The Health Insurance Service Providers Association of Ghana (HISPAG), says it has reconsidered its decision to revert to the cash and carry system, following the intervention of the National Health Insurance Authority (NHIA), to pay their stalled arrears next month.
HISPAG had planned to make NHIS card holders pay cash at their facilities if the NHIA did not take steps to clear the arrears.
However, a meeting between the leadership of HISPAG and the NHIA produced a roadmap to hopefully address the challenge of delays in claims payment.
The meeting follows similar ones the NHIA held with other provider groups such as CHAG and the SPMDP in the same week, as a way of engaging its stakeholders in the face of delayed claims reimbursement.
The NHIA assured the providers that it was working within its means to make payments soon.
A statement signed at the end of the meeting among other things agreed that “HISPAG shall continue to provide service to NHIS members while the NHIA works to settle a good part of the arrears in one month.”
The NHIA currently owes service providers about 5 months.
At the meeting, the NHIA also committed to continue working with the Ministry of Health, to expedite action on the new NHIS medicines list and tariffs for services delivered under the scheme.
The tariffs are jointly calculated and agreed on by the NHIA and the various stakeholders, on how much the Authority pays for conditions and medicines covered under the scheme.
This is done periodically to ensure that prices the NHIA pays for its services reflect market realities.
The medicines list and tariffs as agreed between the parties must then be approved by the Ministry of Health before implementation.
“The NHIA shall continue to work with the Ministry of Health for the approval and subsequent implementation of the 2015/2016 NHIS Tariffs and Medicines List by March 15, 2015 to ensure cost of medical care provision at NHIS credentialed facilities reflects market realities,” the statement said.
The meeting also agreed that “HISPAG shall work with its members to resolve issues of compliance with NHIS procedures and processes that affect reimbursement of claims to providers.”
This is because according to the NHIA, service providers whose credentialing status has expired, will not be reimbursed for services provided within the period of credentialing expiry. This is part of measures the NHIA is putting in place to ensure compliance with regulations and procedures established by the health Insurance Act, 2012, Act 852 which regulates the NHIS.
The statement initialed by Frank Torblu, Executive Director of HISPAG and Dr Anang Adjetey, Director of Corporate Affairs at the NHIA also mentioned that “the NHIA and other stakeholders shall continue to make the case for an even more improved flow of funds to facilitate provision of quality healthcare at NHIS credentialed facilities.”