The National Health Insurance Authority (NHIA) has directed Health Management Organisations (HMOs) to approve patient treatment requests within one hour of receiving them from hospitals and healthcare providers.
This policy, effective from April 1, 2025, aims to reduce delays in healthcare services and ensure prompt, high-quality care for enrollees under the National Health Insurance Scheme.
According to NHIA spokesperson Emmanuel Ononokpono, the move addresses ongoing challenges with delayed authorizations and code issuance, which have continued to impact beneficiaries negatively. He noted that the reforms were agreed upon during a stakeholders’ meeting in February and are now being implemented to enhance service standards.
To enforce the directive, the NHIA has set clear guidelines: HMOs must issue authorisation codes within one hour of receiving a treatment request. Healthcare providers are required to submit their requests without delay, and if an HMO cannot meet the one-hour deadline, it must explain the reason within the same period.
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The directive also mandates HMOs and healthcare providers to keep comprehensive records of all treatment authorization requests and corresponding responses. If an HMO fails to issue an authorisation code within the required one-hour window, healthcare providers are instructed to proceed with the necessary treatment and promptly notify the NHIA, which will then verify that the reported services were provided.
Additionally, enrollees are urged to report any instances of delay or obstacles in accessing timely care, especially when authorization codes are not issued within the specified timeframe. In emergency situations, treatment may commence without prior authorization; however, the necessary code must be obtained within 48 hours in accordance with NHIA’s operational guidelines.
The NHIA also emphasized that any organisation found to be intentionally delaying treatment authorisations will face sanctions. This measure is part of broader efforts to enforce accountability among stakeholders and safeguard the rights of patients within the national health insurance system.
