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Learn how Marie Stopes Uganda utilized Claims Processing Data Management System (CPDMS) to strengthen FP voucher service provision in BlueStar SF network, improving process efficiency, data management, and monitoring. The CPDMS captures client information, medical history, complications, and reimbursement data, enabling timely reports and fraud control.
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Strengthening FP voucher service provision in BlueStar SF Network using Claims Processing Data Management System (CPDMS) Authors:Kanakulya Richard1, William Nnyombi1, Kelsi Kritimaa1 Affiliation: 1 Marie Stopes Uganda
Introduction • MarieStopes Uganda (MSU) is implementing a five year program for provision of long acting and permanent methods (LAPM) of FP services. • 75% of the targeted services are voucher based (targeting the poor populations), and 25% of services are targeting Cash clients • The program works through 400 accredited Bluestar clinics across the country, where MSU reimburses the franchisees for voucher service provided. • As MSU needed a system to help effectively monitor the voucher scheme implementation and be able to process claims on a timely basis, the ‘Claims Processing Data Management System’ (CPDMS) was developed
Design, distributionof Vouchers & BCC activities Contract Mgt Monitor service Quality & CME Contract Mgt Project Supervision & M&E MSU Voucher Management Mechanism Claims Processing & Reimbursement to Providers Accreditation, contracting and training VSPs External relations & Advocacy Voucher distributors Voucher Service providers Voucher recipients
Background • Reimbursement and payment reports to providers were recorded using paper based records and Excel spreadsheet. • The above systems were compounded by several challenges including; • Poor and slow programme monitoring and delayed reimbursements to providers. • None detailed program reports that can help management in strategic operations of the scheme
Program Intervention • MSU implemented the CPDMS, an SQL database to capture information that is used to focus resources and increase efficiency of FP-service provision (program monitor and timely reimbursements to providers) • Implemented in February 2011, the CPDMS captures: • FP clients’ bio data and geographic information and the information on the PGT • Medical & Reproductive history and FP method taken • Complications reasons and treatment given • Reason for FP removal and FP charges in each module • The CPDMS currently provides: • Timely information used for generating service numbers, performance reports & reimbursement reports. • Used to Quarantine claims, reject claims & fraud control
Claims submitted to MSU offices by VSP Claims received is recorded by Admin Assist Claims are entered in the system VSP provides service Medical Advisors vetting claims Reimbursement report are generated by finance team System checks adherence to CP system Payment processed and VSP paid System operation MarieTXT-SMS platform enabling real time reporting and communication with CBDs and service providers Voucher distribution to clients START STOP • The beneficiaries of the CPDMS are BlueStar managers, Research Monitoring & Evaluation department, Finance department and other stakeholders
Program Intervention Coupon for provision of service With Integration of the SMS platform (MarieTXT) in CPDMS; The system has an interactive platform to continuously share information between Voucher management agency (MSU) & service provider (VSP) and the community based distributors of vouchers(CBDs). The SMS platform has been linked to the Hotline for more interaction with the clients, VSPs & CBDs. Coupon for management of complication/side effects Coupon for removal of method
Key findings • The CPDMS has made FP claims processing faster and more efficient than the initial systems with; • Fast and improved data validation to check fraud and other inconsistencies from the voucher scheme and service delivery. • Improved FP data management for decision making through routine tracking of voucher services and generating detailed reports both programmatic and financial. • Enhanced security and access authentication at different modules and levels with over 100 users able to be logged on at the same time
Program Implications/Lessons • Due to the efficiency of the CPDMS in processing FP data, BlueStar management has been able to process FP claims for providers efficiently and has been able to make evidence based decisions through reviews and routine monitoring and evaluation.
Contact information for MSU: http://www.mariestope.or.og Thank you for your attention!
