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Details of EOI:

Provision Of Claims Management Services

Unique EOI ID:
Date EOI
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EOI Closing Date :
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Greater Accra
Accra Metropolis
Consultancy Services
EOI Contact Person:
The Chief Executive, National Health Insurance Authority, Private Mail Bag, Ministries Accra



EOI Description:
The National Health Insurance Authority (NHIA) was established by National Health Insurance Act 2012, (Act 852) to provide financial risk protection for healthcare to all persons legally resident in Ghana through the National Health Insurance Scheme (NHIS). Healthcare Providers (HP's) credentialed by the NHIA, submit claims for healthcare services provided to NHIS members. Since inception, there has been an exponential growth in claims volumes and payments, threatening the sustainability of the Scheme.
The NHIA is therefore seeking a Strategic Partner with the requisite claims management knowhow to effectively and efficiently manage claims with the goal of achieving 90% electronic claims management.
The services shall include the following:
• Provide additional ICT infrastructure to support all software and services to deliver an end-to-end electronic claims management solution
• Provide claims submission solutions that can be utilized in all NHIA credentialed Healthcare Provider (HP's) for submission of eclaims. The Solution should enable online and offline generation and submission of claims.
• Deploy and train HP's to utilize claim submission solution and maintain high availability of the system
• Distribution and Implementation of claims submission solution
• Integration with existing Hospital Management Information Systems
• Business continuity and IT security services
• Security and Audit Requirements
• Reports and Business Intelligence (BI)
• Integration of the claims management system to NHIA ICT infrastructure
• Business rules setup, management and maintenance
• Health Provider Support
The initial phase of the service is expected to be completed by 2022
The National Health Insurance Authority now invites eligible consultancy firms to indicate their interest in providing the above service. Interested firms must provide information indicating they have the capability and are qualified to perform the service.

Qualification and Expertise
• Profile of firm
• Legal status — Business Registration Certificates
• Provide valid copies of SSNIT and GRA Tax Clearance certificates
• VAT Registration certificate
• Evidence of Public Procurement Authority Registration
• Firm must have not less than seven (7) years' experience with a proven track record in rendering similar services in Ghana and or any African Country. References with names, phone numbers and emails must be provided.
• Proof of capability must include demonstrable experience of large scale electronic claims management
• Relevant qualification and experience of all technical personnel.
• Evidence of financial capacity
• Required Licensing and Professional Registrations if applicable

Special Requirements

For more information about this EOI please contact:

The Chief Executive, National Health Insurance Authority, Private Mail Bag, Ministries Accra










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