REPORT ON VETTED CLAIMS

MOSHIE ZONGO HEALTH CENTRE (MANHYIA) – JANUARY 2023

INTRODUCTION
The Moshie Zongo Health Centre submitted claims for the month of January 2023 to NHIS
on 8th March 2023 for services rendered to members of NHIS. Below are the details of the
submission, adjustments and amount due after vetting:

CLAIMS VETTING SUMMARY SHEET

OUT-PATIENT
SUBMISSION ADJUSTMENTS AMT DUE
SPECIALTY ATTEND. SERVICE MEDICINE TOTAL SERVICE MEDICINE TOTAL SERVICE MEDICINE TOTAL
(GHC) (GHC) (GHC) (GHC) (GHC) (GHC) (GHC) (GHC) (GHC)

OBGY 3 186.12 90.23 276.35 0.00 0.00 0.00 186.12 90.23 276.35
OPDC 206 3,547.32 2,462.66 6,009.98 68.88 434.32 503.20 3,478.44 2,028.34 5,506.78
Antenatal/Postnatal 73 1,392.11 471.63 1,863.74 19.07 41.04 60.11 1,373.04 430.59 1,803.63
Detention for 5 83.07 89.36 172.43 0.00 60.86 60.86 83.07 28.50 111.57
Observation and
Treatment
Dressing And Minor 1 17.79 47.17 64.96 0.00 25.99 25.99 17.79 21.18 38.97
Suturing
DUPLICATION 0 0.00 0.00 0.00 1.85 0.00 1.85 -1.85 0.00 -1.85
GRAND TOTAL 288 5,226.41 3,161.05 8,387.46 89.80 562.21 652.01 5,136.61 2,598.84 7,735.45

Reasons for Adjustments

1. INACTIVE MEMBER: 5 claim(s) affected in all, at a total cost of GHC 135.43

The NHIS membership numbers of some claims submitted for reimbursement
were not active subscribers of NHIS. All such claims were rejected.,

Name NHIS No. Folder No. Attendance Date

Y.J 48590448 207/22 04/01/23
L.J 16214286 000024/23 08/01/23
A.C 22688939 140/22 17/01/23
A.S 80880256 000731/14 26/01/23
 A.G 23869522 001041/21 30/01/23

2. INAPPROPRIATE PRESCRIPTION: 83 claim(s) affected in all, at a total cost of GHC

466.33
Some medicine(s) prescribed was (were) not appropriate for the diagnosis stated.,
E.g

• Prescription of Infusions for use at OPD.

• Prescription of injections for use at OPD.

Name NHIS No. Folder No. Attendance Date

S.A 32689426 000072/22 02/01/23
O.J 22836764 00002/23 02/01/23
S.S 30193899 000011/23 03/01/23
M.E 25600338 000014/23 04/01/23
N.H 96777113 214/22 06/01/23
F.B 13408429 000040/23 11/01/23
A.U 42727451 000043/23 12/01/23
D.R 18073107 001493/21 19/01/23
I.S 29357542 001175/21 21/01/23
S.F 19992470 001056/22 21/01/23

3. MULTIPLE ANC VISIT: 1 claim(s) affected in all, at a total cost of GHC 1.85
There were multiple ANC visits in a month contrary to the dictates of NHIS tariff
operation manual. Routine ANC visits are expected to six (6) per pregnancy.
Below are examples extracted from claims submitted.,

Name NHIS No. Folder No. Attendance Date

A.F 48813057 278/22 31/01/23

4. OVERSUPPLY OF MEDICINES: 4 claim(s) affected in all, at a total cost of GHC 4.74

The quantity of some medicines prescribed/dispensed was more than the
recommended dose for the condition or patient.,
 Name NHIS No. Folder No. Attendance Date
M.M 19788234 136/22 06/01/23
S.M 51236113 001417/22 06/01/23
A.A 16721142 229/22 13/01/23
A.F 48813057 278/22 31/01/23

5. TREATMENT TO DIAGNOSIS MISMATCH: 3 claim(s) affected in all, at a total cost of

GHC 17.07
Some treatment or medicines prescribed did not match with diagnosis stated on
the claim forms.,

Name NHIS No. Folder No. Attendance Date

U.I 65375638 001019/21 09/01/23
I.S 29357542 001175/21 21/01/23
A.A 29469755 000759/2022 23/01/23

6. UNCLEAR DIAGNOSIS: 2 claim(s) affected in all, at a total cost of GHC 26.59

There was no specific diagnosis stated on some claims forms to indicate the
condition for which treatment was given,

Name NHIS No. Folder No. Attendance Date

A.N 17552296 000973/2020 20/01/23
A.J 33781914 000471/22 24/01/23

E-CLAIMS -NHIA

16-05-2023

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