Administration

Metropolitan Health and Metropolitan Health Risk Management administer and provide managed care services respectively to NIMAS.

Metropolitan Health incorporated the existing office infrastructure and employees of NIMAS to provide members with state-of-the-art claims processing, premium management, client services, communication, financial and actuarial services, access to managed healthcare programmes and customised e-tools through mobile phone and internet technology. Metropolitan Health Risk Management is a team of dedicated and professional staff who administer and provide a full array of managed care programmes to NIMAS members.

• New member registrations take placef daily.
• Existing members are allowed to choose options once a year.
• Claims receiving - NIMAS receives claims via postal system, drop-offs, collections (companies only and subject to size) and EDI.
• Claims payment - NIMAS has two scheduled payment runs per month. These runs include both payments to service providers and members' refunds. The payments are done electronically.
• Chronic disease management (0860 646 272) - NIMAS makes use of a chronic formulary to provide appropriate levels of chronic cover to members.
• Hospital pre-authorisations (0860 646 272) - NIMAS manages these requests Monday to Friday between 08h00 and 16h30. (In the event of an emergency outside of these days and times, members will have 48 hours to pre-authorise hospitalisation).