Providers Affairs and Quality Assurance Directorate

Services delivered by Providers’ Affairs and Quality Assurance Directorate

1. Ensure availability of implementation manuals for the sections within the directorate, and follow up amendment as deemed necessary
2. Follow up preparations of selection criteria for providers, and ensure incorporation of the necessary criteria
3. Follow up preparations of documents for contract agreement with providers, and ensure that the documents are prepared as per the required standard
4. Establish a medical audit system that controls cost escalation and enables provision of quality & proper health care services for beneficiaries; provide support for branch offices on issues related with medical audit
5. Conduct studies and propose solutions for issues and problems raised with regards to prices and payment mechanisms, make studies on introduction of new payment mechanisms and commend on their implementations
6. Work in collaboration with stakeholders on provision of quality health services
7. Follow up and monitor the availability of adequate contracted health care providers by the branch and follow up if provision of health services are at the required level of quality
8. Follow up and control the screening and registration of health facilities and monitor if quality assurance activities are done properly
9. Follow up and control that reimbursements are made as per the prices and payment mechanisms approved by the Agency
10. Conduct studies on health facility standards and propose amendments as deemed necessary
11. Conduct studies regularly on timeliness of prices approved for providers under each branch of the Agency and propose amendments as deemed necessary
12. Assign and notify beneficiaries the health facilities contracted with the health insurance
13. Compile and analyze information on health services utilization of beneficiaries and epidemiological changes, reimbursements made, issues arising with regard to provision of health services and propose solutions as deemed necessary