In its resolve to finally end 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, the National Health Insurance Scheme (NHIS) has embarked on a reconciliation exercise, designed as a clearing house for areas of disagreement between HMOs and the facilities over unpaid bills.
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 Management of the Scheme, as part of the implementation of its rebranding agenda which highlights transparency and accountability in the system, had in December last year issued a public notice inviting healthcare facilities accredited by the Scheme to submit claims of unsettled bills standing against the HMOs.
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.
The need to address this as an 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.
The process of the reconciliation exercise include 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, 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.
This exercise is part of a series of confidence building initiatives of the new leadership of the Executive Secretary of the Scheme, Prof. Mohammed Nasir Sambo, aimed at restoring trust and credibility to the process and practice of health insurance in Nigeria.
It will be recalled that upon assumption of office in July 2019, Prof. Sambo introduced a 3-Point Rebranding Agenda of reforms anchored on a comprehensive value reorientation to make NHIS a credible organisation, Transparency and Accountability in the entire operations of the Scheme, as well as rapid steps towards the attainment of universal health coverage in the country.
The reconciliation exercise, which is for a period of one month, began on the 15th of June, and has been reported to proceed smoothly and record impressive outcomes already, at the various NHIS offices in the states of the federation and the FCT where it is taking place.
Head Media & Public Relations Division