To enhance patient care and improve access to timely health services, the National Health Insurance Authority (NHIA) has issued a directive to all stakeholders mandating stricter timelines for the authorisation of healthcare services.
Health Maintenance organisations (HMOs) are now required to authorise care and issue authorisation codes within one hour of receiving requests from healthcare providers, effective April 1, 2025.
NHIA disclosed this in a statement by its Acting Director of Media and Public Relations, Emmanuel Ononokpono, on Monday. The statement described the move as part of broader reforms aligned with the NHIA Act 2022, aimed at reducing delays that have long plagued enrollees under the national health insurance scheme.
It said any response indicating “no authorisation” must be communicated within one hour, provided the HMO has justifiable reasons for denying the requested code. Both providers and HMOs are expected to maintain comprehensive records of all authorisation requests and responses.
The organisation emphasised that if authorisation delays exceed the one-hour limit, healthcare providers should proceed to deliver the required services and immediately inform the Authority. The statement added, “The NHIA will verify that such services were rendered. ”
Enrollees have been encouraged to independently report any delays or obstacles in accessing care due to late authorisation to the NHIA.
For emergency cases, NHIA said treatment can begin without prior authorisation. However, per NHIA operational guidelines, the required authorisation code must be obtained within 48 hours of commencing care.
The authority also warned that sanctions would be applied to any entity found deliberately delaying the authorisation of care.
To ensure compliance, the NHIA said it would conduct regular reviews and provide feedback to stakeholders on adherence to the revised timeline.
