Relief for patients amid systems outage at NHIF
Patients using the National Health Insurance Fund (NHIF) will continue receiving services from accredited health facilities, following an appeal from its head office not to deny them services as it seeks to restore a systems outage.
The request came on the day that hospitals started implementing guidelines by the Fund on Saturday afternoon to release patients due for discharge despite delays occasioned by a breakdown of its main transformer at NHIF Building, Nairobi.
In a letter to healthcare providers (HCPs) across the country dated September 10, the Fund’s chief executive officer, Peter Kamunyo, appealed to hospitals to follow a number of guidelines to ease admission and discharge of patients until the IT system is restored.
Discharge approval
“We guide as follows: that you collate the names and telephone numbers of all patients who were notified in the system on admission for medical management and are currently on discharge under rebate and send the list to [email protected] for conditional discharge approval,” the letter reads in part.
Also to be sent to NHIF’s department of hospital admissions are details of all enhanced scheme beneficiaries, which includes pre-admission approvals, the bills and discharge summaries for review and conditional approval.
The NHIF also appealed to HCPs to allow patients who had initial approval (LOU) for procedures/services (surgery, imaging and oncology services) to undergo the relevant services based on the approval issued.
“For enhanced schemes beneficiaries requiring admission, a staff card, medical report, vital signs, and preliminary laboratory results be sent to the [email protected] email for conditional admission approval,” Kamunyo said in the letter.
And for national scheme beneficiaries requiring inpatient admission for medical management, the NHIF wants a health facility to conduct due diligence — card status, last payment, and beneficiary declaration status — through interview and consultation of records for return patients.
Where comfort to admit is secured, the health facilities have been urged to proceed and admit, pending online notification when the system is restored.
“For emergency operations that have not been pre-approved, due diligence — card status, last payment, and beneficiary declaration status — and tenets of constitution on emergency care be employed pending procedure authorization when the system is restored,” Kamunyo directed.
Due diligence
For returning clients, the Fund wants the healthcare facility to carry out due diligence vide the patient records to establish membership to the scheme.
Kamunyo also reminded HCPs that decisions for reimbursement of accessed services should be guided by the terms and conditions of the contract in force (2022-2024). There were reports from various hospitals on patients being stranded following the electrical fault.
At the Kenyatta National Hospital (KNH) and other health facilities in Nairobi, patients were reported to have been stranded for more than 24 hours before the generator kicked in, collapsing the base operating system called ‘red dot’.
It was also reported that health facilities were not able to access payment services to NHIF. This also affected mobile payment services since members could not make their monthly contributions, leading to an online uproar from the public.
On Saturday, following the Friday night fault on the transformer at the Fund’s head office, NHIF notified all its members of the disruption, posting a notice on all its social media handles, and called for calm among members.
“Nhif wishes to apologise to members for the unforeseen disruption of services due to a critical power fault occasioned by a faulty transformer. The Fund notes with deep concern the distress members are facing due to the power outage that has caused system downtime since yesterday mid-morning (September 9, 2022),”
“Nhif thus wishes to assure members that the technical team is working tirelessly to restore the services to normalcy. In the meantime, the public is notified that alternative manual processes have been implemented to ensure uninterrupted services while seeking treatment in hospitals,” the notice read in part.
“We apologise to our members for the inconvenience caused,” it said further providing a Call Toll Free: 0800720601.
NHIF Board chair, Lewis Nguyai pointed out that there is need for a more robust IT System and more data storage in future as back up in case of untimely disruptions. He assured the public that the disruption will be restored soon.
“There was Staff and HP engineers working round the clock to revamp it and the only thing holding is data space that’s being cleaned up. As we speak the CEO has authorized a manual override that is working to have all patients discharged,” he said through telephone yesterday evening.
Kenya Medical Practitioners and Dentists Union (KMPDU) Secretary General, Dr. Davji Bhimji called on hospitals not to detain patients. “Hospitals and NHIF should have mechanisms in place to mitigate the issue,” he told People Daily.
