Departments - Police HMO - Promoting Excellent Healthcare

Our Departments
Police HMO

OUR DEPARTMENTS

MEDICAL SERVICES

This unit ensures Health Care Providers (HCPs) under PHML are continuously being monitored in order to provide high standard of health care services to the enrollees.

Monitoring and Evaluation/ Quality Assurance

This unit ensures Health Care Providers (HCPs) under PHML are continuously being monitored in order to provide high standard of health care services to the enrollees.

Encounter Data

The unit collates data, enters and analyze all enrollee visits and encounter with the HCPs under PHML network in a bid to determine the health care service utilization by our enrollees, disease trend distribution in various states of the country.

Case management

This unit helps in planning and coordination of healthcare services appropriate to achieve the desired outcome. It includes care assessment, including personal interview with the enrollee, and assistance in developing, implementing and coordinating a medical care plan with healthcare providers, as well as the enrollee and his/her family and evaluation of treatment results.

Monitoring & Evaluation/Quality Assurance

The HCPs under PHML are continuously being monitored to ensure that high standard of health care services is provided to the enrollees. In order to achieve this, the department undergo monitoring and evaluation of the facility’s human and material resources by ensuring the availability of qualified personnel, equipment/tools and standard operational procedures and NHIA guidelines are followed at all the service points, and the services have the desired effect on the beneficiaries.

Call Center

This unit is responsible for issuing authorization and referral codes to Health Care Providers for our enrollees for various medical treatments. It also serves as center for receiving and addressing complaints from the enrollees as well as the HCPs.

Hospital Liason

Serves as intermediary between Police HMO and the Health Care Providers.

Finance & Accounts

The Finance and Accounts Department is responsible for recording all financial transactions of the company, ensuring effective and efficient financial management and control, and providing support and advice to management for the smooth and optimal operation of the organization.

The department is responsible for these tasks in the areas of budgeting, taxation, general administration, and regulatory compliance. It holds a pivotal position in the administration of capitation and Fee-for-Service.

The Finance and Accounts Department is responsible for the following:

Statutory Payments:
- Capitation Payment
- Fee for Service
- Tertiary Assistance
- Others

Employee/General Payments:
- Salary Payments
- Tax Deduction & Remittance
- Pension Deduction & Remittance
- Accounts Payables/Receivables

Management Information System:
- Annual Accounts & Financials
- Quarterly Management Reports
- Annual Budget
- Etc

Information & Communication Technology (ICT)

The Information & Communications Technology (ICT) Department plays an indispensable role within Police Health Maintenance Limited (PHML) due to its pivotal contributions to various critical aspects of the company's functioning. Understanding why the ICT Department is vital requires a closer look at its multifaceted responsibilities and how they directly impact the overall effectiveness and efficiency of the company.

Strategic Alignment

The ICT Department is responsible for developing IT strategies that are closely aligned with the overarching objectives of the company. In a dynamic and technology-driven healthcare landscape, having a well-defined IT strategy is essential for adapting to industry changes, improving patient care, and staying competitive.

Communication and Collaboration

Effective communication and collaboration are essential within the healthcare sector, where timely information sharing can be a matter of life and death. The ICT Department develops and supports the network infrastructure that ensures seamless communication among healthcare providers, administrative staff, and patients. This connectivity enables real-time collaboration, improving patient care coordination and administrative efficiency.

Security and Data Integrity

Healthcare organizations handle sensitive patient data that must be safeguarded. The ICT Department plays a critical role in maintaining IT infrastructure security to protect patient records from unauthorized access and cyber threats. Ensuring data integrity is paramount for both compliance with regulations and building trust with patients.

Operational Continuity

The reliability of IT infrastructure is non-negotiable in healthcare. The ICT Department is responsible for ensuring that all IT systems remain operational around the clock. Downtime can lead to disruptions in patient care, billing, and other critical functions. Hence, the ICT Department's role in maintaining operational continuity is vital for the company's day-to-day functioning.

Data-Driven Decision-Making

In today's data-driven world, access to accurate and timely information is essential for making informed decisions. The ICT Department generates operational reports that offer insights into various aspects of the company's performance.

The Information & Communications Technology (ICT) Department is the backbone of the entire PHML operations. Its functions extend far beyond merely managing technology; it actively contributes to the achievement of company's goals, enhances patient care, ensures compliance, and fosters innovation.

Within the ICT Department, several organizational units work collaboratively to fulfill these critical responsibilities:
1) Data Management & Analysis
2) Support & Maintenance Services
3) IT Infrastructure & Services
4) Applications Development & Administration

Business Development & Corporate Affairs

This department is made up of two major units:

Business Development

The Business Development unit that is tasked with enrolment and sensitization of enrollees into the scheme, i.e. serving and retired Police Personnel and their families as well as civilian members of the society are identified, enrolled and periodically sensitized on the workings of the National health insurance.

Corporate Affairs

Corporate Affairs unit is in charge of both internal and external communication as well as forging the public image of the organization. The unit also keeps track of information as it concerns PHML while generating and disseminating same when required knowing that the value the public puts on the organization is determined by its perception. This, it achieves through Public, Government and Media Relations, Advocacy, Corporate Social Responsibility etc.

OPERATIONS

The Operations department is responsible for processing fee-for-service claims, resolving/reconciling disputed claims, monitor (for claims purposes) medical episodes in order to prevent unnecessary treatment, duplication of services and to uncover opportunities to maximize greater outcome. The department also ensures sound risk assessment and pricing practices by improving risk assessment, cost control, compliance and regulatory adherence, customer satisfaction and data analysis and insights. The department consists of three (3) basic units:

Claims Management Unit

The Claims Unit is responsible for all processes concerned with the medical and financial adjudication of fee-for-service claims presented by health care providers for payment. This includes, but not limited to claims eligibility screening, medical necessity, financial tariffing, data capturing and creation of payment manifest.

Reconciliation Unit

The unit is responsible for all processes relating to the receipt, collation and resolution of complaints emanating from Healthcare Providers such as non-payment of fee-for-service claims, short payment of fee-for-service claims, non-payment of capitation, non-submission of payment advice to HCFs after payment of fee-for-service claims, non-submission of payment analysis to HCPs after payment of fee-for-service claims. It is also the responsibility of the unit to obtain Letters of Non-indebtedness (LONIs) from HCPs after successful reconciliation and submit same to the National Health Insurance Authority (NHIA).

Underwriting Unit

The main function of the Unit is to enhance the organization's underwriting capabilities and ensure sound risk assessment and pricing practices by improving risk assessment, cost control, compliance and regulatory adherence, customer satisfaction and data analysis and insights.

Human Resources & Staff Development

At Police Health Maintenance Limited, we believe that our greatest asset is our people. The Human resources department is committed to fostering a supportive, inclusive and engaging workplace culture where team members can thrive.

The department is tasked with the responsibility of; hiring qualified persons with requisite qualification and possibly wealth of experience relevant to the working process of the organization, keeping them engaged, Leave Management and supporting their growth and development within the Head Office and 36 state offices around the country.

Human Resource leads Recruiting and Employee Onboarding and as well assists Managers and Team Leaders towards improving the processes and practices within the organizations as it concerns staff development. Ensure that Human resource database is up to date, accurate and complies with legislation or in accordance with the service manual and extant laws.

The department is responsible for the management of the day-to-day operations of all personnel matters guided by the implemented Human resource procedures and policies.

The department consist of five operational unit:

1) Recruitment and Staffing
2) Performance Management
3) Compensation and Benefits (Welfare)
4) Training and Development / HR Information Systems
4) Employee Relations and Discipline

Internal Control & Audit

The Internal Control and Audit Department is The Board's functional and Management's administrative institution positioned to improve the effectiveness of business governance.

We demonstrate commitment to professionalism and objectivity, in discharging our duties which are not limited to:

1) Establishing and sustaining a working relationship with other departments with a view to driving compliance to organisational policies.
2) Review of organisation's Information and business processes for effectiveness, with the aim of making recommendations for improvement where there are opportunities to do so.
3) Assessment of risk and its management procedures, thereby controlling risk appetite and defining risk limits.
4) Evaluating the means of safeguarding assets and as appropriate, their verification.
5) Ensuring that the organisation is complying with regulatory and statutory provisions to avoid the sledgehammer of the law.
6) Promoting responsible leadership, accountability and commitment to a competent/motivated workforce.
7) Evaluating management controls for adequacy and effectiveness.