NHIA orders HMOs to approve treatment within one hour

The National Health Insurance Authority has implemented a new directive aimed at reducing delays in accessing healthcare services and enhancing patient care.

It said the authorisation of care and issuance of authorisation codes by Health Management Organisations shall no longer exceed one hour from the time of requests by providers and healthcare facilities are to promptly submit requests for authorisation codes to HMOs to mitigate service access delays to enrollees.

NHIA who made this known in a press statement on Sunday signed by its Acting Director on Media and Public Relations, Emmanuel Ononokpono, added that the directive came into operation on April 1st, 2025.

The National Health Insurance Act of 2022, signed into law on May 19, 2021, replaced the 1999 National Health Insurance Scheme Act. Its primary aim is to regulate and integrate health insurance schemes, ensuring that every Nigerian has mandatory health coverage while catering to vulnerable groups.

In addition to the one-hour limit, the NHIA outlined several steps to ensure better service delivery, including improved communication from HMOs when authorisation is not possible within the stipulated timeframe and provisions for emergencies where authorisation codes are not required before treatment.

It noted that in fulfillment of its regulatory role to promote patient health outcomes by improving efficiency and access to care, it has directed all its stakeholders on steps aimed at
reducing delays in accessing services and ensuring that enrollees receive quality healthcare services.

“This has become imperative in view of notable delays in authorisation of treatment and issuance of codes, which continues to negatively impact beneficiaries’ experience. These steps consistent with the effective implementation of the NHIA Act 2022, the following changes regarding authorisation of care were approved at a Stakeholders’ Meeting in February help address delays.