How do I submit patient's claim for lab tests?
Ans: For tests send to Seng’s Lab (Biege or Yellow background in IOT)
1)      Order the lab tests through Seng’s Lab
2)      Submit e-claims for patient’s visit with the lab test(s) done

 For tests not available at Seng’s Lab (Grey background in IOT)
1)      Order the lab tests from other labs and asked the bill to be sent to your clinic
2)      Submit e-claims for patient’s visit with the lab test(s) done

  How do I submit x-ray claims?
Ans: The bill should be sent to your clinic, simultaneously e-claims should also be submitted for the patient's visit.

  HMO SCHEME

Q. When is the last day for submitting claims?

Ans. Please submit all your claims latest by the 7th day of the following month.

Q. How do I decide to collect cash from the patient or submit thru the e-Claims systems?   
Ans. The following scenarios would be able to help you to make the decision:

Did Patient produce         theCard?   

Did Patient produce the   IC/Passport?      

Is the Patient’sname             found in e-  Claims systems?                 

          Action        

 no

 no

               NA

  collect cash

 no

  yes

no

  collect cash

 no

yes

yes

e-claim

 yes

no

no

   collect cash

 yes

yes

      no       

    register &claim

 yes

no

yes

      e-claim           

 
Q. Do I continue to submit ROCs for the employees of HDB, Delgro & HMO NET?
 
Ans. Yes, please continue to submit ROCs to HMO
 
Q. My clinic has not been seeing HDB, Delgro and HMO NET patients. Can I claim when they turn up for treatment?
 
Ans. No. This group of companies was promised that signed ROCs would accompany the bill as proof of attendance. When the above requirement is discontinued all clinics will be able to see all patients under the managed care schemes administered by HMO.

Q. Do I still need to submit the Physical Claim Forms to HMO?

Ans. No, you need not need to with effect from 1 Nov 2000.

Q. How do I find Incision & Drainage in IOT?
Ans. Please key in I & D

Q. How do I find X Ray?
Ans. Please key x-ray. The description of x-rays and prices are based on Radiology Clinic

Q. What does CPU stands for?
Ans. It refers to Cost per unit.

Q. How do I submit claims for Kentucky Fried Chicken & Pizza Hut Pre-employment checkup?
Ans. You can submit ICDCM as Health checkup, not paediatric. For IOT, enter keyword “Tricon” to select appropriate procedures done for the patient

 Q. How do I submit claims for foreign worker’s work permit checkup?
Ans. You can submit ICDCM as Health checkup, not paediatric. For IOT, enter the word “male” or “female” accordingly.

 Q. How do I submit claims for foreign worker’s renewal of work permit checkup?
Ans. You can submit ICDCM as Health checkup, not paediatric. For IOT, enter the word “Renewal”

 Q. Why is it that when I try to perform modification it shows me “Sorry No Records are existing on this Date”?
Please ensure you enter the exact information that was found it the database. You can overcome this in 2 ways.
1)      Ignore the Emp/NRIC field. Just ensure you have the Date of Consultation for this record.             or
2)      Go to Billing History extend your date search. Eg. From date: 01/07/2001 To date: 14/07/2001. Once you found the record, take down the IC number & date. Now, you should be able to use the information to perform modification.

 Q. How do I save the changes made in modification?
Click on “Modify” to save the adjustments you have done.

 Q. How do I check if I have submitted claims previously?
Ans. Click on “Billing History”. Select the appropriate “Range of Dates” and “Sort by”.
Click “Display” if you want a brief summary or Click “Reports” if you want a detail summary. (Note: If you are unable to see the report, please download & install the Crystal Report plug-in)

Q. How many types of Items Of Treatment (IOT) are there?
 
Ans. IOT are grouped into the following types:
 
        S – medicine with a product SIN number
        E – medicine without a SIN number. E number is assigned by EzyCare
        L – lab investigations; for group tests names refer to Path Lab 
        B – brochures, information or educational materials
        R – referrals; enter location, $5 payable for each entry.
        O – office procedures or minor surgery
        X – x-rays
 
Q. What should I do if the IOT that I wish to enter is not found in the e-Claims systems?
 
A. e-Claims systems has been designed to allow you to proceed with your e-claims in this case. What you need to do is to enter the ‘description’ of the new IOT in the systems. You should leave the IOT code blank in this case.  
 
Q. Do I need to submit a diagnosis from the ICD-9 codes for every visit?
 
Ans. Yes you have to. The software is configured to require you to enter the diagnosis before you can submit your claim. You can enter more than one diagnosis if the patient has more than one illness either acute or chronic.
 
This ICD-9 codes for Family Practice was compiled by Dr Allen Daugird, MD, MBA, and Donald Spencer, MD, MBA, of the Department of Family Medicine, University of North Carolina, Chapel Hill. It is being adopted by HMO Medical Centres Pte Ltd on the recommendation of Professor Goh Lee Gan, COFAM Department, NUS. The list of diagnoses have been grouped into 26 types as follows:
 
  1. INFECT – infectious and parasitic diseases>
  2. CANCER – malignant neoplasms
  3. BENIGN – benign neoplasms
  4. ENDOCR – endocrine, nutritional & metabolic disorders
  5. BLOOD – blood disorders
  6. MENTAL – mental disorders
  7. NERVES – diseases of the nervous system
  8. EYES – diseases of the eyes
  9. EARS –  diseases of the ears
  10. CIRCUL – diseases of the circulatory system
  11. RESP – diseases of the respiratory system
  12. DIGEST – diseases of the digestive system
  13. URINA – diseases of the urinary system
  14. MALE – diseases of the male genital organ
  15. FEMALE – diseases of the female genital organ
  16. BREAST – diseases of the breast
  17. MENSES – menstrual disorders
  18. FERTIL – fertility problems
  19. PREGNA – diagnoses related to pregnancy and childbirth
  20. SKIN – diseases of the skin and subcutaneous tissue
  21. MUSCLE – disorders of the musculo-skeletal & connective tissue
  22. CONGEN – congenital anomalies
  23. INFANT – conditions encountered during infancy
  24. SIGNS – signs and symptoms
  25. TRAUMA – fractures, dislocations, sprains & strains, wounds, adverse reactions
  26. MISCEL – supplemental classification

STAFF CARE

 Payment 

    Q. When does the corporate make payment?

    Ans. after the clinics’ submission of claims every month, Ezyhealth will invoice the corporate based on 14-day payment terms. Upon receiving the payment from the corporate, Ezyhealth shall distribute the payment to all the clinics on the 7 th of the next month. (This will also depend on when the corporate pays Ezyhealth.)

    Q. How does Ezyhealth make payment to clinics?

    Ans.The payment to clinics is through GIRO.  The GIRO information is based on the ‘Clinic Information Form’ received from clinics’ doctors/person in-charge.  Please notify Ezyhealth if there are any changes in the bank GIRO account.

    Q.  Do I need to send a manual invoice to the corporate/Ezyhealth?

   Ans. No. The Record of Claims (ROCs) sent to Ezyhealth monthly through our E-claim system enable Ezyhealth/corporate to extract the claims report directly from our website.

 Claim Process

Q.How do I know that the claim has been submitted?

 Ans.The claims summary can be obtained from our E-claim website. 

 The procedure is:-

v      After the log-in, click the ‘Billing History’ at the left column;

v     Type in the date of that period;

v      Then click ‘Search’ and the system display the claims which has been submitted during that period.

 

Alternatively, you may

v   click on ‘Reports’ at the left column;

v   select ‘Medical Claims (By Staff Care Corporates)’;

v   Type in the date of that period;

v   Click ‘Show Report’; and the report will show all the ROCs entered during that period.

Identifications

  Q. How do I identify the Staff Care corporate employees?

   Ans. By logging-in our E-claims system you will be able to process a search on the patient name (minimum 10 characters for a partial search) or patient’s NRIC (minimum 5 characters/digits). Alternatively, when the staff of our Staff Care corporate produce their ‘Staff Care card’, the clinics shall go ahead to see the patient and claim later. Certain corporate prefer to use their own staff card, NRIC,Employment pass, etc. Thus, Ezyhealth shall inform clinics on the method of identification for these corporate.

Q. How do I identify the employees’ dependants?

Ans. Employees’ dependants of certain corporate are not issued with our ‘Staff Care card’ if their medical benefit is the same as the employees. As such, they will share the card with the employees and identify themselves either by the employee’s ‘Staff Care card’ or NRIC of their own/parent. Employees’ dependants of certain corporate have different medical benefits from the employees, thus E zyhealth shall issue ‘Staff Care card’ to these special dependants (one card shared by all dependants).

Q. Where can I obtain the list of corporate under Staff Care plan?

  Ans. You can retrieve from our e-claim website.  The procedure of retrieving the list is as follows:-

1.     Click on the ‘Corporates’ at the left column; and

2.      the Staff Care corporate list shall be shown on the screen.

 

 Business Rules

Can the doctor make referrals to specialists & how do patients know if they will be covered for Specialist visits?
Ans: Yes. However, as we are managing GP coverage, we would not know the terms & conditions. You may advice the patient to check with their respective company on specialist coverage.
  
 
 

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