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The Social Health Authority (SHA) has updated all contracted healthcare providers on the ongoing implementation of Public Officers Medical Scheme Fund (POMSF) tariffs.
In a statement on April 12, SHA Chief Executive Officer (CEO) Dr. Mercy Mwangangi quoted clause 10.2(c) of the POMSF Addendum, “the Authority shall conduct a market analysis during the first three (3) months of the commencement of the POMSF Scheme and following negotiations with healthcare facilities, provide final tariffs subject to approval by the SHA Board.”
As a result, Mwangangi said SHA has commenced the required market analysis and tariff negotiations under POMSF.
“So far, negotiations with Level 5 and Level 6 facilities have been completed, and the next phase will focus on Level 4 and Level 3 facilities,” the CEO said.
How SHA POMSF Tariffs Will be Implemented
Mwangangi explained that the approved POMSF tariffs will be implemented progressively in the SHA claims system at the hospital level and package.
She added that the tariffs will apply to service access, claims submission, adjudication, and reimbursement under POMSF.
“The approved POMSF tariffs will be implemented progressively in the SHA claims system by hospital level and package, and shall apply to service access, claims submission, adjudication, and reimbursement under POMSF, Mwangangi stated.
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Deadline and Provision of Services
Mwangangi stated that facilities which have agreed to the negotiated tariffs will continue delivering services to POMSF beneficiaries in accordance with the approved benefit package and the agreed reimbursement terms.
“Facilities that have accepted the negotiated tariffs will continue providing services to POMSF beneficiaries in line with the approved benefit package and agreed reimbursement terms,” she said.
The exercise is expected to be substantially concluded within the next 21 days, subject to the outcome of ongoing engagements.
For clarification or support, providers may contact their respective SHA County Offices or the SHA Contact Centre via 0800 720 601.
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SHA Chief Executive Officer (CEO) Dr. Mercy Mwangangi has updated all contracted healthcare providers on the ongoing implementation of Public Officers Medical Scheme Fund (POMSF) tariffs. PHOTO/ SHA X.