Welcome To NAMAF

Taking Hands in Namibia's Healthcare

The Namibian Association of Medical Aid Funds (NAMAF) is a juristic body, established in terms of the Medical Aid Funds Act, 1995 (Act 23 of 1995) to control, promote, encourage and co-ordinate the establishment, development and functioning of Medical Aid Funds in Namibia.

Who we are

Vision

To be a recognised leader in the provision of a conducive environment for a sustainable private healthcare funding industry.

Mission

To enable the optimum functionality of the Namibian healthcare industry to maximise value for beneficiaries of medical aid funds.

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Namaf provides Clinical Governance through:

1. Practice Number

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In accordance with regulation 5(1) of the regulations made under the Medical Aid Funds Act, Namaf issues practice numbers (PNs) to healthcare providers.

Practice numbers are a means of identifying healthcare providers and are linked to a scope of practice, which in turn links to procedure codes specific to the scope.

2. Coding structure

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Coding structures are used in the healthcare industry to facilitate the description and billing of health events.

2.1. Diagnostic Codes

The International Classification of Diseases and Related Health Problems (ICD), developed by the World Health Organization, is the international standard for facilitating and organising the communication of a diagnosis of a patient’s condition. Among other things, the ICD coding structure is used to translate diagnoses of diseases and other health information into an alphanumeric code, which allows storage, retrieval, and analysis of the data

2.2. Procedure Codes

Procedure codes translate medical treatments and procedures into numbers. In Namibia, the internationally accepted CPT® (Current Procedural Terminology) code structure, originally developed by the American Medical Association (AMA), is referenced during the development and maintenance processes that apply to the procedure coding systems used by Namaf.

2.2.1. Billing guidelines and rules

Billing guidelines and rules are integral to the Namaf procedure coding structure. They are standards for correct application and usage for the procedure coding structure.

2.2.1. Benchmark Tariffs

The benchmark tariffs themselves, thus, are intended to serve as guidelines as to the reasonable cost of the specified categories of medical services. They are not compulsory – either as a minimum or maximum. Each fund would determine its own benefits and member contributions with reference to the benefit options, which in turn differ in how they are structured. The benefits (level of reimbursement) are usually specified as a percentage of the benchmark tariff.

2.3. Codes for ethical, surgical, and consumable products

The National Pharmaceutical Product Index (NAPPI) codes used in South Africa identify and classify ethical (e.g., medicines), surgical (e.g., prostheses, surgical instruments), and consumable (e.g., gloves, syringes) medical products.

NAPPI codes enable the electronic transfer of information throughout the healthcare delivery chain. Service providers and MAFs can identify items and medicines used in the course of a patient’s treatment and the prices of these items and medicines by using the NAPPI codes.

What we do

Key Activities

The object of Namaf, in terms of Section 10 (3) of the Medical Aid Funds Act, is to promote, coordinate, control and encourage the establishment, development and functioning of the medical aid funds in the country. To this end, Namaf issues practice numbers, which are legally required for any medial service provider who wishes to claim directly from medical aid funds. Namaf also publishes procedure codes billing rules and guidelines which serve as the common mode of communication between medical aid funds and medical service providers when it comes to the submission of claims and the processing and assessment of those claims.

Develop, create & maintain procedure codes, billing rules and guidelines with associated benchmark tariffs

PCNS: - Registration and renewal

Coding Training

Data analysis and reporting
- Industry trends
- Specific investigations

Stakeholders engagement
- Policy makers (MOF/MOH)
- Regulators Namfisa etc.
- Provider groups and individuals

Key Partners

Associates List

Key Partners

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how it works

What we offer

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Key Resources

Human Capital: CEO, expert coder (development, support and training), data analyst, clinical capacity, legal capacity, communication expert, project manager and admin support.

Infrastructure: Office space, provider database, data warehouse and software, reporting management system, customer relations (queries) system.