Claims Processing

The distributors check on the eligibility of potential clients by filling in a standardized reporting sheet (record of sold vouchers) containing a number of client characteristics like name, age, location and date of sale, etc. This standardized reporting sheet is distributed by the Voucher Management Agency (VMA) field manager.

Once the voucher client presents the voucher to an accredited voucher service provider (VSP), the VSP authenticates the voucher and provides services outlined in the benefit package in accordance with the terms and conditions of the VSP contract and project rules. Thereafter a claim form is duly completed by the VSP and signed by the voucher client after satisfactory services are given.

The following documents are attached to the completed claim form:

1. original OBA voucher
2. discharge summary
3. original service invoice
4. photo copy of clients or guardians identity card
5. monthly statement with details of submitted claims.

The claims are then submitted to VMA by courier, registered mail or personal delivery. This is done in order to prevent fraud and ensure the clients are receiving services outlined in the benefit package. It involves:

1. Confirmation that vouchers are genuine and serially numbered
2. Confirmation that claim forms have been duly completed and signed
3. That service fee is in accordance with agreed reimbursement amount
4. Confirmation that services were delivered in accordance with both benefits package and terms and conditions of the VSP contract.

The VMA field manager runs a first check on the record of sold vouchers against the number of vouchers that were distributed beforehand. A second check is done by the VMA central office by comparing the number of sales and issued vouchers in total on district level.

Finally, the VMA central office compares the distributors‘ reports and the voucher claim forms and conducts an in-depth plausibility checks on the coincidence of vouchers sold and services provided. After the check, the providers are reimbursed within (at maximum) 30 days. Provider claims for safe motherhood services can be submitted right after the clients have delivered and do not have be put on hold until the end of the post-partum period of each client (six weeks).