The National Health Insurance Agency (NHIA) has authorized the Health Management Organization (HMO) to authorize patients for treatment within one hour of receiving requests from hospitals and health care providers.
The Directive, effective April 1, 2025, aims to reduce service delays and ensure timely, high-quality health care services under the National Health Insurance Plan.
In a statement released by NHIA spokesman Emmanuel Ononokpono, authorities noted that the ongoing delay in the issuance of treatment authorization and codes continue to have a negative impact on the experience of health care beneficiaries. Ononokpono explained that the reforms were reached at a stakeholder meeting in February and are now being implemented as part of an effort to improve the standards for service delivery.
The NHIA outlines specific measures to implement the new directive, including that the HMO must provide an authorization code within one hour of receiving the treatment request. Healthcare institutions are expected to submit their request immediately to avoid delays and where HMO cannot publish code within an hour window, it must communicate its cause within the same time frame.
The Directive also requires HMOs and healthcare providers to maintain detailed records of all requests and replies related to treatment authorization. If the HMO fails to meet the one-hour deadline, the health care provider is instructed to continue treatment and notify the NHIA, and the service will then be verified as reported.
In addition, registrants are encouraged to report any delays or obstacles to timely health care, especially if authorization codes are not issued within the prescribed time frame. For emergencies, an authorization code will not be required before starting treatment, but must be obtained within 48 hours with NHIA’s operating guidelines.
The NHIA also warned that sanctions will apply to any organization that finds intentional delays in nursing authorization as part of an effort to get stakeholders accountable and safeguard patients’ rights within the framework of national health insurance.
