NHIS resolves HMOs, hospitals debt feud - Businessday NG
  • Wednesday, January 01, 2025
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NHIS resolves HMOs, hospitals debt feud

hospitals

The National Health Insurance Scheme (NHIS) has embarked on a reconciliation exercise to resolve the disruptive contentions between Health Maintenance Organisations (HMOs) and Health Care Facilities (HCFs) over claims of unpaid bills, which have been known to result in service failure in certain instances.

This followed strident complaints by HCFs over the failure of HMOs to effect payment of bills accruing from care given to enrolees under NHIS, as well as other private insurance plans operated HMOs.

Ayo Osinlu Head Media & Public Relations Division, who disclosed this in a statement, added that the need to address this as urgency arises from reported cases of consequent service failure, whereby some facilities in the country are withholding care from enrolees over unpaid capitation and fee-for-service by HMOs, inspite of receiving funds timely from NHIS for those purposes.

According to him, other objectives of the exercise include ensuring that all stakeholders abide faithfully with their obligations under the Operational Guidelines of the Scheme, as well as the restoration of full stakeholder and public confidence in NHIS.

“The process of the reconciliation exercise includes compulsory attendance by representatives of HMOs and HCFs, presentation and careful review of claims and counter-claims, bank statements, contract documents, tariffs, and other relevant documents.

Meanwhile, Osinlu informed that NHIS has directed that provisions of its Operational Guidelines which is the standard of procedure in the industry must be strictly adhered to in the course of the exercise, while payment of agreed figures after the painstaking reconciliation must be effected by the HMOs concerned within two (2) weeks from the date of reconciliation.

He said the exercise is part of a series of confidence building initiatives of the new leadership of the Executive Secretary of the Scheme, Mohammed Nasir Sambo, aimed at restoring trust and credibility to the process and practice of health insurance in Nigeria.

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