LIWANI BAYON-ON

Medical Approval ( Insurance ) at Muhayl National Hospital

• Saudi Arabia - Mahayil Asir
• January 2015 to March 2019

Responsible for the smooth and efficient running of the Company Insurance Department that met the adequate needs of individual client and staff as per standard of service such as:

WASEEL APPROVAL /BUPA/ELECTRIC COMPANY/SPCC


 Check Eligibility of the Patient
 Approval Submission
Write detail of the patient
Write complains, Diagnosis of patient as written by Attending Physician
Write and check service ( Code of Company ) ( New Code or Old Code ) and \[rice of Service ( New Price or Old Price ).
Comment for atatched Laboratory Investigations and Imaging reports
Follow up Thru System
 Check for Approval Inquiry
 If some details n require , inform Attending Physician and Comment written again and send for approval until Requested Services will be approved…


( FOR MONTHLY TREATMENT )

 Pharmacist will write the amount and the quantity of the medications that w e need for approval and we will encode after finish the approval .

ALL DONE --- INFORM ATTENDING PHYSICIAN OR STAFF NURSE TO GET THE FINISH APPROVAL OR IF BUSY, WE PERSONALLY GO TO LINIC….

FAX APPROVAL:

 Write Membership Number of the patient
 Ckeck Service Code and Price ..Send thru Fax or Email
 Request replied …IF APPROVED ..ASK THE STAFF NURSE TO GET THE APPROVAL

OUTPATIENT UCAF/DCAF:

 Complete Ucaf Forms ( Patient file #, date of service, department, service code, price )
 Check missing Laboratoty, Imaging Report and official Receipt
 Official Receipt change for the code and prices as per conract Attachment, ..Then write defficiency note for completeion
 ( BUPA - 1 month approval should have to attach copy of the previous prescription )


INPATIENT

 SEND DAILY EXTENSION OF THE PATIENT INCLUDING THE VITAL SIGN.LAB INVESTIGATIONS, IMAGING REPORT, MEDICATION SHEET IF WE NEEDED AND MEDICAL REPORT OR DISCHARGED SUMMARY IF THE COMPANY NEED( NICU, PICU, ICU, MSW AND OB WARD