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The National Health Insurance Authority (NHIA) has instructed all parties on measures to reduce service access delays and ensure enrollees obtain quality healthcare starting from April 1.
According to a statement from its acting Director of Media, Emmanuel Ononokpono, the initiative is necessary due to significant delays in treatment authorisation and code issuance, adversely affecting beneficiaries’ experiences.
Ononokpono said that the measures align with the effective execution of the NHIA Act 2022, sharing that the modifications concerning care authorisation were validated at a Stakeholders’ Meeting in February to help alleviate delays.
He added that among the measures, authorisation of care and code issuance by Health Maintenance Organisations (HMOs) must not exceed one hour from the time providers submit requests.
Additionally, healthcare facilities are required to quickly send requests for authorisation codes to HMOs to help reduce enrollees’ service access delays.
He noted that if the HMO has valid reasons for not providing the code requested, communication regarding a ‘no authorisation’ response should occur within an hour.
Other measures involve keeping records of all providers’ and HMOs’ treatment authorization requests and responses. In cases where delays exceed the one-hour window, healthcare providers are instructed to proceed with services for the enrollee and promptly notify the NHIA.
Ononokpono added that the NHIA would confirm that such services had been provided and that enrollees should report any delays or obstacles to timely access to healthcare services due to exceeding the one-hour limit for receiving authorisation codes directly from the NHIA.
