NHIA LAUNCHES COMPLIANCE LEVEL CHECKS..... Says MHO's Must Adhere To One-Hour Referral Authorization Deadline

"The NHIA is scheduled to continue monitoring the one-hour authorization deadline by HMOs in other health facilities across the country in the coming weeks."

The National Health Insurance Authority (NHIA), in line with its mandate, has commenced an on-the-spot assessment of the level of compliance with the new directives on the one-hour deadline for the issuance of pre-authorization code by Health Maintenance Organizations (HMOs).

This was the revelation by the Acting Director Media and Public Relations of the National Health Insurance Authority, Emmanuel Ononokpono in a statement credited to Dr. Kelechi Photo, the NHIA Director General on Friday, 2 May 2025 in Abuja, the nation's capital.

The statement revealed that, "Based on the new guidelines introduced by the NHIA under the leadership of Dr. Kelechi Ohiri, facilities are mandated to continue with the provision of healthcare services to enrollees if pre-authorization code from HMOs are delayed beyond one hour.

"To measure and ensure compliance with the directive in the FCT, an NHIA Assessment/ Enforcement team conducted unscheduled visits to two prominent public hospitals in Abuja; Federal Medical Center, Jabi and the National Hospital." The statement said 

The statement further disclosed that, "At the National Hospital, NHIA’s Ag. Director (Enforcement), Dr. Habib Abdulhamid, reported about 70% compliance with the one-hour authorization deadline. The team observed that some personnel of the Facility involved in the request for authorization code from HMOs were not conversant with the new directives and further sensitization on the steps to take towards providing services to enrollees was conducted.

"HMOs who were discovered to have flouted the deadline were also contacted on the spot.

"On his part, the NHIA Desk officer at the foremost hospital, Mr. Tony Osuji told the team that measures have been put in place to reduce waiting time and bottlenecks associated with accessing care by NHIA patients in the hospital.

"At the Federal Medical Center Jabi, the assessment indicated that the HMOs were in total compliance with the directive. A particular case discovered during the visit revealed that the facility had delayed in uploading their data following the HMO's timely response to provide further information to assist in approving the request for authorization." The statement read 

It also revealed further that; "Giving an overall assessment of the exercise, NHIA’s Director, North-Central B region, Dr. Chris Okoh, noted that despite some of the discrepancies observed in some HMOs operations at the National Hospital, there have been improvements in response time to requests for authorization code.

 

Speaking further on the importance of ensuring that facilities always comply with NHIA guidelines, Dr. Habib Abdulhamid expressed the Authority's commitment to investigate some of the discrepancies observed by the team, while urging HMOs and healthcare providers in the country to comply with the new policy directives to avoid facing stipulated sanctions by the Authority. He also stated that the NHIA will not hesitate to sanction any erring health care facility or HMO and advised those not meeting up with the guidelines to improve their performance. 

The NHIA is scheduled to continue monitoring the one-hour authorization deadline by HMOs in other health facilities across the country in the coming weeks. The statement concluded.