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Warns against delayed services
From Fred Ezeh, Abuja
The National Health Insurance Authority (NHIA) has expressed concern over growing complaints from enrollees facing delays in obtaining authorisation codes from Health Management Organisations (HMOs).
These codes are essential for accessing medical care under the national health insurance scheme. The NHIA said these delays have eroded trust in the quality of healthcare services provided.
In a statement released on Monday, 7 April 2025, by Acting Director of Media and Public Relations Emma Ononokpono, the NHIA announced new directives to address the issue. “NHIA, in fulfilment of its regulatory role to promote patient health outcomes by improving efficiency and access to care, has taken some steps regarding authorisation of care as were approved at a stakeholders’ meeting in February,” the statement read.
“This has become imperative in view of the notable delay in the authorisation of treatment and the issuance of codes, which continues to negatively impact beneficiaries’ experience,” it added.
Under the new rules, HMOs must issue authorisation codes within one hour of a provider’s request. For emergencies, no prior code is needed—treatment can begin immediately, with codes obtained within 48 hours, per operational guidelines. Healthcare Facilities (HCFs) must also submit requests promptly to avoid delays. If an HMO denies a code, it must communicate this within the one-hour window, providing a valid reason.
The NHIA further stated, “There shall be a maintenance of records of all requests and responses for treatment authorisation by providers and HMOs, and where delays occur beyond the one-hour timeline, the healthcare provider will be expected to proceed with rendering services to the enrollee and thereafter, inform NHIA immediately of such services rendered.”
Enrollees were urged to report delays exceeding one hour directly to the NHIA, with the agency promising sanctions for deliberate violations. The directive, effective since 1 April 2025, will be regularly reviewed for compliance, with feedback provided to stakeholders.