DigitrustNHIS claims that survive vetting
Facilities rarely lose money to rejected claims — they lose it to deductions, quietly, cycle after cycle. Digitrust HMS is designed to catch the errors that cause deductions before the claim leaves your facility, and to reconcile every cedi submitted against every cedi paid.
The money is lost in deductions, not rejections
Sector studies of NHIS district claims have found under 1% of claims rejected outright — but 10–15% of claim value deducted at vetting. Deductions are invisible unless you reconcile line by line. Most facilities never do.
Small errors, repeated
A wrong age suffix here, an unbundled investigation there, a medicine off the NHIS Medicines List — each one a deduction, each one repeated every cycle until someone notices.
Catch it before submission
Digitrust HMS runs every claim through four pre-vetting checks modelled on what vetters at the Claims Processing Centres actually look for — and names the rule each flag fired on.
Reconcile what was paid
Submitted value vs paid value, per claim, per line. When a deduction happens anyway, you see exactly where — with the documentation to query it.
Four checks on every claim, before it leaves
1 · Eligibility
Active NHIS membership verified and stamped at the date of service, with the NHIS or Ghana Card number stored on the encounter. A member who lapses before month-end still had valid cover on the visit date — and your claim can prove it. Expired membership is flagged as an outright-rejection risk, not a deduction.
2 · Level of care
Every G-DRG is checked against what your facility is actually priced to claim — ownership, level and catering status. A health centre preparing a hospital-only code, or a primary hospital adding unbundled INVE investigations that aren’t priced at its level, is stopped with the reason shown.
3 · Clinical coherence
Diagnosis, G-DRG, medicines and investigations must tell one clinical story consistent with the Standard Treatment Guidelines. Severity upcoding and prescriptions outside the NHIS Medicines List are flagged before a vetter ever sees them.
4 · Arithmetic & bundling
The G-DRG already includes routine care. The system prevents double-claiming bundled services, prices every line from the schedule in force on the date of service, and verifies the totals — so arithmetic deductions simply stop.
The complete claims workflow
From the moment a member is registered to the moment the payment is reconciled, every step lives in one system — no spreadsheets on the side, no re-keying into portals at midnight before the deadline.
Claims can be exported for the NHIA e-claims process and prepared for submission through NHIS Claim-it or paper channels — and the module is integration-ready for the NHIA standardized e-claims XML interface.
Demographics, NHIS / Ghana Card capture, folder creation — once, at the front desk.
Membership status confirmed and stored with the encounter, valid at the date of service.
stamped & storedIn NeHFAMS pilot regions, the One-Time Attendance Code is captured at registration and carried into the claim.
rollout-readyTriage, consultation, diagnosis (ICD-10), orders and prescriptions documented in the EMR.
Investigations, procedures and dispensed medicines captured at the point of care — coded as delivered.
NHIS-covered services route to the claim; lawful patient charges route to the patient bill. Unlawful co-payments are hard to record by design.
The claim’s CCC is generated from the encounter record, ready for the claims pack.
G-DRG assignment with age-band and level-of-care validation, priced from the effective-dated tariff schedule.
726 codes · 27 tariff blocksThe four-check engine runs: eligibility, level of care, coherence, arithmetic & bundling. Flags name the rule and the amount at risk.
Monthly cycle managed against the submission window, with claim packs prepared for Claim-it, e-claims or paper channels.
60-day legal backstop trackedEvery claim’s status — prepared, submitted, vetted, paid, queried — visible in one register.
Submitted value vs paid value, line by line. Deductions surface with their reasons, so you can fix the root cause and query what deserves querying.
Cycle summaries, deduction analysis, revenue by payer, ageing of unpaid claims — for management and for the board.
Tariffs as data, never as code
NHIA revises tariffs mid-year — the August 2026 schedule was revised twice in its first month. Digitrust HMS keeps tariffs in an effective-dated table, so a new schedule loads without a software update, and every claim is priced against the schedule in force on its date of service.
Ownership-aware
Public, Mission (CHAG), Quasi-Government and Private facilities are priced differently for the same care. Your profile is set once; every price follows it.
Level-aware
From tertiary hospitals to CHPS compounds, each level claims a different set of codes at different values. The system only offers what your level is priced for.
Catering-aware
For primary hospitals, catering-inclusive vs exclusive status changes inpatient tariffs. Set it correctly once and stop the silent revenue leak.
Ready for OTAC and NeHFAMS
NHIA’s National Electronic Health Facility Attendance Management System introduces a One-Time Attendance Code (OTAC) verifying that a member actually attended before a claim is paid — piloting in four regions since April 2026, with national rollout to follow.
Digitrust HMS treats the attendance code as a first-class field: captured at registration, stored with its verification status, carried into the claim, and flagged when missing in a pilot region. When OTAC reaches your region, you’re already compliant.
Bring your last claims cycle to the demo
We’ll walk your own claims through the four checks and show you what vetting would have caught — before it cost you anything.