Medical Services
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:
Call Center
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.
Enrollee Liaison/ 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
Health Care Provider Liaison/ Management
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.
Monitoring & Evaluation/Quality Assurance
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.
Enrollee Encounter Data Management
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.
Administration
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
1) Customer Care Unit
2) Facility Management Unit
3) Procurement Unit
4) Inventory Management
5) Transport Unit