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1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management *
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
Version 18, 30 May 2013 * Report to Correspondence Manager
Symbols and Abbreviations
On page reference
Off page reference
Action
Process
Decision
Symbols Abbreviations
· AMA - American Medical Association· BI - Body Identification· BIF - Banking Indemnity Form· CAFS – Central Archiving Filing System· CC - Compensation Commissioner· CLS - Legal and Compliance· CO - Claims Officer· COO - Chief Operations Officer· CSC - Customer Service Consultant/Centre· DM - Document Management· DOA - Date of Accident· DoB - Date of Birth· EA - Expenditure Authorisation· EIL - Employer Individually Liable· ES - Executive Summary· GD- General Damages· GM - General Manager· HCM - Hospital Case Manager· HPCSA - Health Professions Council Of South
Africa· HSC - Hospital Service Consultant/Centre· ICT - Information Communication
Technology· ID - Identity Document· ILD - Internal Law Department· IT - Information Technology· LCO - Legal Cost Officer· LoE - Loss of Earnings
· LoS - Loss of Support· MMI - Maximum Medical Improvement· MVA - Motor Vehicle Accident· NB - Nota Bene (Important)· OAR - Official Accident Report· PA - Panel Attorney· POP - Patient Outreach Program· RAF - Road Accident Fund· RAF 1 - Road Accident Fund Form 1· RAF 2 - Road Accident Fund Form 2· RAF 3 - Road Accident Fund Form 3· RAF 4 - Road Accident Fund Form 4· RAF 5 - Road Accident Fund Form 5· RSA - Republic of South Africa· SAPS - South African Police Service· SMR - Statutory Medical Report· SMS – Summons Management System· SOP - Standard Operating Procedure· U number - Undertakings Number· U system - Undertakings System· UBC - Unabridged Birth Certificate· UO - Undertakings Officer· V&V - Validation and Verification· WCC - Workmen's Compensation Commission
System intervention
1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
4.1.1. Capital payment (Part 1 of 2)
B
Administrative assistant
Administrative assistant
Capital payment officer
Capital payment officer
Capital payment officer Capital payment
officer
Capital payment officer
Capital payment
officerCapital payment
officer
Capital payment officer
Capital payment officer
Capital payment officer
Capital payment officer
Capital payment officer
Capital payment officer
Receive payment request from Claims
Determination or Claims Litigation unit
Acknowledge receipt (register)
and stamp
Verify that the signatory of the payment request
document has the mandate to sign-off the
required amount
Check if the banking details and address
reflect current status which isn’t more than a
month old
A
Is the employee authorised to approve the
required amount?
Yes
No
AAre the
banking details current?
No
Verify amount payable against the invoice,
discharge or court order and supporting
documents supplied/attached
YesAre there issues
with the payment request?
Revert back to the employee or unit
senior and raise the matter
Yes
No
Retrieve file or supporting
documents from CAFS or requestor
NB: the system does allow above mandate – mandate authorisation
Payment to be made to a new
vendor/beneficiary?
Call procurement to liaise with vendor
and update banking details
No
A
Request the latest banking details
from the payment requestor
A
4.1.1.1. BIF Processes
Check for duplicate and prior payments
on the system
Any duplicate payment found?
Escalate duplicate matter to unit
seniorYes B
E
No
Yes
Update banking
details on address book
system
Does the payment request have an
expenditure authorisation
attached?
Yes
Load payment on the system
No
B
D
D
Resolve issues E
B
4.1.1. Capital payment (Part 2 of 2)
Capital payment officer
Capital payment team leader
Capital payment officer
Capital payment officer Capital payment
officerCapital payment
officer
Second officer checks payment as captured by assistant against
source documentation
Second officer approves payment, confirms payment
is due and correct and verifies signatures of prior
two officers
Request payment
End
E
Forward expenditure
authorisation and supporting
documents to finance
Receive payment confirmation from
finance
Forward payment confirmation to
claims file closure
1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
4.2.1. Legal costs validation – Party/Party
Legal cost validation
officer
Administrative assistant
Administrative assistant
Legal cost validation officer
Administrative assistant
Legal cost validation
officer
Legal cost validation officer
Administrative assistant
Legal cost validation senior officer
Legal cost validation
senior/officer
Legal cost validation
senior/officerLegal cost validation
senior/officer
Legal cost validation officer
Legal cost validation
officer
Receive bill of cost from Documents
Management via email, fax or hand delivery
Acknowledge receipt (register)
and stamp
Send instruction to panel attorney or cost consultant to attend settling/taxation
Forward the documentation for
approval and payment
EndRevert queries to officer
D
Receive settled/taxed bills from panel
attorney/cost consultant and distribute to officers.
(system to allocate)
Accept the offer on the system and print out the
Expenditure Authorisation and sign
Request file and assess the bill
Request approved?
Yes
No
4.2.1.1. Instruct panel attorney or cost
consultant to conduct block booking
The system-selected Senior/Officer
reviews the legal cost payment
request
C
Load the settled amount onto the
system. The system allocates the
approval to Senior/Officer with mandate
Can you settle the bill?
Senior to liaise with concerned parties and
negotiate
Is the matter resolved?
Yes C
No
A
Send bill for taxation or instruct
attorney / cost consultant
Create a legal cost query and raise the
matter with the senior when dispute
Are there any variances and/or
irregularities?Yes
No
C
D
A
Yes
No
If the file cannot be located, use the attorney’s file
4.2.2. Legal costs validation – Attorney/Client
Administrative assistant
Legal cost validation
senior
Administrative assistant
Legal cost validation
officer
Legal cost validation
officer
Administrative assistant
Legal cost validation
officer
Legal cost validation
officer
Legal cost validation officer
Legal cost validation
officer
Legal cost validation officer
Acknowledge receipt (register)
and stamp
Request file from CAFS
Receive Assessors files/Advocates accounts/
correspondent bills/ out of town / experts accounts
B
Assess billNegotiate settlement
A
ARequest
approved?
Revert back to the employee or unit
senior and escalate the matter
No
Payment request is escalated to persons with
mandate
B
Forward the documentation for
paymentEndYes
Load the settled amount onto the system. The system allocates the approval to Senior/
Officer with mandate
The system-selected Senior/Officer
reviews the legal cost payment
request
Accept the offer on the system and print out
the Expenditure Authorisation and sign
If the file cannot be located, use the attorney’s file
4.2.1.1. Block booking attorney/client (Part 1 of 3)
Administrative assistant
Administrative assistant
Administrative assistant
Legal cost validation officer
Legal cost validation
senior
Legal cost validation team
leader
Is the list received?
Yes
Did the attorney respond to the
invite?
No
Yes
B
No
C
C
Is the list and bill received before block booking
date?
Yes
B
A
D
No
Follow up with attorney
Invite attorneys and cost consultants to take part in block
bookings
Request and receive a list of matters with the
bills 7 days before block booking date. Scanning process implemented
Follow up with attorney/ set up new date
Request files from CAFS according to
the list from attorney
Team leader decides on
attorney’s to invite for block booking
Did the attorney accept the
invite?
End
No
BYes
4.2.1.1. Block booking attorney/client (Part 2 of 3)
Legal cost validation
junior officer
Legal cost validation junior
officer
Legal cost validation
junior officer
Legal cost validation
officer
Legal cost validationofficer
Legal cost validation
junior officer
Legal cost validation
officer
Files received? Yes
Are files available at
CAFS?
No
Yes
Request file contents from
attorney
No
Have previous bills been received?
Printout any previous payments made for
previous bills to avoid duplicate payments
Yes
No
A
D
Have block settlement on arranged day
F
E
E
Legal cost validation
officer
Check on system if previous bills
have been received
Allocate file on Legal Cost
system
Scan and file settlement
document on Legal Cost system to be allocated to
officer who settled
Load settled amount onto
system. To allocate approval to Senior/Officer
with mandate
H
Legal cost validation
officer
Create a legal cost query and raise
matter with seniorAssess bill
Any variances and/or
irregularities?Yes
Senior to liaise with concerned parties and
negotiate
G
J
F
F
4.2.1.1. Block booking attorney/client (Part 3 of 3)
Legal cost validation officer
Is matter resolved?
Yes
No
Legal cost validation
officer
Legal cost validation officer
Send bill for taxation -set down
by Plaintiffs attorney
G
H
Load the settled amount onto the
system. The system allocates the
approval to Senior/Officer with mandate
Receive settled/taxed bills from panel
attorney/cost consultant and distribute to officers
Administrative assistant
Legal cost validation officer
Legal cost validation
officer
Legal cost validation officer
System-selected Senior/Officer reviews the legal cost payment
request
Request approved?
Yes
Revert queries to officer
No
J
Forward the documentation for
approval and payment
End
Accept offer on system, print and sign Expenditure
Authorisation
H
H
1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
4.3.1. Legal costs payment (Part 1 of 2)
Administrative assistant
Legal cost payment officer
Legal cost payment officer
Legal cost payment officer
Legal cost payment
officer
Legal cost payment officer
Legal cost payment officer
Legal cost payment officer
Legal cost payment officer
Receive legal costs payment request from
‘Legal Costs Validation’
Check if banking details and address
reflect current status
Are the banking details
current?
No
Request latest banking detailsfrom payment
requestor
Verify amount payable against the settled or taxed bill
of costs
YesAny issues with
payment request?
A
Revert back to the employee or unit
senior and raise the matter
Yes
No
Any duplicate payment found?
Escalate duplicate matter to the unit
seniorYes
No
C
Check for duplicate and
prior payments on the system
A
Is the issue resolved?
CYes
B
B
D
Follow up with senior
No
DRefer the details to procurement
4.3.1. Legal costs payment (Part 2 of 2)
Legal cost payment officer
Legal cost payment officer
Legal cost payment officer
Legal cost payment officer
Legal cost payment officer
Second officer checks all aspects of payment as captured by assistant
against the source documentation
Second officer approves payment, confirms that
payment is due and correct and verifies signatures of the
prior two officers
Forward expenditure authorisation and
documents to financeEnd
C
Receive legal cost payment
confirmation from finance
Forward payment confirmation to
claims file closure
1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
4.4.1. Writs payment process
Writ payment officer
Writ payment officer
Writ payment officer
Is the writ amount within
mandate?
Request payment, forward writ with supporting
documents to finance for verification & payment
Yes
Writ payment officer
Diarise follow up in 1 day & verify that payment has been
processed
Has payment been processed?
Treasury
Notify relevant stakeholders, print
confirmation & forward to sheriff
Yes
No
Prepare ES in line with relevant
senior’s mandate
No
Submit ES to senior for approval
ES approved?
No
Writ payment officer
Send payment confirmation to Writ
Management unit and claims file closure
End
Administrative assistant
Receive writ with supporting documents
from Writ Management unit
A
Yes
A
1. Claims Origination 2. Claims Determination 3. Claims Litigation 4. Claims Finalisation
Claims Processing Value Chain
1.1. Hospital service centres
1.1. Community service centres
1.2. Document management
1.3. Registration, validation & verification
1.4. Mobile RAF
2.1. Medical
2.2. Represented claims
2.3. Direct claims
3.1. Summons administration
3.3. Internal law department (ILD)
3.4. Magistrate, high & district court litigation
3.5. Panel attorney management
4.1. Capital payment
4.2. Legal cost validation
4.3. Legal cost payment
4.4. Writs payment
3.6. Judgement monitoring
4.5. Claims file closure
5. Post Claims Settlement
5.1. Post claims management
1.5. Merits
3.2. Writs management
2.4. Supplier claims
4.5.1. File finalisation
Claims finalisation team leader
Administrative assistant
Claims finalisation
officer
Claims finalisation
officer
Claims finalisation
officer
Claims finalisation
officer
Claims finalisation
senior officer
Claims finalisation
officer
Administrative assistant
AAny outstanding
payments?
A
Check against the following:Has capital been paid?Have plaintiff’s costs been paid?Have RAF costs been paid?Have assessors been paid?Have medicolegal experts been paid?Have actuaries been paid?Have sheriff's costs been paid? (If applicable)Has Interest been paid? (if applicable)
No
Send file for archiving
End
Escalate matter to unit senior
Yes
Is it concluded that the file is
finalised?
No
End
YesSenior liaises with
the relevant department
Team leader or senior allocates
newly settled files to team
File is requested from CAFS, ‘Claims Determination’ or ‘Claims Litigation’
Check if file has been settled using
checklist, checking on ‘Claims View’ and
‘Payment system’
Update the file cover, notes on ‘Claims
View’ and change status to “F”
Send the file to CAFS and update notes on
‘Claims View’
Receive payments from other units
· Capital payment· Legal costs· Finance· Writ payment
Frequently asked questions in finalisation
Is capital payment a duplication of effort as this function currently exists in finance?Capital payment will do the checking and finance will do the approval of payments, batch checking and forward the payment to treasury.Capital payment will also be responsible for the manual loading of expert, writ and assessor payments.
Will legal costs validation request payments?Legal costs validation will request payments and these payments will approved by legal costs payments.
Should all payments be amalgamated into one unit (payments)?All payments (legal cost payment, capital payment and writ payment) can be amalgamated into one unit but different officers should handle different portfolios.
Will the finalisation mandate be removed from all other units?The finalisation mandate should be removed from all other units and this should be handled in the claims file closure unit.