Covid-19: NHIS tasks HMOs on prompt payment to healthcare facilities

By Tobias Lengnan Dapam

To ensure that enrolees get unhindered services by health facilities, the National Health Insurance Scheme (NHIS), has called on Health Management Organisations (HMOs) to ensure prompt payment of capitation and fee-for-service to all healthcare providers.
This is even as the NHIS has released funds for such payments for the second quarter (April to June) of 2020.
A statement issued by the Scheme’s spokesman, Ayo Osinlu, said that the initiative was to guarantee uninterrupted access to healthcare services by enrolees of the Scheme in these challenging times occasioned by Covid-19.
“The Scheme took the step to ensure that the looming threat of COVID-19 is not compounded for the enrolees by inability to access healthcare services at the points of need,” the statement noted.
The NHIS also issued out some guidelines to the HealthCare Facilities (HCFs) and the Health Maintenance Organisations (HMOs) on certain actions to be taken towards protecting the interests of the enrolees as the Covid-19 pandemic lasts.
It however, noted that the guidelines may be revised as new developments unfold.
“The guidelines gave clear order to healthcare providers to ensure the safety and protection of their personnel against COVID-19 infection, provide timely and appropriate level of care for all NHIS enrolees as may be required, and ensure that no NHIS enrollee is denied access to care.
“It also directed the providers to note that all NHIS and HMO Call Centres are open 24hours daily.
“They are also to ensure the issuance of authorization codes and resolution of all other issues, ensure prompt report of all cases of denial of authorization codes by HMOs, as well as maintain high index of suspicion and promptly report suspected cases to NCDC or State Ministries of Health.
“On the other hand, the guidelines for the HMOs instructed them to also ensure the safety and protection of their personnel against COVID-19 infection, ensure prompt payment of capitation and fee-for-service to all healthcare facilities, while also ensuring the provision of timely and appropriate level of care for all NHIS enrolees by the healthcare facilities.
“The HMOs are, by the guidelines, required to ensure that no NHIS enrolee is denied access to care, while their call centres are to be open 24hours daily, for prompt issuance of authorization codes and to resolve all other issues that may arise,” the statement stressed.