NHIA Enforces One-hour Referral Policy, Cracks Down On Delays In HMO Approvals

The National Health Insurance Authority (NHIA) has launched unannounced compliance checks at health facilities in the Federal Capital Territory (FCT) to enforce adherence to its new directive mandating Health Maintenance Organisations (HMOs) to issue referral authorisation codes within one hour.

The compliance drive, led by NHIA’s enforcement team, aims to ensure that healthcare services to enrollees are not delayed due to authorisation bottlenecks.

The policy, introduced under the leadership of NHIA Director-General, Dr. Kelechi Ohiri, stipulates that healthcare providers must proceed with treatment if HMO authorization is not received within the one-hour window.

The NHIA Ag. Director, Media & PR, Emmanuel Ononokpono, said in a statement on Sunday that the NHIA team evaluated how well the facilities and associated HMOs were adhering to the directive during an unscheduled assessment visit to two major public hospitals in Abuja: Federal Medical Centre (FMC), Jabi, and the National Hospital.

According to him, at the National Hospital, NHIA’s Acting Director of Enforcement, Dr. Habib Abdulhamid, reported a compliance rate of approximately 70 per cent. He noted that while the hospital had made some progress, certain staff involved in processing pre-authorisations were still unfamiliar with the updated protocols.

He added that the NHIA team conducted on-the-spot sensitisation to address these gaps.

He said several HMOs breaching the one-hour rule were contacted immediately during the inspection.

Ononokpono also stated that the NHIA Desk Officer at the National Hospital, Mr. Tony Osuji, informed the team that internal measures have been introduced to reduce patient waiting time and streamline access to care under the NHIA scheme.

Meanwhile, he said at the Federal Medical Centre, Jabi, the team found full compliance by HMOs. However, the assessment revealed a case where delays were caused by the hospital’s late data upload, despite prompt response from the HMO.

Providing a general review of the inspection, NHIA’s Director for North-Central B region, Dr. Chris Okoh, acknowledged improvements in response time at both facilities but stressed the need for continuous improvement, especially among HMOs, the statement explained.

Dr. Abdulhamid reiterated the NHIA’s commitment to enforcing the new directive nationwide. He warned that healthcare providers and HMOs who fail to comply would face sanctions, as outlined by the Authority’s guidelines.

“The NHIA will not hesitate to sanction any erring HMO or facility. We are committed to ensuring enrollees get timely access to healthcare without bureaucratic delays,” he said.

NHIA is expected to continue similar monitoring exercises in other parts of the country in the coming weeks as part of a broader effort to strengthen health service delivery and accountability.