NHIA Implements New Directive to Reduce Healthcare Access Delays and Enhance Service Delivery

The National Health Insurance Authority (NHIA) has introduced a new policy aimed at improving healthcare service access and reducing delays for enrollees. Starting April 1, 2025, healthcare providers and facilities will be required to ensure that Health Management Organisations (HMOs) issue authorisation codes within one hour of a request. The NHIA’s new directive is designed to eliminate service delays that have been negatively impacting beneficiaries’ healthcare experiences.

Key Aspects of the New Directive:

1. One-Hour Limit for Authorisation Codes: HMOs are now mandated to issue authorisation codes no later than one hour after receiving requests from healthcare providers. This new timeline is expected to reduce delays in treatment and enhance the quality of care for enrollees.
2. Prompt Requests for Authorisation: Healthcare facilities must submit authorisation requests to HMOs in a timely manner to help mitigate delays and ensure quicker access to care for enrollees.
3. Communication and Emergency Provisions: If an authorisation is not provided within the stipulated one-hour period, HMOs are required to communicate the reason for the delay. In cases of emergencies, treatment may proceed without the authorisation code, but it must be obtained within 48 hours as per operational guidelines.
4. Record Maintenance: Both healthcare providers and HMOs must maintain records of all authorisation requests and responses. If delays extend beyond the one-hour timeline, healthcare providers are to proceed with treatment and notify the NHIA immediately. The NHIA will verify that care was provided.
5. Sanctions for Delays: The NHIA has made it clear that entities deliberately delaying the authorisation process will face sanctions, ensuring accountability and timely service delivery.
6. Enrollee Reporting: Enrollees are encouraged to report any delays or barriers in obtaining authorisation codes to the NHIA, ensuring transparency and prompt action in resolving issues.

This directive is part of the NHIA’s broader effort to regulate and integrate health insurance schemes across Nigeria, ensuring that every Nigerian has access to mandatory health coverage. The National Health Insurance Act of 2022, which replaced the 1999 National Health Insurance Scheme Act, aims to provide more efficient and accessible healthcare services for vulnerable groups.

In addition to these reforms, the NHIA is closely monitoring compliance with the new timelines and will provide regular feedback to stakeholders. This initiative aligns with efforts by the Nigerian government to strengthen the healthcare system, including increasing financial support for healthcare providers.

As of December 2024, over 19.2 million Nigerians have enrolled in the health insurance schemes, surpassing the 2024 target, reflecting positive progress in the country’s efforts to improve healthcare access.