The National Health Insurance Authority (NHIA) has issued a new directive requiring Health Management Organisations (HMOs) to authorize patient treatment requests within one hour of receiving them from hospitals and healthcare providers.
In a statement, NHIA spokesperson Emmanuel Ononokpono emphasized that this initiative is designed to reduce delays in accessing services and to improve the overall quality of care for enrollees. He noted that delays in treatment authorization and the issuance of codes have been negatively affecting the experience of beneficiaries.
Although the changes were initially approved at a stakeholders’ meeting in February 2025, the new directive officially took effect on April 1, 2025.
Under the new guidelines, HMOs must authorize care and issue authorization codes within one hour of receiving requests from healthcare providers. To help minimize delays, healthcare facilities are urged to promptly submit requests to HMOs. In cases where authorization cannot be granted within the hour, HMOs must provide justifiable reasons for the delay. Additionally, both healthcare providers and HMOs are required to maintain records of all treatment authorization requests and responses.
If authorization is delayed beyond the one-hour limit, healthcare providers are instructed to proceed with treatment and immediately inform the NHIA. The NHIA will then verify that the services were rendered. Enrollees are also encouraged to report any delays or difficulties in receiving timely authorization codes directly to the NHIA.
For emergency cases, treatment may begin without an authorization code, but the code must be obtained within 48 hours in line with the operational guidelines. Entities that deliberately delay authorization will face appropriate sanctions.
These measures are part of the NHIA’s ongoing efforts to enhance service delivery and ensure that enrollees receive timely, effective healthcare.
