ABOUT HPPSC
HPPSC, formerly known as the Grievance Mechanism Committee, is a multi-stakeholder platform consultative body to strengthen collaboration in medical claims management, address industry-level issues, and improve communications among healthcare partners
The Committee to HPPSC reflects its expanded and more proactive role in identifying issues, developing solutions and driving implementation through collaborative protocols and best practices.
ROLES OF HPPSC
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What HPPSC Does
co-developing claims protocols, resolving systemic issues, improving communications, fostering collaboration, and recommending practical best practices that enhance operational efficiency and patient experience
reviews issues received through medical professional bodies and industry associations with the objective of bridging knowledge gaps and providing broad guidance aligned with fair treatment of policyholders and ethical patient management
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What HPPSC Does Not
determine any punitive action against doctors, hospitals or the insurance industry
adjudicate in individual medical dispute but to provide broad guidance for future reference purpose
MEMBERS OF
HPPSC
HPPSC brings together healthcare, insurance and regulatory stakeholders to support industry collaboration.
14
Members
2
Observers
Co-Chairs
Dr Gunalan Palari
Mark O'Dell
ONGOING INITIATIVES
Key initiatives undertaken by HPPSC to improve communication, transparency, and operational efficiency across the healthcare ecosystem.
Establish a dedicated “doctor-to-doctor” hotline to facilitate direct clinical discussions between medical practitioners and insurers and takaful operators (ITOs) to enable swift resolution of clinical queries and reduce unnecessary delays that may disrupt patient care
Currently available. Please log in to view more. Access is restricted to members of MMA, APHM, LIAM, MTA and PIAM
Establish a transparent and streamlined framework for reviewing and panelling of doctors and hospitals for cashless facility of medical and health insurance/takaful (MHIT), including communication, engagement, review and appeal processes.
Clinical protocols and policy coverage
Develop standardised processes to guide ITOs in managing claims involving treatment recommended by medical practitioners which may be not directly aligned to or covered by existing clinical practice guidelines (CPGs)
Develop framework for ITOs to assess and determine coverage for new procedures, diagnostics, treatments and medicines (including emerging medical technologies such as robotic surgery, genetic testing and new cancer therapy)
Endorse cancer drug list develop with MOH's prescribed formulary prior to publication by MOH/PHCorp. This is to ensure private hospital doctors stay updated on MOH's current prescribed cancer drug formulary.
The above will include:
Collaboration with MOH, hospitals, treating specialist and relevant medical associations to facilitate alignment and resolution
Implementation of a mechanism to disseminate such outcomes, protocols and solutions from such engagements to all ITOs to promote consistency in application
Simplify and improve Guarantee Letter issuance process to ensure timely issuance and effective communication between ITOs/TPAs, medical practitioners and hospitals.
PRESS RELEASES
MEETINGS
10 November 2025
1st Meeting
3 December 2025
2nd Meeting
7 Apr 2026
3rd Meeting
28 April 2026
4th Meeting
23 June 2026
Webinar
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INDUSTRY RESOURCES
Clinical Practice Guidelines by Ministry of Health
Note:
Please contact Malaysian Health Technology Assessment Section (MaHTAS) at htamalaysia@moh.gov.my for further enquiry on the Clinical Practice Guidelines.
MaHTAS is a division within Ministry of Health and hence, regarded as equivalent to Ministry of Health.
Ministry of Health Medicines Formulary (MOHMF)
Charging Protocols by Ministry of Health (Medical Practice Division)
For further queries, please reach out to:
In Support of
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