NHIA begins checks on HMOs over ‘one hour’ patient waiting time directive

The National Health Insurance Authority (NHIA) has commenced on-the-spot assessment of the level of compliance with the new directives on the one-hour deadline for the issuance of pre-authorisation code by Health Maintenance Organizations (HMOs).

Based on the new guidelines introduced by the NHIA under the leadership of Dr. Kelechi Ohiri, facilities are mandated to continue with the provision of healthcare services to enrollees if pre-authorisation code from HMOs are delayed beyond one hour.

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To measure and ensure compliance with the directive in the FCT, an NHIA Assessment/ Enforcement team conducted unscheduled visits to two prominent public hospitals in Abuja: Federal Medical Center, Jabi and the National Hospital.

At the National Hospital, NHIA’s Ag. Director (Enforcement), Dr. Habib Abdulhamid, reported about 70% compliance with the one-hour authorisation deadline. The team observed that some personnel of the Facility involved in the request for authorization code from HMOs were not conversant with the new directives and further sensitization on the steps to take towards providing services to enrollees was conducted.
HMOs who were discovered to have flouted the deadline were also contacted on the spot.

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 the Federal Medical Center Jabi, the assessment indicated that the HMOs were in total compliance with the directive. A particular case discovered during the visit revealed that the facility had delayed in uploading their data following the HMO’s timely response to provide further information to assist in approving the request for authorization.

Giving an overall assessment of the exercise, NHIA’s Director, North-Central B region, Dr Chris Okoh, noted that despite some of the discrepancies observed in some HMOs operations at the National Hospital, there have been improvements in response time to requests for authorization code.

Further speaking on the importance of ensuring that facilities always comply with NHIA guidelines, Dr. Habib Abdulhamid expressed the Authority’s commitment to investigate some of the discrepancies observed by the team, while urging HMOs and healthcare providers in the country to comply with the new policy directives to avoid facing stipulated sanctions by the Authority. He also stated that 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.

The NHIA is scheduled to continue monitoring the one-hour authorization deadline by HMOs in other health facilities across the country in the coming weeks.