Resource Library for Healthcare Providers on M-TIBA
M-TIBA helps you focus on what matters the most – your patients.
- Seamless patient check-in
- Speed up routine administrative tasks
- Get set up for financial success with timely and reliable payouts
Step by Step Guides
The M-TIBA platform handles administrative tasks and operations related to healthcare plans for insurance companies. This includes processing claims and making payments to healthcare providers on their behalf.
Getting Started on
M-TIBA
Familiarize yourself with the new platform, from logging in and managing your profile, to understanding the new system and who to contact for help.
Navigating the Platform
Step by step guide through the new platform. Understand the full interface and streamline workflows for better care delivery to your patients.
Patient Management on the Platform
Step by step guide through verifying patient eligibility, understanding member benefits, and starting a visit.
Billing and Claims Management on the Platform
Instructions on how to start a treatment, add treatment details, using medical codes and billing for service.
Frequently Asked Questions
M-TIBA streamlines your entire workflow by connecting patients, payers, and providers in one platform. This means:
- Faster patient check-in: Instantly verify insurance, reducing wait times and paperwork.
- Simplified pre authorisation approvals: Submit and track pre-auths electronically.
- Easy claims processing: Submit claims digitally and track them in real-time.
- Faster, reliable payments: Get paid quickly and consistently to improve your cash flow.
By automating tasks and eliminating manual processes, M-TIBA helps you:
- Reduce administrative costs.
- See patients faster.
- Get paid faster and more reliably.
- Focus on delivering quality care to patients.
Integrated Providers | These are healthcare providers where M-TIBA has integrated its portal with their HMIS for ease of billing. |
Non- Integrated Providers | These are healthcare providers who bill directly on the MTIBA portal. |
Inpatient cases | Outpatient cases |
Filled in claims form | Filled in claims form |
Diagnostic results (if applicable) | Medical reports (if applicable) |
Discharge summary | Diagnostic results (if applicable) |
Medical reports (if applicable) |
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Itemized invoice-at discharge |
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Requires Preauthorization |
Does not require preauthorization |
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All admissions and discharges. |
KEPI vaccines. |
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All day cases. |
ANC profiles. |
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Advanced imaging e.g. CT scans, MRI etc |
Bills of less than KES 15,000 per service point for outpatient. |
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General exclusions. |
X-rays and ultrasounds |
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Bills of more than KES 15,000 per service point for outpatient. |
Bills of less than KES 10,000 for dental and optical services.
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Private vaccines. |
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Physiotherapy sessions. |
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Drug prescriptions with supplements. |
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Bills of more than KES 10,000 for dental and optical services. |
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Annual Wellness checks. |
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Baby friendly vaccines. |
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- All advanced imaging requests e.g CT scans, MRIs.
- All specialized procedures.
- All advanced lab requests e.g biofire panels.
- In the absence of a fully filled claim form.
- In cases where the diagnosis given does not match the item requested.
- Self-requested examinations.
Bundled services:
All bundled services must be itemized on the claim form e.g packaged lab tests.
Claim Accuracy:
- Fill in all fields correctly, especially diagnosis, to avoid rejections.
Payment:
- CarePay provides monthly reconciliation reports.
- Payment is based on the number of visits and billed exclusions.
NHIF:
- Scheduled procedures: Request NHIF undertaking for clients. M-TIBA pays the difference after NHIF deductions.
- Emergency procedures: Check if member has NHIF approval. If not, M-TIBA covers the entire cost.
Claims:
- Submit claims within 24 hours of service.
- Fill in the OP claim form electronically (physical copies not required).
- Keep physical forms for 12 months from the treatment date.
- May be requested by M-TIBA Claims Assessors.