NHIA Instructs HMOs to Approve Treatment Within One Hour

The National Health Insurance Authority (NHIA) has mandated that Health Management Organisations (HMOs) must approve patient treatments within one hour of receiving requests from hospitals and healthcare providers.

This new policy, which took effect on April 1, 2025, aims to minimize delays in service delivery and ensure prompt, high-quality healthcare for enrollees under the National Health Insurance Scheme.

According to a statement from NHIA spokesperson Emmanuel Ononokpono, the authority emphasized that ongoing delays in treatment authorization and code issuance have negatively impacted the experiences of healthcare beneficiaries. Ononokpono explained that these changes stemmed from discussions held at a February stakeholders’ meeting and are now being enforced to improve service standards.

The NHIA has set clear guidelines for implementing the new rule, including the requirement for HMOs to issue authorization codes within one hour of receiving treatment requests. Healthcare providers are expected to submit these requests quickly to avoid delays. If an HMO cannot provide a code within the one-hour period, it must explain the delay within the same timeframe.

Additionally, both HMOs and healthcare providers must keep detailed records of all treatment authorization requests and responses. If an HMO fails to meet the one-hour deadline, healthcare providers are instructed to proceed with treatment and report the situation to the NHIA, which will verify the services provided.

For emergency cases, while authorization codes are not required before treatment, they must be obtained within 48 hours, according to NHIA guidelines.

The NHIA has also warned that penalties will be imposed on organizations found intentionally delaying authorization processes, in order to ensure accountability and protect patient rights within the national health insurance system. Enrollees are encouraged to report any delays or difficulties accessing timely care, particularly when codes are not issued within the specified timeframe.