The National Health Insurance Authority (NHIA) has directed all its stakeholders on steps aimed at reducing delays in accessing services and ensuring that enrollees receive quality healthcare services with effect from April 1, 2025.
The Agency acting Director of Media, Emmanuel Ononokpono, said the measure has become imperative in view of notable delays in authorization of treatment and issuance of codes, which continues to negatively impact beneficiaries’ experience.
The steps are consistent with the effective implementation of the NHIA Act 2022, adding the changes regarding authorization of care were approved at a Stakeholders’ Meeting in February help address delays.
Also Health Care Facilities (HCFs) are to promptly submit requests for authorization codes to HMOs to mitigate service access delays to enrollees, while authorization of care and issuance of authorization codes by HMOs shall no longer exceed *one hour from the time of requests by providers.
Other steps include maintenance of records of all requests and responses for treatment authorization by providers and HMOs and where delays occur, beyond the one-hour timeline, the healthcare providers are to proceed to render services to the enrollee and inform NHIA immediately.
Ononokpono further said that NHIA will verify that such services were rendered and that enrollees are to report any delays or barriers to timely access to health service resulting from receiving authorization codes in excess of the one-hour limit independently to the NHIA.
“For all emergency cases, authorization codes shall not be required before commencing treatment but shall be obtained with 48 hours of commencing care as stipulated in the operational guidelines.”
NHIA said that it will regularly review compliance with this revised timeline and provide feedback to stakeholders. Sanctions shall be applied appropriately to entities deliberately delaying authorization of care.
