Medical services department is one of the operational departments of the Police HMO that involves both Medical and Non-medical activities that centers on the enrollee management.

Units-

This unit ensures Health Care Providers (HCPs) under PHML are continuously being monitored in order to provide high standard of health care services to the enrollees.

The unit collates data, enters and analyze all enrollee visits and encounter with the HCPs under PHML network in a bid to determine the health care service utilization by our enrollees, disease trend distribution in various states of the country.

This unit helps in planning and coordination of healthcare services appropriate to achieve the desired outcome. It includes care assessment, including personal interview with the enrollee, and assistance in developing, implementing and coordinating a medical care plan with healthcare providers, as well as the enrollee and his/her family and evaluation of treatment results.

The HCPs under PHML are continuously being monitored to ensure that high standard of health care services is provided to the enrollees. In order to achieve this, the department undergo monitoring and evaluation of the facility’s human and material resources by ensuring the availability of qualified personnel, equipment/tools and standard operational procedures and NHIA guidelines are followed at all the service points, and the services have the desired effect on the beneficiaries.

This unit is responsible for issuing authorization and referral codes to Health Care Providers for our enrollees for various medical treatments. It also serves as center for receiving and addressing complaints from the enrollees as well as the HCPs.

Serves as intermediary between Police HMO and the Health Care Providers.

The administration department is tasked with the responsibility of ensuring seamless operations in the organization by providing administrative and logistic assistance to all departments in meeting up with their daily duties.

The Finance and Accounts Department is responsible for recording all financial transactions of the company, ensuring effective and efficient financial management and control, and providing support and advice to management for the smooth and optimal operation of the organization.

The department is responsible for these tasks in the areas of budgeting, taxation, general administration, and regulatory compliance. It holds a pivotal position in the administration of capitation and Fee-for-Service.

The Finance and Accounts Department is responsible for the following:

The Information & Communications Technology (ICT) Department is the backbone of the entire PHML operations. Its functions extend far beyond merely managing technology; it actively contributes to the achievement of company’s goals, enhances patient care, ensures compliance, and fosters innovation.

Within the ICT Department, several organizational units work collaboratively to fulfill these critical responsibilities:

This department is made up of two major units:

The Business Development unit that is tasked with enrolment and sensitization of enrollees into the scheme, i.e. serving and retired Police Personnel and their families as well as civilian members of the society are identified, enrolled and periodically sensitized on the workings of the National health insurance.

Corporate Affairs unit is in charge of both internal and external communication as well as forging the public image of the organization. The unit also keeps track of information as it concerns PHML while generating and disseminating same when required knowing that the value the public puts on the organization is determined by its perception. This, it achieves through Public, Government and Media Relations, Advocacy, Corporate Social Responsibility etc.

At Police Health Maintenance Limited, we believe that our greatest asset is our people. The Human resources department is committed to fostering a supportive, inclusive and engaging workplace culture where team members can thrive.

The department is tasked with the responsibility of; hiring qualified persons with requisite qualification and possibly wealth of experience relevant to the working process of the organization, keeping them engaged, Leave Management and supporting their growth and development within the Head Office and 36 state offices around the country.

Human Resource leads Recruiting and Employee Onboarding and as well assists Managers and Team Leaders towards improving the processes and practices within the organizations as it concerns staff development. Ensure that Human resource database is up to date, accurate and complies with legislation or in accordance with the service manual and extant laws.

The department is responsible for the management of the day-to-day operations of all personnel matters guided by the implemented Human resource procedures and policies.

The department consist of five operational unit:

The Internal Control and Audit Department is The Board's functional and Management's administrative institution positioned to improve the effectiveness of business governance.

We demonstrate commitment to professionalism and objectivity, in discharging our duties which are not limited to:

The Operations department is responsible for processing fee-for-service claims, resolving/reconciling disputed claims, monitor (for claims purposes) medical episodes in order to prevent unnecessary treatment, duplication of services and to uncover opportunities to maximize greater outcome. The department also ensures sound risk assessment and pricing practices by improving risk assessment, cost control, compliance and regulatory adherence, customer satisfaction and data analysis and insights. The department consists of three (3) basic units:

The Claims Unit is responsible for all processes concerned with the medical and financial adjudication of fee-for-service claims presented by health care providers for payment. This includes, but not limited to claims eligibility screening, medical necessity, financial tariffing, data capturing and creation of payment manifest.

The unit is responsible for all processes relating to the receipt, collation and resolution of complaints emanating from Healthcare Providers such as non-payment of fee-for-service claims, short payment of fee-for-service claims, non-payment of capitation, non-submission of payment advice to HCFs after payment of fee-for-service claims, non-submission of payment analysis to HCPs after payment of fee-for-service claims. It is also the responsibility of the unit to obtain Letters of Non-indebtedness (LONIs) from HCPs after successful reconciliation and submit same to the National Health Insurance Authority (NHIA).

The main function of the Unit is to enhance the organization's underwriting capabilities and ensure sound risk assessment and pricing practices by improving risk assessment, cost control, compliance and regulatory adherence, customer satisfaction and data analysis and insights.