CMA issues health claims regulation
The Capital Market Authority has issued Decision no. (107/2022), a regulation for managing the health insurance claims revenue cycle, which aims to organise the documentary cycle and provision of filing, following up and processing of insurance claims on behalf of the health service provider. The regulation includes the necessary rules to license health insurance claims revenue cycle management companies in the Sultanate of Oman.
Ahmed Ali AlMaamari, vice president for the Insurance Sector, Capital Market Authority, confirmed that the issuance of the regulation governing the activity of managing health insurance claims revenue cycle was made in light of the ongoing preparations for the implementation of the compulsory health insurance scheme.
Al Maamari added that the remarkable growth of the health insurance activity in the local market, the increase in the number of health insurance policyholders and the regulatory procedures associated with the health insurance structure requires to introduce such activity and provide a clear regulation that ensure an appropriate investment environment, which contributes to the safety, accuracy and high quality of the transactions related to health insurance services.
Al Maamari added, “This activity will also contribute to improving the quality of health insurance claims sent to insurance companies, verifying their compatibility with the medical coding system, reducing differences and disputes between insurance companies and private health institutions as a result of rejected claims and nonpayment.” He said that the introduction of such activities in the insurance market will contribute to expanding the role of the insurance sector to accommodate the graduate of educational institutions, as well as providing technical and administrative job opportunities.
The company will also be responsible for following up the collection of funds for treatment services provided to health insurance policyholders, as well as training and qualifying the employees of private health institutions to use the approved medical coding systems or the systems that may be introduced in the future.
