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· A. Eligibility and Registration

My clinic is already participating in ‘Medisave for CDMP’ but is not registered for CHAS. How do I register it for CHAS and do I need to re-register for CDMP?

If your clinic is already accredited under the ‘Medisave for CDMP’ framework, then you do not need to re-register for ‘Medisave for CDMP’. Please click here to register for CHAS. The assigned polyclinic administrator will follow-up directly with you to sign the CHAS contract.

My clinic is currently not participating in ‘Medisave for CDMP’ or CHAS. How do I register it for CDMP and CHAS?

You can jointly register your clinic for CDMP and CHAS accreditation. Please click here for joint registration.

As a doctor, do I need to register for CDMP and/or CHAS?

To participate in CDMP, and thus also for CHAS, doctors providing treatment need to be accredited under the Medisave scheme by MOH. Doctors who are already accredited under the Medisave scheme do not need to register separately for CHAS, if their Medisave accreditation is still valid. 


Medisave accreditation for doctors is renewed every two years. MOH will send you a reminder letter when your Medisave accreditation is due for renewal.


Doctors who are not yet Medisave accredited or who need to renew their Medisave accreditation, please click here .

Why must the medical clinic be CDMP accredited to provide services under CHAS?

The aim of aligning CHAS with the CDMP framework is to incorporate well-established evidence-based protocols for chronic disease management at the primary care setting, as we extend patients’ access to subsidised chronic disease care. Streamlining CHAS registration with CDMP accreditation also reduces duplication of accreditation and training processes required for clinics and GPs providing treatment for chronic diseases.

I would like to participate in CHAS but I do not expect to make Medisave claims for my patients. Do I still have to complete all the setup and paperwork for the submission of Medisave claims (Contd)

(Contd) such as applying for GIRO with CPF Board/NCS and purchasing the token card etc.?

 

Although you may not expect to use Medisave for CHAS patients, your patient may be able to use the Medisave accounts of his immediate family members to help pay for his treatment. To avoid delays in such cases, clinics are encouraged to complete all the setup and paperwork for the submission of Medisave claims to enable you to make Medisave claims for both your CHAS and non-CHAS patients.

How will I know if my application is successful?

After you have completed the online application, you should receive an acknowledgement email informing you that your application has been received and is being processed.

If you have signed up for both CDMP and CHAS, you would need to complete the CDMP e-learning module first which includes the Medisave claims submission process and CDMP clinical data submission. After your clinic has completed this training, your assigned polyclinic administrator will contact you to sign the CHAS contract.

If you have signed up for only CHAS (as you are already CDMP accredited), you will receive an acknowledgement email upon completing the online registration. The assigned polyclinic administrator will contact you to sign the CHAS contract.

When do I attend the clinic training required for CDMP accreditation?

The clinic training requirement for Medisave CDMP accreditation is now conducted through e-learning. Users can complete the accreditation at their own convenience. There will be no more classroom training for Medisave accreditation.  

 

To register for e-learning, please click here.You may also wish to apply for training exemption via this link. The registration will take approximately 2-3 working days to process. Thereafter, you will receive an email notification with e-learning login details. Please note that if your clinic is currently not Medisave-accredited, you will need to first submit an application for accredition before registering for e-learning.   

 

Who will sign the CHAS contract with me? When will this happen?

All clinics signing up for CHAS will be assigned to a polyclinic administrator that will contact you and sign the CHAS contract with you after your clinic has achieved CDMP accreditation

Can I choose which polyclinic administrator I would like to sign the CHAS contract with?

Clinics are assigned by the system to a particular polyclinic administrator (e.g. NHGP or SHP) at the point of application in order to facilitate the administration of CHAS by the polyclinics, from registration to claims processing.

· B. Services Provided

Who qualifies for treatment as a patient under CHAS?

Patients who hold a valid CHAS, Pioneer Generation (PG) or Public Assistance (PA) card are eligible to receive subsidies for treatment of conditions covered under CHAS. For patients with the Public Assistance (PA) card, there will not be any patient payable amount, and the cost of the bill will be reimbursed in full to the clinic.

Merdeka Generation seniors will receive special CHAS subsidies at CHAS clinics from 1 November 2019.

How can I help my needy patients to apply for the CHAS card?

You can direct them to the nearest CDC, Community Centre/Club (CC), polyclinic or restructured hospital to apply for the card. If you wish to keep some copies of the CHAS application form and brochures in your clinic to give to needy patients, please contact AIC at gp@chas.sg or 6632 1199 to request for the materials to be delivered to your clinic. 

Alternatively, these can be downloaded here.

What types of medical treatment can be claimed under CHAS?

Under CHAS, you can claim subsidy from the Government for the provision of treatment for acute and chronic conditions. Please login to the MOH Healthcare Claims Portal (MHCP) for more information.

What do CHAS subsidies cover?

CHAS subsidies can be used to cover relevant consultation fees, medication and basic investigations/lab tests, up to the respective per visit and annual patient subsidy caps.

Where do I send a CHAS patient to if he needs a laboratory test or X-ray as part of his treatment? Does CHAS subsidy cover the cost of such investigations?

If the investigations required are not available at your clinic, you can send CHAS patients to have the test done at the most affordable and convenient laboratory/diagnostic centre or radiological centre. If the investigations are relevant to the patient’s chronic condition(s), the cost of such investigations can and should be claimed from CHAS subsidy. The per-visit and annual patient subsidy caps would still apply and no additional subsidies would be given for such investigations.

· C. Patient Visit

Are both the patient and I still required to sign the CHAS Patient Consent Form (PCF)?

For visits on/after 1 January 2017, you and your patient no longer need to sign the PCF. This is because your patient will be deemed to have given their consent for your clinic to disclose their information with the Ministry of Health and its authorised agents, when they use the Health Assist or Pioneer Generation card at your clinic.

 

For your existing signed PCFs, please retain them for at least 6 years from the time they were signed, as per the 2015 National Guidelines for Retention Periods of Medical Records. Original paper records may be destroyed upon digitisation of medical records, as long as the copies are accurate and satisfy the legal requirements for admission as seconday evidence in court.

How do I categorise CHAS patients into Simple chronic vs. Complex chronic? (Contd)

(Contd) Can a patient be re-categorised from simple chronic to complex chronic and vice versa? How should this be reflected?

Please refer to the table below for the clinical definitions of how to classify patients into the correct tier.

Table: Patient Classification According to Disease Severity  

Tier  Description 
Simple chronic
One chronic condition, either on/not on medication

Complex chronic

 One chronic condition with complication(s) (e.g. with diabetic nephropathy, retinopathy, diabetic foot or ischaemic heart disease)
  More than one chronic condition (i.e. any combination of chronic conditions under CDMP)

 


This assessment should be done during each patient visit. The claim made for the visit should reflect the tier assigned, based on the GP’s assessment of the patient’s condition for that visit.

If during the course of managing the patient’s chronic condition(s), the patient develops complications or his/her condition improves, the patient should be re-classified to complex chronic or simple chronic accordingly. Clinical data submitted for the patient should match the tier assigned. For example, if the patient is diagnosed as having diabetes and hypertension, clinical data should be submitted for both conditions as per CDMP requirements.

Can a CHAS patient see me for both acute and chronic conditions in the same visit?

Conditions covered under CHAS Acute can be claimed as part of a CHAS Chronic claim only when the patient consults the doctor on both CHAS Acute and CHAS Chronic conditions during the same visit. For such CHAS Chronic claims, the CHAS Acute claim cannot exceed the maximum CHAS Acute subsidy (i.e. $18.50 for CHAS Blue and $28.50 for PG) that the patient would have been eligible for if a separate visit/claim had been made for the CHAS Acute condition(s). 

 

Is there a limit on the number of visits a CHAS patient can make?

It is generally not expected that a patient would need to make more than 1 visit a day or more than 4 visits per month to the clinic. Clinics are also not allowed to make more than one acute or one chronic claim on the same day for the same patient.

From 2020, MOH will be instituting a limit on the number of visits for common illnesses allowed under CHAS to be 24 per year per patient, across all CHAS clinics. We have assessed that it is not expected that more than 24 visits per year would be required for common illnesses. This guideline has been put in place to limit potential abuse of subsidies and to ensure that patients with multiple, frequent visits and might potentially require specialist or hospital care are reviewed in the appropriate setting in a timely manner.

If I have a patient who is currently being seen at the polyclinic for his chronic conditions but wishes to seek treatment with my GP clinic under CHAS, how can I access his previous medical (Contd)

(Contd) records to continue their care?

 

Patients will need to obtain a memo from their previous polyclinic doctor so that you may provide the continuity of care. Alternatively, medical history will have to be obtained from the patients.

· D. Clinical Data Submission

Why must I submit clinical data for the patient’s chronic condition(s)? How and when do I submit this data?

Clinical data submission is a key component of the CDMP framework, which is important to MOH as it allows for the evaluation of clinical outcomes with the goal of improving overall health of the population. For individual GPs, clinical data submission is equally important as a clinical quality improvement tool for self-evaluation. For a more detailed discussion of clinical data submission requirements and benefits, please refer to the latest Handbook for Healthcare Professionals 2018. 


For those clinics using the CMS platform, submission of clinical data for your CHAS patients can be done directly within CMS itself using the same method as for CDMP submissions. For clinics doing web-based submission of claims, the submission of clinical data should be done via the MOH Healthcare Claims Portal(MHCP)

If I have a CHAS patient who is using Medisave to pay for his bills in addition to the CHAS subsidy, (cont'd)

(cont'd) must I submit two sets of clinical indicators on MediClaim as well as MHCP?

For such patients you would only need to submit clinical data either via the MOH Healthcare Claims Portal (MHCP) or CMS. The same set of clinical data does not need to be re-entered on MediClaim as it will be integrated backend at the database level.

· E. Financial Matters

How much should I charge the patient?

GPs have the autonomy to determine the reasonable rate to be charged to their patients. CHAS patients are expected to co-pay for their treatment under CHAS. However, for patients on the PA scheme, no fees should be collected from them– the full visit cost will be reimbursed by the Government. Clinics have 30 days from the patient’s visit date to submit a claim.

Can I help a CHAS patient make a Medisave claim for his treatment?

Medisave claims can only be made for the treatment of chronic conditions covered under CDMP. For such treatments, CHAS patients can make use of their own or their immediate family members’ Medisave account(s) to help pay for the remaining bill after CHAS subsidies has been deducted. Prevailing Medisave rules and withdrawal limits would apply. Medisave can only be used to co-pay the remaining bill after deducting CHAS subsidies.

If a patient consults more than one GP for his chronic conditions, would I still be able to draw on the full annual subsidy or is this shared between the GPs?

The annual subsidies for chronic conditions are allocated to the patients i.e. the subsidy cap of will apply across all GP clinics/consultations. However, patients are encouraged to stay with the same family physician for all their primary care needs so that they can receive holistic care.

How do I check my patient’s balance for his annual subsidy for the treatment of chronic condition(s)?

Both the CMS and MOH Healthcare Claims Portal (MHCP) platforms include a function for you to check your patient’s annual subsidy balance for chronic treatment using the patient’s NRIC number. Please refer to the CMS and MHCP user guides for detailed instructions on how to do this.

If patients who come to see me for chronic treatment have already made claims up to their annual subsidy cap, can I make an additional claim?

You cannot make additional chronic claims under CHAS if the patient’s annual subsidy cap for the treatment of chronic condition(s) has been reached. Claims made cannot exceed the per visit cap and the patient’s annual subsidy balance.

How are patients tier classification – simple chronic or complex chronic registered by the system? (Contd)

(Contd) Is the tier classification for the purposes of determining the annual subsidy cap the same as the classification for each visit?

 

The assignment of simple chronic or complex chronic classification is done via the CHAS claims process. Each visit claim should include a tier classification for the patient. Based on the history of assigned tiers for past claims, the system will set the annual subsidy cap that will apply for the calendar year accordingly. Regardless of the annual subsidy cap that is in place for the patient, GPs should assign the appropriate tier classification to the patient at each visit based on their diagnosis of the patient’s condition at that point in time, as the clinical data submitted would need to match the tier classification assigned.

Will there be transaction fees deducted for submitting claims and clinical data?

There will not be any additional transaction fees deducted from the subsidy amounts claimable for acute and chronic visits.

I submitted a CHAS claim but it was rejected. What are the possible reasons for this?

Claims may be rejected for various reasons (e.g. annual subsidies for the patient has been fully utilised). Please contact your CHAS account manager to enquire on such claims.

I checked the annual subsidy balance for my patients prior to submitting the claims and there were sufficient balances for the amount being claimed. (Contd)

(Contd) However, I was subsequently informed that the claims were unsuccessful, as the CHAS annual subsidy cap for patients had been exceeded. Why did this happen?


This could happen if there is a lag between the time you checked the balance and when you submitted your claim. In the interim, additional claims could have been made that used up the annual subsidy balance.

For example:

Date Item Remaining
CHAS
annual
subsidies
displayed
upon check
CHAS
subsidies
claimed
Actual
annual
subsidies
left
1 Nov Patient Visit 4 $60 - $60
15 Nov Patient Visit 5 $60 - $60
20 Nov Claim
submitted
for
Visit 5
- $60 $0
30 Nov Claim
submitted
for
Visit 4
- $60 (this
claim will
be
rejected)
$60

Since the claim for Visit 4 was only submitted on 30 Nov, the balance was used up by the claim submitted for Visit 5 in between the time the balance was checked and when the claim for Visit 4 was submitted.

When will the polyclinic reimburse my claim?

You will be reimbursed within 1 month from the receipt of your claim if there are no queries. If there are queries relating to your claim, payment will be made to you within 7 days after the resolution of all such queries.

Are we required to issue itemised bill to all CHAS patients?

Itemised bills will help your patient better understand the charges for the services and medication received, and know how much CHAS subsidy the clinic is claiming for him/her.

 

From 1 January 2017, all CHAS clinics are required to issue an itemised bill to all CHAS (including PG and Public Assistance) patients. This includes patients whose charges are covered fully by CHAS subsidies and do not make any out-of-pocket payment. The itemised bill must at least state the following:  

  • the total charges before CHAS subsidy (with a breakdown into Consultation, Medication, Investigation and Others);  
  • the total CHAS subsidy given; and  
  • the remaining amount that the patient pays.

 

Please note that if your clinic already issues bills that are more detailed, you do not need to make any changes to your bill format.  

 

Minimun level of bill itemisation required:   

Description   

Price (Before Subsidy)   

(Example)    

Consultation   

$20.00  

Medication  

$15.00  

Investigation  

$5.00  

Others (e.g. procedures)   

$0.00  

  

  

Total Bill Before Subsidy  

(including GST, where applicable)  

$40.00  

- CHAS Subsidy   

$18.50   

= Amount You Pay   

$21.50  

 

You may contact your clinic’s AIC account manager to seek any clarification or help if needed. 

 

· F. Referrals to Specialist Outpatient Clinics (SOCS)

If I refer CHAS patients to a SOC for treatment, will the patients be charged at a subsidised rate?

CHAS patients referred by a participating CHAS GP will be considered a subsidised patient at the SOC. However do note that this must be an unnamed referral. In addition, please complete the CHAS Referral Form for subsidised Specialist Outpatient Clinics (SOCs) at public hospitals and attach it to your referral. When calling the public hospital for an SOC appointment, please inform the SOC of the patient’s CHAS status. Patients have to produce these documents, their CHAS/ PA card and NRIC upon registration at the SOC.

Can such subsidised referrals be made for conditions not covered by CHAS? Can I refer a CHAS patient directly for specialised tests at the SOC to be charged at subsidised rates?

The referral is not limited to the conditions that are covered by CHAS. For example, you can refer a CHAS patient to the SOC for suspected cancer and this would still be considered a subsidised referral. However, the subsidised referral must be made to the SOC and not directly to the laboratory, to ensure that the test ordered is necessary for the patient’s condition.

Can CHAS Green cardholder qualify for subsidised referrals to SOCs in public hospitals?

As both CHAS Green and MG cardholders are considered subsidised medical patients, CHAS Green and MG cardholders can also enjoy subsidised referrals to medical SOCs.
However, as CHAS Green cardholders do not receive dental subsidies, they would not qualify for subsidised referrals to dental SOCs. 

· G. Audits

What aspects of compliance could I be audited on?

The polyclinic administrators may conduct operational and clinical audits on your clinic to check for compliance with the CHAS guidelines. The following table summarises the areas of compliance that may be audited:-

 

Type of audit  Aspects of Audit 
Clinical

• Patient Consent Forms (PCFs) are required to be submitted for audit, for visits before 1 January 2017. For visits on/after 1 January 2017, clinic would no longer need to submit the PCFs for audit.

 

• Patient's classification into simple chronic or complex chronic was in accordance with his level of disease severity, and for condition(s) with complication(s), that the causal relationship or link between the condition(s) and its complications was documented.

 

• Clinical data was submitted as required under the CDMP guidelines.

Financial

 • Financial data was submitted for each visit for which a claim for Subsidy reimbursement under CHAS was made as required in the contract. 

 

• The CHAS Subsidy was used in accordance with specifications in the contract and such guidebook or guidelines that the Administrator or MOH may issue regarding CHAS (Medical), and in particular, that the CHAS (Medical) Subsidy for Chronic Conditions was used for the treatment of Chronic Conditions according to evidence-based treatment programmes and that regard was had to, amongst other things, clinical practice guidelines issued by MOH for chronic disease management. 

 


 

What types of documents must I keep for audit purposes?

For the purposes of meeting the above audit requirements, GPs and the clinics are minimally required to keep the following set of documents:- 

    a) Patient Consent Forms are required to be submitted for audit, for visits before 1 January 2017. For visits on/after 1 January 2017, clinic would no longer need to submit the PCFs for audit. 
    b) GP’s clinical notes stating classification of patient into simple chronic or complex chronic and for complex chronic patients with complications, documentation of the causal link between the chronic conditions and its complications; 
    c) Prescription or clinical notes detailing medication prescribed to the patient, if any; 
    d) Records of laboratory tests carried out for diagnosis and follow-up, if any; and 
    e) Records showing the itemised breakdown of the bills submitted for CHAS claims, including a record of the amount paid by the patient.

Who will conduct the audit?

Audits may be conducted by the polyclinic administrators or MOH appointed auditors.

When will audits be conducted?

Audits will be scheduled by auditors and may not occur during the same period for all participating GP clinics. A formal notice will be sent to your clinic informing you of an impending audit and sufficient notice will be given for you to collate the necessary documents for audit.

What will happen if discrepancies are found during an audit of my clinic?

In the event that discrepancies are found during the audit, the polyclinic administrators/MOH reserves the right to hire an independent party to conduct further investigations into the matter if need be. If non-compliance is determined, the polyclinics/MOH may issue a warning letter and/or terminate a clinic/GP’s CHAS approved status as provided for in the CHAS Contract.

If it is found that improper claims were made, GPs will be required to: 
    1. reimburse to the polyclinic any subsidy wrongfully received; and/or 
    2. amend the claim and reimburse any affected Medisave account(s) if necessary.

If you have a question on CHAS which is not covered in this FAQ, kindly contact AIC at gp@chas.sg or 6632 1199