NHIS Initiates Open Policy On Claims Payment

The National Health Insurance Authority (NHIA) has initiated yet another novel policy to the tall list of innovations, in their quest to update stakeholders in the health delivery sector.

The Authority introduced a digital payment system that allows service providers to submit claims electronically, and allows it to vet and pay same electronically within a 90-day period as enshrined by law. Over 95% of claims are currently submitted electronically to reduce delay in claims processing and payment, to ensure that members of the scheme do not encounter challenges in accessing healthcare.

In addition to the digital payment system, the NHIA, under the leadership of Dr. Bernard Okoe Boye, has added the “Sunshine Policy” that updates all stakeholders on the payment status of claims paid to healthcare providers credentialed under the NHIS.

The Authority, in ensuring transparency, has introduced what it calls the “Sunshine Policy”. This open policy affords stakeholders and the public the opportunity to check the claims payments made by NHIA. This has already been described by stakeholders as the missing piece in the jigsaw puzzle.

The “Sunshine Policy” allows stakeholders to go online and find out which facilities have been paid claims, how much, and for which month(s) the claims have been paid. Providers’ payment can then be accessed by all stakeholders through a filter system, categorised as public or private providers.

Addressing stakeholders at the Ghana Medical Association (GMA) summit, Dr. Okoe Boye urged service providers to diligently serve clients and subscribers and avoid taking illegal charges from patients under the scheme.

According to Dr. Okoe Boye, the Authority pays not less than 100 million cedis to service providers every month on the average. A situation he deems as fulfilled promise and, therefore, urged providers to also fulfil their part of the obligation to sustain confidence in the scheme.

According to the CEO, “the intention behind the policy is to bring transparency on payments by the NHIA and the need to encourage honest discussions on health financing in Ghana.”

To access the policy, one can log onto the NHIA website (www.nhis.gov.gh), and click on the claims button on the top left corner of the homepage.

Led by Dr. Bernard Okoe Boye, the National Health Insurance Authority has witnessed some special initiatives as part of plans to have an inclusive and transparent authority.

The innovative CEO graced the 65th GMA anniversary at Takoradi as part of plans to update the medical ecosystem.