The National Health Insurance Authority (NHIA) has directed Health Management Organisations (HMOs) to issue authorisation codes to healthcare facilities within one hour of request, in a move aimed at ending delays in service delivery to enrollees.
The North West Zonal Coordinator of NHIA, Alhaji Ibrahim Gwamba, disclosed this during a one-day stakeholders’ sensitisation forum held in Gusau, Zamfara State capital.
He explained that the directive was part of recent achievements recorded by the authority to improve healthcare access and efficiency.
According to him, healthcare facilities have also been instructed to treat enrollees or patients in emergency cases, while awaiting authorisation codes, and to go ahead with treatment after one hour if there is no response from HMOs.
Gwamba added that NHIA would compel defaulting HMOs to reimburse facilities for services rendered during such situations.
The Northwest zonal coordinator further highlighted the launch of a self-service portal as another milestone, noting that it allows enrollees to add or remove dependents, switch healthcare facilities, and access other key services online.
He also revealed that HMOs have been directed to conduct surprise visits to healthcare facilities frequently to ensure compliance.
Presentations at the forum emphasised the roles of different stakeholders. Dr. Jamilu Musa Gusau listed the responsibilities of healthcare facilities to include providing accommodation, delivering health services within the approved package, collecting ten percent co-payment on prescribed drugs, and ensuring prompt referrals.
On the part of patients, Dr. Tasiu Yelwa said they are expected to provide accurate biodata during registration, enroll in social health insurance, and freely choose any registered healthcare facility.
In his closing remarks, Zamfara State Coordinator of NHIA, Alhaji Sanusi Mannir Maaruf represented by Dr. Jamilu Musa Gusau explained that the authority currently runs three schemes: the contributory scheme for civil servants, the non-contributory scheme for the vulnerable, and private health insurance for the private sector.
