The National Health Insurance Authority (NHIA) has directed all Health Management Organisations (HMOs) to approve treatment requests and issue authorisation codes within one hour of receiving them from healthcare providers.
The new directive, which took effect on April 1, 2025, is aimed at improving access to healthcare and enhancing patient experiences under the national health insurance scheme.
In a statement signed by NHIA’s Acting Director of Media and Public Relations, Emmanuel Ononokpono, the agency emphasised that healthcare providers must promptly submit requests to HMOs to avoid delays. Where approval is not granted within one hour, providers are to proceed with treatment and notify NHIA immediately.
“This directive addresses the recurring delays in treatment authorisations, which have adversely affected enrollees’ access to timely healthcare,” the NHIA said.
The mandate includes key provisions:
– **One-hour limit** for HMOs to authorise care after receiving requests.
– **Healthcare providers must submit authorisation requests promptly.**
– **If HMOs cannot provide authorisation within the hour**, they must communicate reasons for the delay.
– **Providers may treat enrollees if delays exceed the timeline**, with NHIA to verify services rendered.
– **Emergency cases are exempt** from prior authorisation but require notification within 48 hours.
The NHIA also instructed stakeholders to maintain records of all authorisation requests and responses, and warned that sanctions will be applied to any entity found deliberately causing delays.
Enrollees have been urged to report any delays beyond the one-hour limit directly to NHIA for prompt action.
The reform follows a stakeholders’ meeting in February and aligns with the effective implementation of the **NHIA Act of 2022**, which replaced the 1999 National Health Insurance Scheme Act. The law mandates health insurance coverage for all Nigerians, with a focus on vulnerable populations.
Meanwhile, Coordinating Minister of Health and Social Welfare, Prof. Muhammad Pate, recently highlighted government efforts to support healthcare providers. He noted a **90% increase in capitation fees** and a **378% rise in fee-for-service payments**, as part of broader measures to boost the quality of care nationwide.
As of December 2024, over **19.2 million Nigerians** have enrolled in the national health insurance scheme, surpassing the year’s target.
Discussion about this post