Approve treatment within one hour – NHIA directs HMOs

The National Health Insurance Authority (NHIA) has mandated Health Management Organisations (HMOs) to authorise patient treatment within one hour of receiving requests from hospitals and healthcare providers.

This directive, which came into effect on April 1, 2025, is aimed at reducing service delays and ensuring timely, quality healthcare delivery for enrollees under the National Health Insurance Scheme.

In a statement issued by NHIA spokesperson Emmanuel Ononokpono, the authority noted that persistent delays in treatment authorisation and code issuance have continued to negatively affect the experiences of healthcare beneficiaries. Ononokpono explained that the reforms were agreed upon at a stakeholders’ meeting held in February and are now being enforced as part of efforts to improve service delivery standards.

The NHIA outlined specific measures for implementing the new directive, including that HMOs must provide authorisation codes within one hour of receiving treatment requests. Healthcare facilities are expected to submit their requests promptly to avoid delays, and where an HMO is unable to issue a code within the one-hour window, it must communicate its reasons within the same timeframe.

The directive also requires both HMOs and healthcare providers to maintain detailed records of all requests and responses related to treatment authorisation. In cases where HMOs fail to meet the one-hour deadline, healthcare providers are instructed to proceed with treatment and notify the NHIA, which will then verify that services were delivered as reported.

Furthermore, enrollees are encouraged to report any delays or barriers to accessing timely healthcare, particularly when authorisation codes are not issued within the stipulated timeframe. For emergency cases, authorisation codes will not be required before treatment begins, but must be obtained within 48 hours, in line with the NHIA’s operational guidelines.

The NHIA also warned that sanctions would be applied to any organisations found deliberately delaying authorisation of care, as part of efforts to hold stakeholders accountable and uphold patient rights within the national health insurance framework.