May 24, (THEWILL) – To manage enrollees of health insurance better, the National Health Insurance Authority (NHIA), says it is developing a system digitally so that when billings get to Health Maintenance Organisations (HMOs), there will not be any dispute in terms of claims management.
The Authority also said that the system will take care of everything from registration, electronic medical records, and also claims payment for enrollees who are on their health insurance programme.
Lagos Zonal Coordinator, NHIA, Mr Olufemi Akingbade, who disclosed the new development at the Ikeja Stakeholders Forum held Tuesday, at NECA House, Ikeja, noted that the development has become necessary, now that they are growing their figures.
Aimed at bridging the gap between the Authority and stakeholders, the Stakeholders Forum, which is organised quarterly by NHIA, accommodates a lot of stakeholders ranging from HMOs to service providers, MDAs and enrollees.
According to Akingbade, what NHIA has at present, is a kind of semi-manual operation, but affirmed that there is a need to migrate from their present state to eNHIA.
He said, “We are developing a system that will actually take it from that beginning of registration, retrieval when you get to the hospital so that there will be no issue of bringing your ID card. In each hospital, we will have a terminal that once you give them your NHIA number, it calls up your data. Along the way, whatever you pass through at the hospital will be recorded, which is the Electronic medical record. With it, dealing with medical records will be easy. This is because if you have been treated with malaria and we have a code for malaria treatment, there is a price that is fixed for that malaria treatment, such that once they click the code, the price will come out. It is not something that anybody can dispute. When the billing gets to HMO, there will not be any dispute. In terms of claims management; also, the system will take care of everything from registration, electronic medical records and also claims payment”.
Explaining further, Akingbade emphasised the fact that, within the system, there is going to be an app and a portal. With the portal, he said those who don’t have the app can go to the website to do whatever they want to do in terms of health care needs.
Noting that the best thing that can actually happen to Nigeria is the signing in of the mandatory health insurance law, he is of the view that such enabling Act will shore up the number of enrollees in health insurance coverage in Nigeria.
The zonal coordinator cautioned on the fragmentation of health insurance funds in Nigeria, advising that it is high time Nigeria established a single pool of funds for the growth and development of health insurance in the country
With the National Health Insurance Act, signed into law last year in 2022, he informed that the operational guideline is now very strict, as NHIA has been given power as an authority to delist erring operators.
Corroborating Akingbade, Lagos State Coordinator, NHIA, Ikeja Office, Dr Bethuel Kasimu Abraham, pointed out that the operational guideline NHIA had before this new Act came, did not empower the Authority to take certain actions before now.
“It didn’t give us the power to really do some regulations we wanted to do to effect some things in the system. But thank God that, with the new Act now, as an authority, if you go wrong, at my level, I can hammer you without making recourse to Abuja. The Act is going to give us more power. In fact, we are expecting a new guideline that is based on this Act.. From the Act alone, some things have been criminalised that could have happened previously and we were limited to what we can do”, Dr Abraham said.
In her presentation titled: “GIFSHIP: Expanding Coverage”, Assistant General Manager, Programme Unit NIHIA, Ikeja, Mrs Chika Amahalu, said Group, Individual and Family Social Health Insurance Programme (GIFSHIP), is a basic programme for NHIA, which provides access to quality and affordable health care services to all.
According to her, it is health insurance that is taken up and paid for by groups, individuals and families not covered by other NHIS coverage platforms.
She, therefore, advised individuals, constituencies, retirees and members of the National Youth Service Corps (NYSC) whose categories have been accommodated, to log on to the programme.
Anthony Awunor, is a business correspondent who holds a Bachelor of Arts Degree in Linguistics (UNILAG). He is also an alumnus of the Nigerian College of Aviation Technology (NCAT), Zaria Kaduna State. He lives in Lagos.
