Uganda Insurance Regulatory Authority issues medical insurance claims directives setting 30 working day settlement standard

The Uganda Insurance Regulatory Authority has issued Directives on Medical Insurance Claims to streamline and standardise medical claims processing for licensed insurers providing medical insurance and regulated health membership organisations, with the framework coming into force on 30 January 2025. Among the payment requirements, all new service level agreements must specify a claims settlement period of within 30 working days from the date of receipt of a claim, and service level agreements with newly contracted service providers must be submitted to the Authority for review and approval using a standard template. The directives also prescribe end-to-end processing steps, including 24-hour availability of pre-authorisations, stamping and dating claim forms on receipt, coding claims in accordance with International Classification of Diseases clinical modification codes, vetting claims against agreed pricing, and permitting further investigations where fraud is reasonably suspected. After approval of schedules detailing payable and non-payable claims and execution of payments, insurers and HMOs must notify service providers with a remittance schedule, complete reconciliations within 14 working days post-payment, and communicate rejected claims during payments with a 14 working day reconciliation window.