The National Health Insurance Authority (NHIA) has introduced a new directive aimed at reducing delays in accessing healthcare services and enhancing patient care.
The directive, which came into effect on April 1st, 2025, outlines several steps to ensure better service delivery.
Key Provisions of the Directive
– One-Hour Limit for Authorisation: Health Management Organisations (HMOs) are required to authorise care and issue authorisation codes within one hour from the time of requests by providers.
– Prompt Submission of Requests: Healthcare facilities are expected to promptly submit requests for authorisation codes to HMOs to mitigate service access delays to enrollees.
– Communication of Response: HMOs must communicate a response of ‘no authorisation’ within the one-hour period if they have justifiable reasons for not issuing the requested code.
– Maintenance of Records: Providers and HMOs are required to maintain records of all requests and responses for treatment authorisation.
Emergency Cases and Sanctions
– No Authorisation Required: For emergency cases, authorisation codes are not required before commencing treatment, but must be obtained within 48 hours of commencing care.
– Sanctions for Delays: Sanctions will be applied to entities deliberately delaying authorisation of care.
NHIA’s Regulatory Role
– Promoting Patient Health Outcomes: The NHIA’s directive aims to promote patient health outcomes by improving efficiency and access to care.
– Regular Review of Compliance: The NHIA will regularly review compliance with the revised timeline and provide feedback to stakeholders .