NHIS claims payments must stay in 90-day arrears window
The Ghanaian Times front page banner headline story is about an interesting development at the National Health Insurance Authority, (NHIA) announcing that within 42 days, it has paid its credentialled healthcare providers over GH¢471 million to cover claims submitted for periods up to January 2023.
According to a statement issued by the Authority, “for the first time in several years, the NHIS is back into the accepted 90-day arrears window meaning healthcare providers are only owed two months of claims for February and March 2023, ”
The statement states further that between May and June 2023 alone, the Authority paid over GH¢ 367 million to over 4,000 health facilities across the country with a further payment of GH¢104.5 million paid last Friday.
“Over the years, previous management teams have had to traverse the difficult path of pooling funds from the Ministry of Finance to pay for claims.
“Though Out Patients Department (OPD) cases and membership in the scheme have seen some upward trends coupled with the tariff adjustments, the NHIA today pays on average between GH¢150 – GH¢ 200 million per month as claims reimbursements,” the statement said.
The authority said management in an effort to eliminate financial irregularities set up decentralised Co-payment committees at the head office, regional and district offices with mandates that include engaging with the credentialled healthcare service providers and NHIS members who were sometimes compelled to pay such extra monies for services covered by the Scheme.
The Ghanaian Times would like to commend the Authority for working hard to reverse the trend where claims remained in arrears past the stipulated time for payment.
Previous management had to grapple with this challenge without success due to several factors that prevented the Authority from paying claims promptly.
Besides the Scheme as of the end of 2022, having an active membership of 17.2 million, representing approximately 55 per cent of the population with over 4,500 health facilities across the country comprising Public, Private, Quasi, and Faith-based facilities, payment of claims would always be daunting.
On several occasions in the past, service providers had to threaten the Authority or resort to other means before their claims are paid.
Thankfully, it looks like that era is now in the past and hopefully, the Authority is in the position to pay within the claim period.
We sincerely hope that the Authority has overcome the factors that militated against its effort to operate unhindered to provide access to healthcare.
