Prof. Mohammed Sambo, the Executive Secretary, National Health Insurance Scheme (NHIS), says the scheme will give authorisation code directly to enrollees if Health Maintenance Organisations (HMOs) fail to give within six hours.
Sambo said in Abuja that NHIS would issue the code to ameliorate the sufferings of enrollees (patients) if the HMOs could not issue the code within the hours.
He said NHIS had set up a committee to look into the complaints and delays in accessing authorisation code on time by HMOs.
He added that “the committee reported that we can ensure that within six hours, authorisation code is advanced to every client who requires it.
“And if HMOs fail to give authorisation code, we will ensure that we take over; NHIS will take over authorisation code to ameliorate the problems of enrolees.
“That is why we said we need healthcare professionals to achieve that.’’
The executive secretary said NHIS would have implemented the recommendation of the committee since January but was hindered by the lack of personnel to issue the code.
“In fact, we wanted to start by January but when we took inventory of our human resource at the state level, we realised that those compliment officials are not there.
“There are no doctors, there are no pharmacists in most of our state offices; there are no laboratory scientists who can quickly review and give you that authorisation code within the period of six hours.
“So what we are going to do is to ensure that we have the compliment of professions within our state offices.
“So that if there is a client in say Bayelsa and he or she requires authorisation code, and within six hours, HMO cannot provide, we will call the NHIS office to quickly review and issue authorisation code directly to clients.’’
According to him, if NHIS succeeds in issuing a code directly, it will deduct money from what it pays HMOs.
“This is what we are planning to do but we need to put our house in order to be able to achieve that.’’
Sambo also told NAN that there were other measures put in place to ensure that HMOs received payment in time to boost good service delivery.
“There are some immediate measures that we took; there are some remote measures that we also agreed to undertake to correct all these anomalies.
“Before Jan. 1, health maintenance reimbursement mechanisms were done on monthly basis, NHIS will pay the HMOs and then in turn pay the providers.
“This monthly payment is very huge. The administrative process is very huge for NHIS and is also huge for health maintenance organisations.
“We have changed the mode of payment to quarterly basis so that every quarter, we give HMOs the money based on the agreed rate of capitation and fee for service.
“They will now in turn ensure that before the beginning of every month, they pay the healthcare providers.
“We have started the intervention and so far, the reports we are receiving are encouraging, the providers are happy, the HMOs are happy, they are being paid.’’
In addition, he said, the scheme was making a lot of progress compared with previous years, saying “NHIS is getting stabilised and with stability, sky is not even our limit.’’ (NAN)