(Keep reading: Chronic non-communicable diseases impact the finances of the health system: EPS)
“A year ago we made a promise of value and it was to turn Supersalud into an ally, friend and solidarity Entity with the user, and this entails guaranteeing problem-solving capacity. Through this new methodology, we seek to restore the rights of Colombians and work for an equitable and guaranteeing health system with citizens,” said the National Health Superintendent, Ulahí Beltrán López.
As a result, the reasons that previously exceeded 300 were reclassified into 37 specific ones, which allows a more efficient response and according to the
health needs of citizens.
(It may interest you: At the end of 2022, the EPS reported losses of $2.3 trillion, according to a report)
“The new methodology implemented will not change the access mechanisms to
the Supersalud care channels established for users, neither
will generate a variation in the way they are filed. However, if it is a
call to attention to insurers to give priority to claims in
health according to the risk to which the user is exposed,” said Beltrán López.
Capital Salud is a district EPS of the subsidized regime. The picture is only illustrative
– Vital risk claims with a maximum of 24 hours to resolve in the background by the guarded party.
– Prioritized risk claims with a 48-hour response.
– Simple risk claims with 72 hours for resolution.
This change will benefit users, who until now were only offered
two types of risk: regular claims with 5 business days of response and risk
of life with 2 days.
The Supersalud explained through a statement that, when a denial of service is presented, the transfer will be made on a bimonthly basis to the Comptroller General of the Republic through shared access, this in order to initiate investigations or to identify presumed fiscal findings to the detriment of public resources allocated to health.
“We want three types of effects: first, that a complaint be addressed to generate
a more timely, effective and problem-solving response. Second, that the
user can monitor what is the route and trace of it; and the third, that
there is an immediate order of care, as soon as the claim is filed,” added the
Supersalud.
The response to the petitioner with the decision of the EPS must be dated and addressed to the informed address,
It is important to highlight that, in order to respond to the claim, The EPS may not demand from the user documents that are in their possession or in entities that make up their service provider network when applicable.
Another advantage of the new methodology is that before it was not possible to identify if the users had a medical order and now they do.
The response to the petitioner with the decision of the EPS must be dated and addressed to the informed address, the communication must be clear, complete and contain the solution or clarification of the claim and must be accompanied by a copy of the documents deemed appropriate. to support your answer.
(Read also: The reasons for the EPS to affirm that there is a financing risk in health)
It will be understood that there is no response, when it is issued outside the deadlines
according to the type of claim and in cases where the EPS does not
give a substantive solution. In these cases, The EPS has the obligation to
inform the user that, in the event of not receiving a response, they may notify the National Health Superintendency.
In accordance with the provisions of the Circular, non-compliance with the instructions given will lead to the imposition of sanctions after exhausting due process.
