NHIA charges stakeholders on steps to reduce delay in accessing services

The National Health Insurance Authority (NHIA), in fulfillment of its regulatory role to promote patient health outcomes by improving efficiency and access to care, has directed all its stakeholders on steps aimed at reducing delays in accessing services and ensuring that enrollees receive quality healthcare services.

This has become imperative in view of notable delays in authorization of treatment and issuance of codes, which continues to negatively impact beneficiaries’ experience.

These steps consistent with the effective implementation of the NHIA Act 2022, the following changes regarding authorization of care were approved at a Stakeholders’ Meeting in February help address delays.

These include, authorization 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 authorization 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.

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Maintenance of records of all requests and responses for treatment authorization 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 authorization codes in excess of the one-hour limit independently to the NHIA.

For all emergencies cases, authorization codes shall not be required before commencing treatment but shall be obtained with 48 hours of commencing care as stipulated in the operational guidelines.

Sanctions shall be applied appropriately to entities deliberately delaying authorization of care.

The NHIA will regularly review compliance with this revised timeline and provide feedback to stakeholders as this directive came into operation on April 1, 2025.