NHIA implements measures to safeguard claims processing

Ghanaian

The National Health Insurance Authority (NHIA) has made significant strides in reducing its debt to service providers, now only owing for claims from November and December 2023 as it initiates the processing of January 2024 claims.

Over the past couple of years, the NHIA has been diligently making monthly payments to healthcare providers after thorough scrutiny and approval of claims.


Read full article/>
In its most recent payments on February 13, 2024, totaling GH¢130.24 million, over 4,850 Mission, Public, Private, and Quasi-Public healthcare providers nationwide were compensated, primarily for claims submitted for October 2023.

The NHIA aims to adhere to the scheme’s 90-day claim processing timeline, as agreed upon with healthcare providers.

Introducing the "Sunshine Policy" in March last year, the NHIA prioritized accountability, social auditing, and transparency in monthly claims payments. All payments made are now accessible on the NHIS homepage, nhis.gov.gh/payments, to keep healthcare facilities and stakeholders informed.

In an effort to enhance efficiency and combat fraud, the NHIA is working towards achieving 100% electronic claims management by the end of the first quarter.

This will streamline the vetting and payment process by allowing facilities to submit claims electronically through the Claim-IT platform.

Recently securing a facility with the World Bank Group, the NHIA obtained $27.7 million to expand NHIS annual active membership and facilitate claims processing and payments for primary healthcare providers. However, this funding is contingent on meeting specific targets, including expanding active membership and digitizing the claims management process.

Despite progress, the NHIA has cautioned against illegal payments by some credentialed service providers, who charge NHIS members for services covered by the scheme. In response, the NHIA has suspended 81 identified health facilities involved in unauthorized charges and is enforcing contract clauses to deduct amounts from claims submitted for services wrongly charged to members.

Reiterating its commitment to reducing out-of-pocket payments under the NHIS policy, the NHIA aims to prevent catastrophic health expenditures, particularly among the poor and vulnerable.