The National Health Insurance Authority (NHIA) in Nigeria has introduced a strict one-hour deadline for the authorization of care and issuance of treatment codes by Health Maintenance Organizations (HMOs).
This move is aimed at reducing delays in healthcare service delivery and improving patient outcomes across the country.
The directive, which took effect on April 1, 2025, mandates that all HMOs must respond to authorization requests within one hour of submission by healthcare providers.
This development follows rising complaints over treatment delays and inefficiencies in the health insurance system.
A statement by the Ag. Director of Media and PR of NHIA, Emmanuel Ononokpono, said the initiative aligns with the provisions of the NHIA Act 2022 and was agreed upon during a Stakeholders’ Meeting held in February.
“It is part of ongoing reforms to strengthen the authority’s regulatory role and promote timely access to quality healthcare.
“In situations where HMOs are unable to issue authorization codes within the stipulated time, they must provide justifiable reasons within the one-hour window. Meanwhile, healthcare facilities are encouraged to promptly submit requests to avoid unnecessary service delays,” he added.
NHIA said that where delays exceed the one-hour limit, healthcare providers are instructed to go ahead with treatment and inform the NHIA immediately. The authority will verify that such services were rendered to the enrollees in line with the guidelines.
For emergency cases, the NHIA stated that treatment may commence without prior authorization. However, authorization codes must be obtained within 48 hours of beginning care, as stipulated in the operational guidelines.
Enrollees who encounter delays or obstacles in accessing services due to late authorization are encouraged to report such incidents independently to the NHIA for redress and monitoring.
The NHIA has also mandated that HMOs and providers keep proper records of all treatment authorization requests and responses. This will serve as evidence for audit purposes and ensure transparency in service delivery.
The authority warned that sanctions would be imposed on any stakeholder found deliberately delaying authorization, adding that it will continually review compliance and provide feedback to ensure accountability across the system.
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