Best Practice Guidelines: Healthcare Management Internal Controls

3. Weekly internal controls summary

3.2. Medical aids & stock updates

It is vital that medical aid and stock item information is updated weekly. This will result in fewer claims being rejected and less under-billed claims.

Medical Aid Updates

Medical aid update files are available weekly if the practice is registered with a provider like Medprax. If the practice is not registered to receive update files from a provider, the latest information needs to be sourced by the practice and manually inserted on GoodX.

The following information will be updated with the new files:

  • Routing codes of the medical aids for successful EDI.
  • Discontinued medical aid plans
  • Changed medical aid plans
  • New medical aid schemes and plans
  • Changed medical aid administrators
  • Billing rules for medication and materials

Remember to run the medical enablement to update the new and changed medical aid plans or schemes and check that all new medical aids are linked to the correct price lists.

The update report can be checked to see if the medical aid update was done correctly.

Stock Updates

Stock updates can be done through Medprax, IQest or manually depending on with whom your practice is registered.

  • Medprax has an update available once a week. 
  • IQest has an update available once a day.
  • If the practice wants to do their own updates, the information must be sourced from the manufacturers.

Stock updates will include the following information:

  • Stock prices
  • Discontinued items
  • Nappi Codes
  • Pack sizes
  • Descriptions
  • Strength, Size and Volume
  • Manufacturers
  • Dates of discontinued items

The information must be up to date with the correct information on the items to ensure that claims are paid by the medical aids. Stock updates will also assist in correct stock management in the practice.

The following can be checked when the update is done on the physical stock:

  • Broken Stock 
  • Expired Stock

If the practice has markups on the items, the markup rules must be checked and if every item has its own markup, the item markup must be updated every time when the rule in the practice changes.

When items have been excluded from the Medprax update, the item information must be checked to make sure everything is still correct. The following information must be checked:

  • Nappi Code
  • Packsize
  • Description
  • Price (very important)