SLA knowledge
Not yet approved. Analyses can still use it; approving records the version you stand behind.
What to bring
Drop in everything you hold for this area. More is better — the app tells you what is missing rather than refusing incomplete input.
- The signed Service Level Agreement and every schedule attached to it
- Any addendum, side letter or renegotiation memo that changed a term
- Circulars from the HMO announcing a rule change
- Notes on anything agreed verbally that the officer relies on in practice
Warnings and flags
None of these stop you working. A flag marks something whose absence quietly distorts naira findings; a warning marks something worth knowing.
1 document carries no date
• 2025-02-25-NMSL-VenusMedicare-SLA.pdf (2025-02-25-NMSL-VenusMedicare-SLA.pdf) — no date found in the file
Where the app looked: Searched for an effective date, a commencement date, and any date written in the first pages
What to do: An undated document cannot be shown to have applied on a given date of service. Set the date by hand so findings drawn from it can be cited.
"2025-02-25-NMSL-VenusMedicare-SLA.pdf" was transcribed, not read directly
Transcribed prose is usually reliable but never certain. Spot-check any figure or date drawn from this document before it goes into a letter to the HMO.
Where the app looked: 2025-02-25-NMSL-VenusMedicare-SLA.pdf
What to do: Findings citing this document are marked as transcribed.
SLA commencement / effective date — mentioned but not pinned down
The subject is discussed in your documents, but no exact value has been extracted, so the app cannot use it in a finding. Without it, nothing in this agreement can be tied to a date. A claim cannot be tested against the version of the rules that applied on its date of service, and every clause citation is undated.
Where the app looked: "effective date" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
What to do: Open the item, read the passage, and enter the value so analyses can rely on it.
Services always needing Pre-Authorization — mentioned but not pinned down
The subject is discussed in your documents, but no exact value has been extracted, so the app cannot use it in a finding. Categories that need a code regardless of cost — usually admissions, surgery, imaging and specialist referral. A value threshold alone will miss these, and they are the highest-value claims in the batch.
Where the app looked: "admission" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
What to do: Open the item, read the passage, and enter the value so analyses can rely on it.
Claim submission deadline — mentioned but not pinned down
The subject is discussed in your documents, but no exact value has been extracted, so the app cannot use it in a finding. The window for getting claims in after the month of encounter. Missing it voids otherwise valid claims, and it is the only defence against a late-submission denial.
Where the app looked: "submission of claims" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
What to do: Open the item, read the passage, and enter the value so analyses can rely on it.
Payment timeline — mentioned but not pinned down
The subject is discussed in your documents, but no exact value has been extracted, so the app cannot use it in a finding. How long the HMO has to pay after a clean claim. Needed to say whether a payment is genuinely overdue before the hospital escalates.
Where the app looked: "settle" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
What to do: Open the item, read the passage, and enter the value so analyses can rely on it.
Exclusions — mentioned but not pinned down
The subject is discussed in your documents, but no exact value has been extracted, so the app cannot use it in a finding. Services the agreement does not cover at all. Without the list the app cannot warn before a service is rendered, and every exclusion denial arrives as a surprise.
Where the app looked: "exclusion" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
What to do: Open the item, read the passage, and enter the value so analyses can rely on it.
Co-payment rules — mentioned but not pinned down
The subject is discussed in your documents, but no exact value has been extracted, so the app cannot use it in a finding. Where the enrollee pays a share. Affects what the hospital may collect at the desk and what it may bill the HMO, so getting it wrong double-bills the patient.
Where the app looked: "copayment" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
What to do: Open the item, read the passage, and enter the value so analyses can rely on it.
Emergency treatment rules — mentioned but not pinned down
The subject is discussed in your documents, but no exact value has been extracted, so the app cannot use it in a finding. Emergencies normally suspend the Pre-Authorization requirement for a stated window. This clause is the standard answer to a no-authorization denial on an emergency case.
Where the app looked: "emergency" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
What to do: Open the item, read the passage, and enter the value so analyses can rely on it.
Dispute / reconciliation process — mentioned but not pinned down
The subject is discussed in your documents, but no exact value has been extracted, so the app cannot use it in a finding. The agreed route and time limit for challenging a deduction. Without it the officer has no procedural footing for a reconciliation letter.
Where the app looked: "dispute" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
What to do: Open the item, read the passage, and enter the value so analyses can rely on it.
Tariff reference and review cycle — mentioned but not pinned down
The subject is discussed in your documents, but no exact value has been extracted, so the app cannot use it in a finding. How the agreement points at the price list and how often prices are renegotiated. Determines whether the tariff on file is still the operative one.
Where the app looked: "tariff" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
What to do: Open the item, read the passage, and enter the value so analyses can rely on it.
Scheme type (fee-for-service / capitation) — mentioned but not pinned down
The subject is discussed in your documents, but no exact value has been extracted, so the app cannot use it in a finding. Capitation pays a flat sum per enrollee per month; fee-for-service pays per item. Analysing a capitated claim line by line produces findings that mean nothing.
Where the app looked: "fee-for-service" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
What to do: Open the item, read the passage, and enter the value so analyses can rely on it.
Termination / notice period — mentioned but not pinned down
The subject is discussed in your documents, but no exact value has been extracted, so the app cannot use it in a finding. Bounds how long the agreement can be relied on, and matters when a provider is deciding whether to keep extending credit to a slow-paying HMO.
Where the app looked: "terminate" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
What to do: Open the item, read the passage, and enter the value so analyses can rely on it.
Digest
This — not the raw documents — is what every analysis reads. Correct anything the app got wrong; your entry always wins and survives re-checks.
SLA commencement / effective date
Discussed in your documents but no value extracted: “…over including Beneficiaries from Plans developed after the effective date of this Agreement. 2.2. Benefits. General Medical Health Care Provider shall provide or arrange for all General Health Care Services covered by…”
Source: "effective date" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
Enter the value
Pre-Authorization threshold
entered by youDiscussed in your documents but no value extracted: “”
Source: Clause 1.19 "Pre-Authorization (PA)", page 4; Clause 2.17(a) "Submission of Claims", page 8
Enter the value
Services always needing Pre-Authorization
Discussed in your documents but no value extracted: “…d throughout this agreement are defined as follows: 1.1. **Admissions** – The hospitalization of a Beneficiary for a least one Inpatient Bed Day; 1.2. **Agreed Tariff** – The Agreed Tariff Rates are the preferential ra…”
Source: "admission" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
Enter the value
Claim submission deadline
Discussed in your documents but no value extracted: “…in advertising and marketing materials. 2.17. Claims. a. Submission of Claims- Claims for Covered Services provided to Beneficiaries shall be submitted to **"VML"** using **VML's** approved claim forms or, if submitti…”
Source: "submission of claims" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
Enter the value
Payment timeline
Discussed in your documents but no value extracted: “…on, conditions or restrictions; or becomes the subject of a settlement Agreement with the Board of the Medical and Dental Council of Nigeria (MDCN) 6 --- b. General Medical Health Care provider becomes the subject of…”
Source: "settle" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
Enter the value
Exclusions
Discussed in your documents but no value extracted: “…ditions as determined by the admitting consultant. 1.11. **Exclusions (Non-Covered Services)** – Means services that are outside of the covered benefits of the Beneficiary for which the HMO is not liable to pay when off…”
Source: "exclusion" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
Enter the value
Co-payment rules
Discussed in your documents but no value extracted: “…price agreed in advance of provision of the Service. 4.3. Copayments. General Medical Health Care Provider shall diligently pursue and have sole responsibility for collection of any applicable repayment from Beneficiar…”
Source: "copayment" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
Enter the value
Emergency treatment rules
Discussed in your documents but no value extracted: “…or by calling our 24 hours call centre. Except in cases of emergency or as otherwise stated in this Agreement, the General Medical Health Care Provider shall not be entitled to payment if verification of the Beneficiari…”
Source: "emergency" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
Enter the value
Dispute / reconciliation process
Discussed in your documents but no value extracted: “…l Practitioner or a settlement is entered into to resolve a dispute between General Medical Health Care provider/Medical Practitioner and a patient. g. There is a change in General Medical Health Care Provider's busines…”
Source: "dispute" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
Enter the value
Tariff reference and review cycle
Discussed in your documents but no value extracted: “…neficiary for a least one Inpatient Bed Day; 1.2. **Agreed Tariff** – The Agreed Tariff Rates are the preferential rates negotiated by **VENUS MEDICARE LIMITED** detailed as compensation due to the General Health Care P…”
Source: "tariff" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
Enter the value
Scheme type (fee-for-service / capitation)
Discussed in your documents but no value extracted: “…ogy adopted by **VML** for purpose of this Agreement is the Fee-for-Service basis. In some other cases, the Capitation method can be agreed between Parties and an agreement entered into for this purpose. **VML** shall pa…”
Source: "fee-for-service" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
Enter the value
Termination / notice period
Discussed in your documents but no value extracted: “…ider's license to practice in Nigeria is suspended, evoked, terminated or subject to terms of probation, conditions or restrictions; or becomes the subject of a settlement Agreement with the Board of the Medical and Dent…”
Source: "terminate" in 2025-02-25-NMSL-VenusMedicare-SLA.pdf
Enter the value
Approving records this as the version you stand behind. It does not clear the warnings and never blocks an analysis.
Documents (1)
2025-02-25-NMSL-VenusMedicare-SLA.pdf
application/pdf · 8.1 MB · 18 pages · Transcribed — spot-check
🚩 No date — set one so findings from it can be cited
Transcribed from a scan. Spot-check any figure or date drawn from it.
Set date