Oct 05, Kathmandu - The Health Insurance Board has taken various important decisions with the aim of making the health insurance program more digital, systematic and effective. The second meeting of the board decided to make the national identity card mandatory for citizens who have completed 16 years of age to join, renew and receive services in the health insurance program.

According to the board, from 1 Poush 2083, citizens who have completed 16 years of age will have to use the national identity card compulsorily while joining, renewing and receiving services in the health insurance program.

Similarly, it has been decided to issue a public notice to make it mandatory for all insured families of general and target categories to update their details through the HIB e-Portal. The board expects that this will ensure the identity of the insured and help in controlling double affiliation, updating KYC and making claims management effective. 

Formation of a task force on strategic procurement
It has also been decided to form a study task force on strategic procurement to make the service procurement and payment system under the health insurance program scientific, cost-effective and sustainable.

The task force will have to submit a report within 60 days, including the basis for selection and contract of service providers, classification of services, service procurement and payment methods, draft of the contract and phased implementation plan.

The board expects this to improve the financial sustainability of the health insurance fund, service quality, cost control and claim management.

Claim recognition of details received from EMR
The board has decided to recognize digital health records and claim details received from service providers through the EMR (Electronic Medical Record) system as claims in accordance with the prevailing laws and prescribed standards.

Along with this, it is expected that the use of handwritten prescriptions, manual claims and paper records will decrease and delays in the payment process will also decrease. The board has also decided to use the digital data received from EMR in an AI/ML based claim review system in the near future.

2,158 ICD-11 codes to be used
It has been decided to use 2,158 Customized ICD-11 Codes in HMIS in the first phase to make health insurance claim management factual and in line with international standards.

The board believes that this will help maintain consistency in disease diagnosis and documentation and make claims testing and management more systematic.