The National Health Insurance Authority (NHIA) has come up with a new directive designed to reduce delays in healthcare access and enhance patient care under the health insurance scheme.
Authorization of care and issuance of authorization codes by Health Management Organizations shall henceforth not exceed one hour from the time of requests by providers, while healthcare facilities are to promptly submit requests for authorization codes to HMOs to mitigate service access delays to enrollees, NHIA, has submitted.
Over 19.2 million Nigerians have enrolled in the health insurance schemes as at December 2024, surpassing its 2024 target.
In addition to the one-hour limit, the NHIA has taken several measures to ensure better service delivery, including improved communication from HMOs when authorization is not possible within the stipulated timeframe and provisions for emergencies where authorization codes are not required before treatment
Team@orientactualmags.con learned that the NHIA disclosed this in a statement issued by its acting Director of Media and Public Relations, Emmanuel Ononokpono on Sunday noting that the directive became operative on April 1, 2025.
‘This has become imperative in view of notable delays in the authorization of treatment and issuance of codes, which continues to negatively impact beneficiaries’ experience. These steps are consistent with the effective implementation of the NHIA Act 2022. The following changes regarding the authorisation of care were approved during a meeting attended by stakeholders in February to help address delays.
These include: Authorization of care and issuance of authorization codes by HMOs shall no longer exceed one hour from the time of requests by providers. Healthcare facilities are to promptly submit requests for authorisation codes to HMOs to mitigate service access delays to enrollees. 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 authorization 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’ the NHIA submitted while urging enrollees to report any delays or barriers to timely access to health service resulting from receiving authorization codes in excess of the one-hour limit.
‘For all emergency cases, authorization 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.
The NHIA will regularly review compliance with this revised timeline and provide feedback to stakeholders’ the statement added.
The National Health Insurance Act of 2022, signed into law on May 19, 2021, replaced the 1999 National Health Insurance Scheme Act.
Its primary aim is to regulate and integrate health insurance schemes, ensuring that every Nigerian has mandatory health coverage while catering to vulnerable groups.
Recall that Dr Ibrahim Yahaya Oloriegbe was appointed as Chairman of National Health Insurance Authority (NHIA) late last month.
Dr Oloriegbe a medical doctor, was born on November 12 ,1960. He received Bachelor of Medicine, Bachelor of Surgery Degree (MB.BS) from the Ahmadu Bello University, Zaria in 1985 and he had distinctions in Human Physiology, Biochemistry, Community Medicine and Laboratory Medicine.
He was the majority leader and Chairman, Committee on Health and Chairman, Committee on Local Government , Kwara state House of Assembly from 1999 to 2003.
Dr Oloriegbe also represented Kwara Central senatorial district in the Senate between 2019 and 2003 and he served as Chairman, Committee on Health-Team@orientactualmags.com Do you have any information you wish to share with us? Do you want us to cover your event or programme? Kindly send SMS to 08059100286, 09094171980 or get in touch via orientactualmag@gmail.com. Thank you
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