The National Health Insurance Authority (NHIA) has directed all Health Management Organisations (HMOs) to authorise the treatment of patients within one hour from the time of requests by hospitals and other healthcare providers.
A spokesperson for the NHIA, Emmanuel Ononokpono, in a statement, said reducing delays in accessing services and ensuring that enrollees receive quality healthcare services were some of the mandates of the authority.
He said the delays in the authorisation of treatment and issuance of codes continues to negatively impact beneficiaries’ experience.
He said though the changes regarding authorisation of care were initially approved at a stakeholders’ meeting in February 2025, it came into operation on April 1, 2025.
Some of the authorisations include:
- Authorisation of care and issuance of authorization codes by HMOs shall no longer exceed one hour from the time of requests by providers. Health Care Facilities (HCFs) are to promptly submit requests for authorisation codes to HMOs to mitigate service access delays to enrollees.
- Communication of a response of ‘no authorization 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 authorisation 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.
- Enrollees are to report any delays or barriers to timely access to health service resulting from receiving authorisation codes in excess of the one-hour limit independently to the NHIA.
- For all emergencies cases, authorisation 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 new guidelines are meant to ensure beneficiaries’ interests are protected and they receive proper care especially when they are at their most vulnerable state.
