The National Health Insurance Authority (NHIA) has issued a directive mandating Health Management Organisations (HMOs) to authorise healthcare treatment requests within one hour, effective April 1, 2025.
The move is aimed at reducing delays in accessing healthcare and improving patient outcomes under Nigeria’s health insurance scheme.
According to a press statement signed by NHIA’s Acting Director of Media and Public Relations, Emmanuel Ononokpono, healthcare providers must promptly submit authorisation code requests to HMOs, and any delays beyond one hour must be immediately reported to NHIA.
The directive also allows healthcare facilities to proceed with treatment if authorisation is delayed, provided NHIA is notified. In emergency cases, treatment can commence without prior authorisation, but codes must be obtained within 48 hours as stipulated in the operational guidelines.
“Sanctions will be applied to any entity that deliberately delays treatment authorisation,” the statement noted.
The NHIA Act of 2022, which replaced the 1999 Act, mandates health coverage for all Nigerians and seeks to protect vulnerable groups through regulatory oversight and service efficiency.
The NHIA emphasized that records of all authorisation requests and responses must be maintained, and HMOs must communicate valid reasons for any delays. Enrollees are encouraged to independently report any service access barriers caused by delays exceeding the one-hour limit.
This policy shift follows recent remarks by the Coordinating Minister of Health and Social Welfare, Prof Muhammad Pate, who revealed that the Tinubu administration had approved a 90% increase in capitation fees and a 378% rise in fee-for-service payments to ease the financial burden on healthcare providers.
As of December 2024, over 19.2 million Nigerians were enrolled in the national health insurance scheme, surpassing the year’s target.
