The National Health Insurance Authority (NHIA) has significantly reduced its debt to service providers, now owing only for claims from November and December 2023, as it begins processing claims for January 2024.
Over the past two years, the NHIA has been making monthly payments to healthcare providers following thorough vetting and approval of claims.
The most recent payments, totaling GH¢130.24 million, were made on February 13, 2024, to 4,850 Mission, Public, Private, and Quasi-Public healthcare providers nationwide, primarily for claims submitted for October 2023. The NHIA aims to process claims within 90 days of submission, as per the scheme’s design and agreed arrangements with healthcare providers.
The NHIA introduced the “Sunshine Policy” in March last year to enhance accountability, social auditing, and transparency in monthly claims payments. All claims paid are now published on the NHIS homepage, nhis.gov.gh/payments, to update healthcare facilities and stakeholders.
To further improve efficiency and reduce fraud, the NHIA is set to achieve 100% electronic claims management by the end of the first quarter. This will allow facilities to submit claims electronically through the Claim-IT platform, streamlining the vetting and payment process.
Recently, the NHIA signed a facility with the World Bank Group, providing $27.7 million to increase NHIS annual active membership and facilitate claims processing and payments for primary healthcare providers. The funding is contingent on achieving set targets, including expanding active membership and digitizing the claims management process.
Despite progress, the NHIA cautioned against illegal payments by some credentialed service providers charging NHIS members for services covered by the scheme. The NHIA has suspended 81 identified health facilities involved in unauthorized charges and is enforcing its contract clause to make deductions from claims submitted for services wrongly charged to members.
The NHIA reiterated its commitment to reducing out-of-pocket payments under the NHIS policy to prevent catastrophic health expenditures, especially for the poor and vulnerable.