The National Health Insurance Authority (NHIA) has disbursed GHC130,244,000 million to 4,850 credentialled healthcare service providers nationwide.
According to the Authority, it has also succeeded in reducing the claims payments arrears to just two months.
“The most recent payments were made on February 13, 2024, with a sum of One Hundred and Thirty Million, Two Hundred and Forty-Four Thousand, Cedis, (GHS130,244,000.00) paid to 4,850 Mission, Public, Private, and Quasi-Public healthcare providers nationwide largely for claims submitted for the month of October 2023,” the Authority said in a statement.
Following the February 13 payment, the Authority will owe service providers for only November and December 2023, indicating that “claims for January 2024 are now coming in to be vetted.”
Per the design of the Scheme and agreed arrangements with healthcare providers, the NHIA should take about ninety (90) days to receive, vet, and pay claims.
Meanwhile, the Authority emphasized the introduction of the “Sunshine Policy” last March, stating that it “has deepened accountability, social auditing, and transparency with regards to claims paid monthly.”
World Bank Support
NHIA further revealed that a recent facility signed with The World Bank Group made available Twenty-Seven Million, Seven Hundred Thousand ($27.7 M) to the Authority, to increase the National Health Insurance Scheme (NHIS) annual active membership and as well facilitate Claims processing and payments for primary healthcare providers.
The funding is allocated based on the Disbursement Linked Result (DLR), which is a set of targets to be achieved to access the funds, which include expanding the number of active members of the Scheme and digitising the claims management process to enable the prompt payment of claims within a stipulated time.
Caution on Illegal Payments
The Authority therefore cautioned healthcare service providers to refrain from charging patients for drugs covered under the NHIS package.
“In as much as the Authority has been successful in reducing the Claims payments backlog to acceptable thresholds, there are still some credentialled service providers charging NHIS members for services covered by the Scheme.
“In January 2024, the NHIA Governing Board and Executive Management served notice to suspend some 81 identified credentialed health facilities involved in such unauthorized charges ‘Copayments’,” it added.
It said, “Such practice is a clear violation of Section 35(1) of Act 852 and point 16.0 on “forbidden conduct” in the Master Provider Service Agreement.”
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In this regard, NHIA issued a further directive in February 2024, notifying healthcare providers of the Authority’s intention to enforce clause 15 of its contract with them, which allows the Authority to make deductions from claims submitted as a Return of Payment for Services otherwise covered under the Scheme but charged to members.
“All such monies will be refunded to the aggrieved members after investigations are conducted,” it said.
The Authority maintained that it is working to reduce Ghana’s NHIS Policy’s unintended out-of-pocket payments, which could lead to catastrophic health expenditures, especially for the poor and vulnerable.