The National Health Insurance Authority (NHIA) has officially commenced a series of on-the-spot assessments to evaluate how well Health Maintenance Organisations (HMOs) and healthcare providers are adhering to the recently introduced directive mandating the issuance of pre-authorisation codes within one hour. This decisive move follows the implementation of new guidelines rolled out by the Director General and Chief Executive Officer of NHIA, Dr. Kelechi Ohiri, aimed at significantly improving access to healthcare services for enrollees across the country.
As part of the new directive, which took effect in April, HMOs are now required to process and issue authorisation codes within a maximum of one hour from the time a request is received from a healthcare provider. This policy is a critical step toward minimizing delays in the treatment process and ensuring that patients do not face unnecessary waiting times when seeking medical care. Under the directive, healthcare facilities must continue to provide services even in cases where pre-authorisation codes are delayed beyond the stipulated one-hour window.
In line with its commitment to enforcing the new policy and enhancing service delivery within the health insurance ecosystem, NHIA dispatched an assessment and enforcement team to conduct unscheduled compliance visits to two major public hospitals in the Federal Capital Territory: the Federal Medical Centre (FMC), Jabi, and the National Hospital, Abuja.
A statement released on Saturday and signed by the Acting Director of Media and Public Relations at NHIA, Emmanuel Ononokpono, disclosed the findings of the compliance checks. At the National Hospital, Dr. Habib Abdulhamid, the Acting Director of Enforcement at NHIA, reported an encouraging 70 percent compliance rate with the new one-hour authorisation deadline. However, the team identified some gaps in the knowledge and awareness of the facility�s personnel responsible for requesting authorisation codes. To address this, the NHIA team conducted immediate sensitisation sessions to educate staff on the new protocol and the importance of adhering strictly to the stipulated timeframe.
Furthermore, HMOs found to be in violation of the one-hour deadline were immediately contacted by the enforcement team, and discussions were held to ensure prompt corrective actions. Mr. Tony Osuji, the NHIA Desk Officer at the National Hospital, assured the visiting team that proactive steps have already been taken to streamline the internal processes and reduce the bottlenecks hindering timely access to care for NHIA enrollees.
In contrast, the situation at the Federal Medical Centre, Jabi, reflected full compliance by the HMOs with the directive. However, the assessment uncovered a specific instance in which a delay was traced to the healthcare facility itself. According to the report, although the HMO involved had responded promptly with the required information, the hospital experienced delays in uploading patient data necessary for completing the authorisation process.
Dr. Chris Okoh, NHIA�s Director for the North-Central B region, acknowledged the progress being made despite some operational inconsistencies observed among certain HMOs at the National Hospital. He commended the improvements in response time and encouraged all stakeholders to redouble their efforts in aligning with the agency�s new standards.
Reinforcing the Authority�s stance, Dr. Abdulhamid reiterated NHIA�s commitment to ensuring strict adherence to all policy guidelines. He stressed that any healthcare provider or HMO found violating the new directives will face appropriate sanctions. He urged those currently struggling with compliance to urgently improve their systems and processes or risk regulatory action.
�The NHIA remains fully committed to upholding quality healthcare standards for all Nigerians under the health insurance scheme. We will not hesitate to apply the necessary penalties against erring facilities or HMOs that fail to comply with this important directive,� Dr. Abdulhamid said.
The statement concluded by announcing that NHIA�s monitoring activities will continue in health facilities nationwide in the coming weeks, as part of its broader strategy to guarantee prompt service delivery and eliminate systemic delays in Nigeria�s health insurance ecosystem.
