuals to be informed by mid-March 2019. Just last month, MOH announced that the confidential data of 14,200 individuals with HIV were illegally leaked online and the information is in the possession of American Mikhy K Farrera Brochez, who used to reside in Singapore. A police report was made and investigations are still pending. *The ‘Pioneer Generation’ is defined as living Singaporeans who meet 2 criteria: i. Aged 16 and above in 1965 (born on or before 31 Dec 1949, which also means they are aged 65 and above in 2014); and ii. Obtained citizenship on or before 31 Dec 1986.

The new Claims Lifecycle Artificial Intelligence works with Change's Intelligent Healthcare Network to improve the revenue cycle, the company says.

The Maryland insurer is already involved in a lawsuit stemming from a 2014 breach of about 1.1 million members.

The retooled Intelligent Healthcare Network platform allows for improved transparency and efficiency of claims management.

The biggest electronic health record company made plenty of big news this past year, beginning with the scoop that it would develop new technology aimed at smaller hospitals.

As the department work to finalize its EHR modernization contract with Cerner, it extends a smaller deal for centralized claims management.

Some would pay as much as $1,000 for genomic sequencing offered through employer health plans.

Emerging technologies will start to gain some firmer footing in the year ahead, moving out of pilot testing and into production environments.

As genomic tests and therapies advance, proliferate and get easier to administer, the group wants payers to be more transparent about how providers can bill for them.

Better is among a new breed of start-ups trying to lead customers through the labyrinth of medical billing with a single app to submit claims.