By Cecilia Ologunagba
Abuja – The National Health Insurance Scheme (NHIS), says it has embarked on reconciliation to finally resolve claims of indebtedness by Health Maintenance Organisations (HMOs) and Health Care Facilities (HCFs).
NHIS’s Head of Media and Public Relations Division, Mr Ayo Osinlu, disclosed this in a statement on Thursday in Abuja.
Osinlu said NHIS had resolved to finally end the disruptive contentions between HMOs and HCFs over claims of unpaid bills, which had been known to result in service failure in certain instances.
The official said the scheme had embarked on reconciliation 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 had in December 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.
“Some facilities 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 included 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,’’ he said.
According to him, NHIS has directed that provisions of its Operational Guidelines must be strictly adhered to in the course of the exercise.
He said payment of agreed figures after the painstaking reconciliation must be effected by the HMOs concerned within two weeks from the date of reconciliation.
“This exercise is part of a series of confidence building initiative of the new leadership of the Executive Secretary of the Scheme, Prof. Mohammed Sambo.
“The initiative is 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, Sambo introduced a 3-Point Rebranding Agenda of reforms.
“The agenda is anchored on a comprehensive value reorientation to make NHIS a credible organisation, Transparent and Accountable in the entire operations of the Scheme, as well as rapid steps towards the attainment of universal health coverage in the country,’’ the official said.
According to him, the reconciliation, which is for a period of one month, began on June 15.
“It 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.’’