Administrative Requirements and Procedures Imposed by Insurers for Cancer Drug Claims

Dr Hamid Razak asked the Coordinating Minister for Social Policies and Minister for Health (a) whether the Ministry is aware of the administrative requirements imposed by insurers on doctors for cancer drug claims under the Cancer Drug List (CDL); and (b) whether the Ministry has endorsed or advised on these procedures for Integrated Shield Plan claims.

Claims for MediSave, MediShield Life (MSHL) and Integrated Shield Plans (IP) are filed electronically through the national claims processing system. The system contains all relevant data fields required for the assessment and processing of claims for cancer drugs listed on the Cancer Drug List (CDL). This minimises administrative hassle and follow-on clarifications from insurers.

The Ministry of Health (MOH) is aware that for some cancer drug claims, especially those for drugs not listed on CDL, insurers may require additional information from healthcare providers. For example, for non-CDL treatments that are not covered by MSHL and IPs but are covered by riders, insurers may need to request for information on whether the treatments have been approved by regulatory authorities or supported by established clinical guidelines, in order to process for reimbursement.

In addition, manual submissions would be required for cases involving providers or payers that cannot be filed through the system. These additional submissions enable insurers to assess the claims and pay out the correct benefits. Where specific feedback about the administrative processes is surfaced, MOH will engage the healthcare providers and insurers to explore opportunities to further streamline the claim processes.