Health Management Organizations (HMOs) are required by the National Health Insurance Authority (NHIA) to grant authorization for patients’ care within one hour of receiving requests from hospitals and other healthcare providers.
According to a statement from the NHIA’s Emmanuel Ononokpono, a spokesperson, the organization’s goals included ensuring that patients receive high-quality healthcare services as well as reducing delays in access to services.
He claimed that the treatment process is still hampered by the delays in obtaining codes and obtaining treatment.
He claimed that the changes to the authorization of care were first put into effect on April 1, 2025, despite having been approved at a stakeholders’ meeting in February 2025.
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Among the authorisations are:
1. HMOs’ time for requesting authorization to care and issuing authorization codes shall not longer exceed one hour. To help enrollees receive service access delays, health care facilities (HCFs) must submit requests for authorization codes to HMOs right away.
2. Communication of a response that states “no authorization within the hour” where the HMO has valid arguments against not issuing the requested code.
3. keeping up all records regarding all requests and responses from providers and HMOs for treatment authorization.
4. The healthcare providers must proceed with the services provided to the enrollee and immediately notify NHIA if there are delays beyond the one-hour window. The NHIA will check the quality of the services provided.
5. Employers are required to notify the NHIA of any delays or obstacles to timely access to health services as a result of receiving authorization codes that exceed the one-hour limit.
6. Authorization codes must be obtained within 48 hours of receiving treatment in all emergencies, as required by the operational guidelines.
Source: Channels TV
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