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Individual clinical needs considered
The Private Health Administrators™ Hospital Risk Management programme provides a personalised approach through Registered Professional Nurses using Scheme system guidelines, protocols and any additional information that may be available to make a funding decision according to individual clinical need rather than a one size fits all approach.
Requests on behalf of members’ from providers and hospitals for authorisation and updates are accepted by email or telephonically. Every request and case is reviewed for validity and authorised by a PHA Nurse rather than a clerk
The PHA system caters for individual needs where the merits of each case can be measured against clinical evidence and scheme benefits.
PHA Case Managers, who are all PHA Nurses review and authorise updates from hospitals and where feasible visit patients in hospital. The PHA authorisation system links ICD10 codes and procedure codes to scheme benefits and length of stay criteria.
If a member is being admitted for a procedure that is likely to exceed benefits, the PHA Nurses will negotiate and liaise with the provider to minimise the risks of benefits being depleted and negotiate with the hospital to reduce costs.
Depending on scheme requirements, clinical audit and processing of claims can be included.
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0860 PHA CARE
0860 742 2273
Durban
PO Box 343, Westville
3630
Fax # 031 267 5169
Contact Us
Johannesburg
PO Box 826, Randburg
2125
Cape Town
PO Box 5636, Cape Town
8000
Welkom
PO Box 57184, Pansig
9465
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