Amended Instructions for the Computerization of Medical Insurance Payments and Claims No. (11) of 2022

In the Name of Allah, the Most Gracious, the Most Merciful

[Logo of the Central Bank of Jordan]

Number: 3/17/ 16604
Date: 21 / 3 / 1444 AH
Corresponding to: 17 / 10 / 2022 AD

Dear Insurance Companies,
Dear Insurance Business Management Companies,

Based on the provisions of paragraph (b) of Article (109) of the Insurance Business Regulation Law No. (12) of 2021, We attach to you Instructions No. (11) of 2022 "Amended Instructions for the Computerization of Medical Insurance Payments and Claims No. (1) of 2020" issued pursuant to the decision of the Board of Directors of the Central Bank No. (181/2022) dated 2022/9/29.

And accept our highest regards,

The Governor
Dr. Adel Al-Sharqas

Copy to: The Jordanian Union of Insurance Companies.

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Number: 3/17/ 16604
Date: 21 / 3 / 1444 AH
Corresponding to: 17 / 10 / 2022 AD

Instructions No. (11)

[Logo of the Central Bank of Jordan]

Amended Instructions for the Computerization of Payments and Claims of Medical Insurance No.
(1) of 2020

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Number: 3/17/ 16604
Date: 21 / 3 / 1444 AH
Corresponding to: 17 / 10 / 2022 AD

Instructions No. (11) of 2022
Amended Instructions for the Computerization of Medical Insurance Payments and Claims No. (1) of 2020

Article (1):
These Instructions shall be known as the "Amended Instructions for the Computerization of Medical Insurance Payments and Claims of 2022" and shall be read together with the aforementioned Instructions No. 1 of 2020 hereinafter referred to as the Original Instructions, and shall come into effect as of the date (2022/9/29).

Article (2):
Addition of a new article to become Article No. (4) with the following text:
The insurance company and the insurance business management company shall be committed to the following:
A- Receiving pre-approval requests from healthcare providers through the system, observing the following:
1- Responding to approval requests for medical services provided to outpatient clinic patients, emergency departments, and emergency hospital admission cases within a maximum period of seven minutes from the time the approval request reaches them. 2- Responding to approval requests for medical services provided to patients in other cases within a maximum period of twenty minutes from the time the approval request reaches them. 3- The response to the request shall include approval of the medical condition or treatment, the coverage value and/or the coverage cap. 4- Automatic update of the pre-approval requests screen and pulling every thirty seconds.

B- Receiving medical claims from healthcare providers through the system and sending responses to all medical services included therein within seven days from the date of receipt in cases fully computerized through the system, with automatic updates of the claims screen and pulling at least daily.

C- Linking their electronic claims systems with healthcare providers to ensure the exchange of approvals and claims through the system when applying the provisions of paragraphs (a) and (b) of this Article. D- Entering and modifying chronic prescriptions for service recipients on the system and updating them at least daily. E- Regularizing their status in implementation of the provisions of paragraphs (c) and (d) of this Article within one month from the date of entry into force of these Instructions.

Article (3):
Addition of a new article to become Article No. (10) with the following text:
1- The provisions of these Instructions shall apply to the insurance business management company when managing the insurance company and self-funded funds, to the extent that they apply to them. 2- Self-funded funds are exempt from any fees or charges when applying the services stipulated in these Instructions, and an agreement may be reached to provide additional services for consideration.

Article (4):
The Original Instructions are amended by renumbering Articles (4, 5, 6, 7, 8, 9) to become (5, 6, 7, 8, 9, 10) respectively, and renumbering Articles (9, 10) to become (11, 12). ---