FREQUENTLY ASKED QUESTIONS

Hospital (17)

Hospital a page contain the most questions related to Hospitals and any related issues

Below are the list of Hospitals related FAQ's

How much does the injured contributor receive during the period of temporary cessation of work?

a.If, as a result of an employment injury, the injured person is temporarily disabled, he is entitled to a daily allowance for each day of work disability including holidays and weekly rest days during the disability period. GOS will be committed to pay such allowance. The amount of the daily allowance is 100% of the contributory wage. The amount of daily allowance is reduced to 75% while the injured person is under treatment at GOSI's expense at a treatment body

b.The temporary work disability is established by a medical report to be issued by such medical authority, and the injured person for whom the allowance is determined should present himself for medical examination whenever he is requested to do so

c.The daily allowance falls due on and from the day immediately following the date of occurrence of the injury or from the date of work disability if it is later

What would be the solution for: injuries claims that disappear from GOSI site (Online) after reception of the situation and send the initial reports to Riyadh office?

In case a hospital admitted a preliminary medical report admitted, the injury cannot be disappeared and will remain assigned to him until the end of treatment unless the Office re-assigned it to another therapeutic point, it should be contacted with the competent office.

What are the cases in which the payment of daily allowance is suspended?

The payment of the daily allowance is suspended by a decision of the director of GOSI's office to which the injured person belongs, if it is established by a medical report that the injured person has refused to abide by the medical instructions required by his physical condition or to undergo a medical examination

Does the Primary Medical Board determine the state of permanent disability of the injured person as long as he is hospitalized for treatment?

The Primary Medical Board does not determine the state of permanent disability of the injured person as long as he is hospitalized for treatment. It determines the state of permanent disability, if any, after the required treatment is completed and the condition is stabilized and he is discharged from the treating center. As an exception of this, if the treatment center or the office physician discovers that the physical condition of the non-Saudi injured person does not permit him to resume his employment and that he must leave the hospital to his home country directly, the Medical Board may examine him while he is in the treating center. If the Board is satisfied that his condition is stabilized, it may issue its decision before he is discharged from the treating medical center, in which case, the Office coordinates with the employer and arrange for his travel to his home country, so that his cash benefit will be paid to him in due course prior to his departure.

What is the method to deal with such cases transferred through the contracting therapeutic entity to other hospitals?

Cases transferred to other therapeutic entity during the period of hospital treatment.

Example: an injured being treated through a contracting therapeutic entity and during treatment, he was transferred to the National Guard Hospital for three days to have certain services, they shall be dealt with as follows:

*He enters into the treatment period (the three days) through entering the required data into the screen page of “entering treatment periods” at the account of the hospital on the site of insurance online. After being approved by the institution office, the bill of services provided to the injured at the National Guard Hospital shall be entered into the screen page of “entering diverse therapeutic services” with attaching the required documents.

Shall the hospital raise the claim for amounts after the deduction provided in the contract (25% for services and 5% for medicines) or the system shall automatically deduct them before such deduction?

The hospital shall raise the claim for the amounts before the deduction and the system shall automatically deduct them.

Can the hospital make E-claim (using the lifting of the file) and paper service at the same time?

Starting from the date of the paper bills, the request will be accepted electronically for therapeutic services provided after the date of cessation. The previous services can be sent on paper.

What is the mechanism to deal with the prosthetic devices?

The prosthetic devices may be ordered by entering the required data into the screen page of “request for approval of the prosthetic devices” at the account of the hospital on the site of insurance online (as the service makes it available to enter multi pricing for one device, thus the office shall choose what is deemed fit among them).

How to intercept the hospital on the deducted service by the auditors? And would it be in a separate file or add to a current month file?

For example, (7/2013, the first file was uploaded in the second week of the month, in 01/08/2013 been uploaded the fourth file, and after the uploading of the fourth file, the bill is issued. During this period, the colleagues in the Insurance Office for reviewing the file (1), which was uploaded in the second week of the month being it included the deductions and objections adopted by them
These deductions and objections are deducted from the total final bill, the amount that was uploaded by the hospital is two million and an invoice issued by you is 1.5 million due to the presence of the deductions in the first file, or export the invoice by the total amount which is two million. All deductions and objections are listed after a review and audit the last file.
# After the completion of a full review of the bill by the Foundation office, the system automatically sends a notice to the hospital stating the completion of a review. Also, it has a period of 30 days to object and then can the hospital:

- Issue objection through online insurance site (This can be done by going to the "introduction of therapy bills" to screen and then choosing the bill to be challenged and pressure on the deductions addressing button). After reviewing objections at the office, the check will be issued with the invoice
- Or in the absence of objections and the desire to release the invoice, it can be through "the absence of objections" (screen "enter the therapy bills", then choosing the bill to be no-objection to it. After that, the deductions addressing button are pressured, then button there is no objection), which can be from the issuance of a check with the invoice

Is the reference number a unified number until the completion of the treatment period?

Yes, the reference number is unified (for each injury or setback or request to assess the medical committees ).

What is the work mechanism of the electronic approvals?

The request for a therapeutic teratment srvicce approval is insterted by entering the data in the screen "approval request for treatment" in the hospital account on Gosi Online, then to be sent to the office physician for Audit (approval or rejection).

How are approvals obtained through GOSI Website?

A- What about the approvals of medical operations for emergency and urgent cases.

B- What about the approvals of magnetic resonance imaging and CAT scan for emergency and urgent cases.

C- How are the approvals of magnetic resonance imaging and CAT scan for Elective Cases obtained.

D- Physical Therapy, What about the approvals of the medical devices.

* All types of approvals for therapeutic services are provided by data entry in screen "approval request of treatment" in the hospital account on Insurance Site Online and to send to the physician of the office for reviewing (approval or rejection).

For the preparation of claims by the new way ( upload file using the service) to claim the costs of all patients, how can the hospital Determine the charge of the situation and its costs, both Riyadh office or outside Riyadh offices?

When uploading the claims by the hospital with the new way (using the File upload service), the system automatically creates the bill for the competent office, where it is required from the hospital to upload the electronic file with the treatment costs of all cases, regardless the office that injury belongs to.

* Example: the electronic file in January, whereas there are 10 cases concerning the Jeddah office and 50 cases to the Office of Tabuk and the rest of the cases concerning the Riyadh office. The system creates a three bills of the said office.

What is the technique used to deal with patients to be accounted with the lump sum amounts?

It may deal with the patients to be accounted with the lump sum amounts by adding a service for pricing, named "treatment with the lump sum" on the screen " insert a treatment services list" in the hospital accout at Gosi Online. After getting an approval from the office, the invoicing process shall be done by adding the service for each day in which the injured received treatment.

How to deal with the additional discount (example: second and third operations)

It shall be dealt with by adding the service in the additional discount area on the main service record.

When issuing the invoice at the end of the month; can the hospital issue many invoices for each office separately? or collectively in a one invoice?

Yes, it shall issue an invoice for each office separately (automatically). Please review the previous paragraph for more details.

How to deal with the old cases (pre-effective date of the new law? file upload service)?

We deal with old cases (before the date of enabling the new system) by sending a hard copy to the Office by the previous way.

Hospital (17)

Below are the list of Hospitals related FAQ's

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