BHeC Release Latest Claim Regulations Report
The Bermuda Health Council has released the Claims Regulations Report, which represents activity between 1st April 2015 and 31st March 2016.
BHeC said, “Claims data shows that patients continue to have decreasing out-of-pocket expenses.
“The enactment of the 2012 Health Insurance [Health Service Providers and Insurers] Claims Regulations guaranteed that insured patients would not pay upfront and out-of-pocket for the insured portion of their service. This was made possible by health service providers submitting claims electronically, guaranteeing that they would be paid on time.
“Since the introduction of the Regulations in 2012, the Health Council has seen a 66% reduction in complaints and increased efficiency in claims processing.
“Additionally, there was a 30% increase in the number of health service providers submitting electronic claims and 62% of all claims were processed electronically, with the Health Insurance Department processing 81% of their claims electronically.
The Claims Regulations Summary Report 2015-16 [PDF here ]
“The 2012 Health Insurance Claims Regulations requires insurers to reimburse electronic claims within 30 days. Currently, the turnaround time is 9 days. Therefore, if a claim is submitted electronically, health service providers are being paid in 9 days or less.
“Since the regulation was enacted, the Health Council has seen a gradual increase in the number of electronic claims submitted and the number of health service providers submitting claims electronically. This year, 874,842 claims were submitted electronically with 528,081 submitted manually.
“By January 2017, the Health Council expects that all insurers will have the full capacity to begin accepting electronic claims. Pharmacies and the hospitals [KEMH, Lamb-Foggo Urgent Care Centre, MWI] continue to be the only cohort of providers that have complete capacity to submit electronic claims.”
Compliance Officer, Ian Cameron said: “The Health Council is pleased to report that insured patients no longer have to pay out of pocket for their care.
“The increase of health service providers submitting electronic claims and the number of electronic claims submitted, confirms the Health Council’s commitment to collaborating with insurers and health service providers in the best interests of the public.
“Managing claims electronically is convenient and financially efficient, ensuring that providers are paid on-time for the important and life-saving care they deliver. Furthermore, this initiative reduces insurers’ exposure to defective and fraudulent claims, while saving money on administrative costs.”
