The National Health Insurance Authority (NHIA) has issued a new directive mandating Health Maintenance Organisations (HMOs) to approve treatment requests within one hour of submission by healthcare providers.
Mr. Emmanuel Ononokpono, NHIA’s Acting Director of Media and Public Relations, disclosed this in a statement released on Sunday in Abuja.
According to him, the directive—effective April 1, 2025—is part of NHIA’s efforts to fulfill its regulatory role in promoting positive health outcomes by improving efficiency and access to care.
He explained that the decision followed persistent complaints about delays in treatment authorization and code issuance, which have negatively impacted the experience of beneficiaries.
Ononokpono stated that the NHIA has also directed all its stakeholders to take steps at reducing delays in service access and ensuring that enrollees receive quality healthcare services.
He added that these measures, which align with the effective implementation of the NHIA Act 2022, were approved at a Stakeholders’ Meeting held in February to address authorization delays.
Key highlights of the new directive
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 for enrollees.
“HMOs must communicate a response of ‘no authorization’ within the one-hour period when there are justifiable reasons for not issuing the requested code.
“All requests and responses for treatment authorization by providers and HMOs must be recorded. In cases where delays occur beyond the one-hour timeline, healthcare providers are to proceed with rendering services to the enrollee and immediately inform NHIA. The NHIA will verify that such services were provided.”
Reporting and emergency care provisions
The NHIA also urged enrollees to report any delays or barriers to timely access to health services resulting from receiving authorization codes beyond the one-hour limit directly to the NHIA.
“For all emergency cases, authorization codes shall not be required before treatment commences but must be obtained within 48 hours of starting care, as stipulated in the operational guidelines.”
“Sanctions will 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,” it added.
The NHIA emphasized that it will continually monitor compliance with these new timelines and provide ongoing feedback to all stakeholders.
