The National Health Insurance Authority (NHIA) has commenced on-the-spot compliance assessments to monitor adherence to the newly introduced one-hour pre-authorisation code directive by Health Maintenance Organisations (HMOs) in Nigeria.
This move, led by NHIA’s Director General and CEO, Dr. Kelechi Ohiri, is part of broader reforms to ensure timely access to healthcare services for NHIA enrollees. According to the directive issued in April, healthcare providers must proceed with treatment if HMO authorisation codes are delayed beyond one hour from the request.
The NHIA emphasized that this policy is designed to reduce delays in healthcare access and enhance patient care across NHIA-accredited facilities.
In a statement released on Saturday by NHIA’s Acting Director of Media and Public Relations, Emmanuel Ononokpono, a compliance team from the Authority conducted unscheduled visits to two major public hospitals in the Federal Capital Territory (FCT)—Federal Medical Centre (FMC), Jabi, and the National Hospital, Abuja.
“At the National Hospital, NHIA’s Ag. Director (Enforcement), Dr. Habib Abdulhamid, reported about 70 per cent compliance with the one-hour authorisation deadline. The team observed that some personnel of the facility involved in the request for authorisation code from HMOs were not conversant with the new directives, and further sensitisation on the steps to take towards providing services to enrollees was conducted. HMOs that were discovered to have flouted the deadline were also contacted on the spot,” the statement said.
“On his part, the NHIA Desk officer at the foremost hospital, Mr. Tony Osuji, told the team that measures have been put in place to reduce waiting time and bottlenecks associated with accessing care by NHIA patients in the hospital.”
At FMC Jabi, the assessment revealed full compliance by HMOs, although a delay caused by the healthcare facility’s late data upload was noted despite the HMO’s prompt response.
Dr. Chris Okoh, NHIA’s Director for North-Central B region, acknowledged improvement in HMO response times, even though certain operational gaps still exist.
“The NHIA is scheduled to continue monitoring the one-hour authorisation deadline by HMOs in other health facilities across the country in the coming weeks,” the statement added.
Dr. Abdulhamid reaffirmed the agency’s dedication to ensuring all HMOs and healthcare providers comply with the new NHIA treatment approval guidelines. He warned that the Authority would not hesitate to apply sanctions where necessary.
“The NHIA will not hesitate to sanction any erring health care facility or HMO and advised those not meeting the guidelines to improve their performance.”
This enforcement drive underscores NHIA’s commitment to enforcing policies that support efficient health insurance service delivery in Nigeria.
