How new NHIA guidelines to HMOs will reduce delay in access to healthcare for enrollees’
The National Health Insurance Authority (NHIA), has directed all its stakeholders on steps to reduce delays in accessing healthcare services for enrollees. A statement from the agency signed by the Acting Director, Media and Public Relations, Emmanuel Ononokpono, said the directives became imperative in view of notable delays in authorisation of treatment and issuance of […]
The National Health Insurance Authority (NHIA), has directed all its stakeholders on steps to reduce delays in accessing healthcare services for enrollees.
A statement from the agency signed by the Acting Director, Media and Public Relations, Emmanuel Ononokpono, said the directives became imperative in view of notable delays in authorisation of treatment and issuance of codes, which continues to negatively impact beneficiaries’ experience.
While saying the steps were consistent with the effective implementation of the NHIA Act 2022, he said the following changes regarding authorisation of care were approved at a stakeholders’ meeting to help address delays.
-Authorisation of care and issuance of authorisation codes by HMOs shall no longer exceed *One hour from the time of requests by providers*. Health Care Facilities (HCFs) are to promptly submit requests for authorization codes to HMOs to mitigate service access delays to enrolees.
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-Communication of a response of ‘no authorisation within the one-hour period where the HMO has justifiable reasons for not issuing the requested code.
-Maintenance of records of all requests and responses for treatment authorisation by providers and HMOs.
-Where delays occur, beyond the one-hour timeline, the healthcare providers are to proceed to render services to the enrollee and inform NHIA immediately. The NHIA will verify that such services were rendered.
-Enrolees are to report any delays or barriers to timely access to health service resulting from receiving authorisation codes in excess of the one-hour limit independently to the NHIA.
-For all emergency cases, authorisation codes shall not be required before commencing treatment but shall be obtained within 48 hours of commencing care as stipulated in the operational guidelines.
-Sanctions shall be applied appropriately to entities deliberately delaying authorisation of care.
He said the directive came into operation on April 1, 2025, adding that the NHIA will regularly review compliance with this revised timeline and provide feedback to stakeholders.