It stated the authorisation of care and issuance of authorisation codes by Well being Administration Organisations shall not exceed one hour from the time of requests by suppliers and healthcare services are to promptly submit requests for authorisation codes to HMOs to mitigate service entry delays to enrollees.
NHIA who made this recognized in a press assertion on Sunday signed by its Appearing Director on Media and Public Relations, Emmanuel Ononokpono, added that the directive got here into operation on April 1st, 2025.
The Nationwide Well being Insurance coverage Act of 2022, signed into regulation on Might 19, 2021, changed the 1999 Nationwide Well being Insurance coverage Scheme Act. Its major goal is to manage and combine medical insurance schemes, making certain that each Nigerian has obligatory well being protection whereas catering to weak teams.
Along with the one-hour restrict, the NHIA outlined a number of steps to make sure higher service supply, together with improved communication from HMOs when authorisation isn’t doable inside the stipulated timeframe and provisions for emergencies the place authorisation codes aren’t required earlier than remedy.
It famous that in achievement of its regulatory position to advertise affected person well being outcomes by enhancing effectivity and entry to care, it has directed all its stakeholders on steps aimed toward
decreasing delays in accessing providers and making certain that enrollees obtain high quality healthcare providers.
“This has grow to be crucial in view of notable delays in authorisation of remedy and issuance of codes, which continues to negatively influence beneficiaries’ expertise. These steps in line with the efficient implementation of the NHIA Act 2022, the next adjustments relating to authorisation of care had been authorised at a Stakeholders’ Assembly in February assist deal with delays.
“These embrace: Authorisation of care and issuance of authorisation codes by HMOs shall not exceed one hour from the time of requests by suppliers. Healthcare services are to promptly submit requests for authorisation codes to HMOs to mitigate service entry delays to enrollees. Communication of a response of ‘no authorisation inside the one-hour interval the place the HMO has justifiable causes for not issuing the requested code.
“Upkeep of information of all requests and responses for remedy authorisation by suppliers and HMOs. The place delays happen, past the one-hour timeline, the healthcare suppliers are to proceed to render providers to the enrollee and inform NHIA instantly. The NHIA will confirm that such providers had been rendered.”
It urged enrollees are to report any delays or limitations to well timed entry to well being service ensuing from receiving authorisation codes in extra of the one-hour restrict independently to the NHIA.
“For all emergencies circumstances, authorisation codes shall not be required earlier than commencing remedy however shall be obtained with 48 hours of commencing care as stipulated within the operational pointers.
“Sanctions shall be utilized appropriately to entities intentionally delaying authorisation of care.
“The NHIA will frequently overview compliance with this revised timeline and supply suggestions to stakeholders,” it added.
Just lately, the Coordinating Minister of Well being and Social Welfare, Prof Muhammad Pate stated President Bola Tinubu’s administration is taking vital steps to strengthen Nigeria’s healthcare system by growing monetary assist for healthcare suppliers, approving a greater than 90 per cent enhance in capitation charges and a 378 per cent rise in fee-for-service funds.
Prof Pate acknowledged that adjustment is aimed toward easing the monetary burden on healthcare suppliers nationwide, making certain they’ve the mandatory sources and instruments to ship the very best high quality of care to Nigerians enrolled within the nationwide medical insurance scheme.
As of December 2024, no fewer than 19.2 million Nigerians have enrolled on the medical insurance schemes surpassing its 2024 goal.
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