NHIS reconciles HMOs, HCFs over unpaid bills
The National Health Insurance Scheme, NHIS, said it had commenced reconciliation between Health Maintenance Organisations and Healthcare Facilities over unpaid bills.
The organisation premised the decision on its resolve to end the contentions between the HMOs and HCFs over claims of unpaid bills, which had been known to result in service failure in certain instances.
The decisions were contained in a statement issued in Abuja by the NHIS Head Media and Public Relations Division, Ayo Osinlu.
According to him,effort had been made in ensuring that all stakeholders adhered faithfully with their obligations under the operational guidelines of the scheme, as well as the restoration of full stakeholder and public confidence in the NHIS.
Ayo said the management of the NHIS, is part of the implementation of its rebranding agenda which highlights transparency and accountability in the system.
He said last December, he issued a public notice inviting health care facilities accredited by the scheme to submit claims of unsettled bills standing against the HMOs.
In his words, “This followed strident complaints by the HCFs over the failure of the HMOs to effect payment of bills accruing from the care given to enrolees under the NHIS, as well as other private insurance plans operated the HMOs".
Ayo said there is need to address all contending issues 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.
The NHIS also directed that provisions of its operational guidelines which is the standard 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 weeks from the date of reconciliation.
He said the exercise was part of a series of confidence –building initiatives of the new leadership of the Executive Secretary of NHIS, Prof. Mohammed Sambo, aimed at restoring trust and credibility to the process and practice of health insurance in Nigeria.