The National Health Insurance Authority (NHIA) has commenced on-the-spot assessments to evaluate the level of compliance with the new directives regarding the one-hour deadline for the issuance of pre-authorization codes by Health Maintenance Organizations (HMOs).
These inspections follow recent guidelines introduced under the leadership of NHIA Director-General, Dr. Kelechi Ohiri.
According to the NHIA, healthcare facilities are now mandated to continue providing healthcare services to enrollees if the pre-authorization code from HMOs is delayed beyond the one-hour deadline.
In a statement issued on Saturday by the Acting Director of Media and Public Relations, Emmanuel Ononokpono, the Authority stated that to measure and ensure compliance with the directive in the Federal Capital Territory (FCT), an NHIA Assessment/Enforcement team conducted unscheduled visits to two prominent public hospitals in Abuja: Federal Medical Center, Jabi, and the National Hospital.
At the National Hospital, NHIA’s Acting Director (Enforcement), Dr. Habib Abdulhamid, reported about 70% compliance with the one-hour authorization deadline.
“The team observed that some personnel of the facility involved in the request for authorization codes from HMOs were not conversant with the new directives, and further sensitization on the steps to take towards providing services to enrollees was conducted,” the statement read.
Immediate action taken against non-compliant HMOs
The Authority also noted that HMOs found to have violated the deadline were contacted on the spot.
“On his part, the NHIA Desk Officer at the foremost hospital, Mr. Tony Osuji, told the team that measures have been put in place to reduce waiting times and bottlenecks associated with accessing care by NHIA patients at the hospital.”
Full compliance at Federal Medical Center Jabi
At the Federal Medical Center Jabi, the assessment indicated that the HMOs were in total compliance with the directive. A particular case discovered during the visit revealed that the facility had delayed uploading its data following the HMO’s timely response to provide further information to assist in approving the request for authorization.
Giving an overall assessment of the exercise, NHIA’s Director for the North-Central B region, Dr. Chris Okoh, noted that despite some of the discrepancies observed in some HMOs operations at the National Hospital, there have been improvements in response time to requests for authorization codes.
Further speaking on the importance of ensuring that facilities always comply with NHIA guidelines, Dr. Habib Abdulhamid expressed the Authority’s commitment to investigating some of the discrepancies observed by the team.
He also urged HMOs and healthcare providers in the country to comply with the new policy directives to avoid facing stipulated sanctions by the Authority.
Sanctions for non-compliance
Dr. Abdulhamid emphasized that the NHIA will not hesitate to sanction any erring healthcare facility or HMO and advised those not meeting the guidelines to improve their performance.
The NHIA is scheduled to continue monitoring the one-hour authorization deadline by HMOs in other health facilities across the country in the coming weeks.
