Medical services department is one of the operational departments of the Police Health Maintenance Limited that involves both Medical and Non-medical activities that centers on the enrollee management, Health care Provider management, Monitoring and Evaluation/Quality Assurance and encounter management. The desires are that, the enrollees of Police Health Maintenance Limited received quality healthcare services in conjunction with the network of both public and private health care providers accredited under National Health Insurance Authority

In order to have proper supervision and delineation of responsibilities for all the staff in the department, the department is divided into units as follows:

The Call Centre Unit acts as the gatekeeper of the organization as it is the first line responder to all complaints and clarifications emanating from both enrollees and providers. The Unit is also responsible for the generation and dissemination of pre-authorization codes to providers for secondary level management.

To build and increase enrollee confidence, satisfaction, safety and to improve quality healthcare services provided to our enrollees, we under take health education and promotion by developing enrollee health education pamphlets and management strategies for pre, intra and post admission care through follow up either by direct visit to Health care provider or phone calls. The department ensures PHML enrollees are aware of the beneficiary package and their rights as a beneficiary of National Health Insurance Authority through and intensive enrollee education. In ensuring enrollees satisfaction and safety, their enquiries/complaints are given prompt and desirous attention. As part of ensuring that our enrollees receive comprehensive, effective, efficient and quality health care, we ensure in collaboration with our Call Centre, they get pre-authorization code through appropriate referral protocol to specialist and performing of enrollees case files Medical Auditing

In ensuring the organization maintain trusted and cordial relationships with all providers under the PHML network, this unit created a WhatsApp group with all Provider Desk Officers and the State Coordinators as medium of communication to ensure the organization has effective and efficient communication with the providers. The department as well, organize HCPs versus PHMO interactive forum every quarter through which HCPs are educated on NHIA benefit package, referral protocols, medical bill preparation and submission and ensuring all contractual agreements with them are respected. This medium provides opportunity for the department to collate and attend to the HCPs enquiries/complaints.

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 collates data, enters and analyze all enrollee visits and encounter with the HCPs under PHML network in a bid to determine health care service utilization by our enrollees, disease trend distribution in various states of the country. This will help PHML in developing her health policy and intervention strategies and as well as generation of epidemiological data for the country

In addition to above responsibilities, the department collaborates with other departments to perform other functions and any other responsibility given by the management when necessary with the aim of achieving the Organizational goal and objectives.

The reports generated from these activities are submitted to NHIA every quarter in compliance with the NHIA Operation guidelines.

The department provides administrative and technical support in the area of human resources in addition to serving as a link between the organisation’s (Police Health Maintenance Limited) various departments and ensures the smooth flow of information within the organisation. Thus, without an effective administrative department, Police Health Maintenance Limited would not run professionally and smoothly as it is the case today. Its activities includes but not limited to the execution of the administrative functions such as preparing budgets, policies, contracts, maintenance of company facilities, provision of working implement for efficient and conducive day to day running of a result oriented work place, long range planning, and keeping inventories of equipment and managing the company’s physical assets and utilities all within the Head office and the 36 State offices.

The department consist of five sub unit for effective operation. This you can find below

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:

This department is responsible for developing IT strategies that support the organization’s objectives, developing and supporting the network to support effective communication and collaboration, IT infrastructure security, ensuring that the IT infrastructure remains operational and offering support to all PHML staff to enable them function more effectively. The department also generates operational reports to aid critical business decisions.

Therefore, the Information & Communications Technology Department is the backbone of the entire PHML operations and comprises the following organisational units:

This department is tasked with the mandate to ensuring that Officers and Men of the Nigerian Police Fore, Police retirees and their respective families are adequately enrolled and receiving satisfactory medical services under the National Health Insurance Authority (NHIA). The department among others engages in:

Identifying new potentials for ultimate enrolment in the Scheme

Periodic sensitization exercises in Commands, Divisions, and Barracks etc. nationwide to properly update existing and prospective enrollees on the workings of the Scheme.

Identifying new potentials for ultimate enrolment.

Review and build good relationship with new and existing enrollees.

Registration, sensitization and maintenance of the health insurance of all Nigeria Police Retirees registered into the Scheme.

The corporate Affairs unit is saddled with the responsibility of tracking and keeping in touch with information as it concerns PHML. This includes generating and disseminating same when required. The value the public puts on the PHML is determined by their perception. Basically, the corporate affairs unit is the image maker of PHML. It is therefore the duty of the corporate Affairs unit to ensure that the public has a good perception of PHML. These can be achieved through effective communication to staff, public, as well as stakeholders in the industry (hospitals, enrolees, NHIA etc.). The means includes public relations, government relations, advocacy, corporate social responsibility and so on.

Prospecting, development and engaging in other means of activities that generate interest from potential enrollees.

This department in Police Health Maintenance Limited 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 all geared towards improving the processes and practices within the organizations as it concerns staff development. The department administers Human resource-related documentation, such as contract of employment. Ensure the relevant Human resource database is up to date, accurate and complies with legislation or in accordance with the service manual and extant laws.

Human Resource deals with Human Beings (Employees) and in addition deals with the support functions related to those Employees. It is responsible for the management of the day-to-day operations of all personnel administrative matters guided by the implemented Human resource procedures and policies.

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 department is responsible for the creation of the highest level of efficiency possible within the organization by ensuring and increasing the effectiveness and efficiency of support services (HR, IT and finance), through improvements to each function as well as coordination and communication between support and business functions, creating and monitoring performance of systems, improving the operational system, processes and policies in support of the organization’s mission, playing a significant role in long term planning, including initiatives geared towards operational excellence and in addition, the department consist of the following unit and human resources.

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 unit is supported by a robust claims software, which has significantly improve the efficiency of the unit.

The unit is responsible for all process relating to the receipt, collation and resolution of complaints emanating from Healthcare Providers relating to the following: Non-payment of fee-for-service claims, short payment of fee for service claims, non-submission of payment advice to HCFs after payment of fee-for-service claims and non-submission of payment analysis to HCPs after payment of fee-for-service claims. It’s also the responsibility of the unit to inform the regulator on the status of resolution.