The Claims Directorate of the National Health Insurance Authority (NHIA) has commenced a four-day intensive training programme for staff of the Claims Processing Center (CPC) in Accra, aimed at strengthening staff capacity in claims management. The initiative, funded by the World Bank Programme for Results (P for R) project, forms part of a nationwide programme to improve efficiency, transparency, and service delivery within the National Health Insurance Scheme (NHIS) across the four (4) CPCs.

First Batch Trainees

The first batch of staff, which attended sessions on Monday and Tuesday, comprised CPC Accra staff and Actuarial Directorate staff and district managers from the Greater Accra Region. They were trained on the new electronic claims (e-Claims) systems designed to enhance efficiency, reduce disputes, and speed up processing times. Sessions also covered clinical appropriateness, claims verification guidelines, matrimonial issues under Ghanaian law, conflict resolution, code of ethics and code of conduct for NHIA staff.

Day One: Synopsis on Matrimonial Causes and Related Matters, Updates on Claims Management Guidelines, and Conflict Resolution

In her opening remarks, Acting Director of Claims, Dr. Abigail Nyarko Codjoe Derkyi-Kwarteng, underscored the central role of claims management in sustaining the NHIS. She explained that the training forms part of broader efforts to standardise claims processing nationwide under the P for R project.

She highlighted several interventions under the project, including training Tier 3 facilities on expedited claims generation and submission, introducing an Android version of Claim-it for electronic submissions, transitioning from manual to electronic processing through PCAP, and organising continuous staff training.

Delivering a session on conflict resolution, Dr. Derkyi-Kwarteng stressed the importance of collaboration in addressing disputes. She explained that while conflict is inevitable and sometimes necessary in organisations, managers must channel it productively for growth, creativity and innovation. “You can become more effective in handling conflict by understanding its root causes, mastering conflict management approaches, and developing personal skills to navigate tense, emotionally charged situations,” she advised.

Other sessions on Day One included a presentation by Baba Sadique Zankawah (Esq.), Acting Director of Infrastructure, who guided staff through key matrimonial issues such as divorce, spousal support, child custody, and inheritance. He urged professionalism, empathy, and thorough documentation when handling sensitive claims.

Dr. Abena Ekufua Esia-Donkoh, Deputy Director, Claims of CPC, Cape Coast, delivered a session on updates in claims management guidelines with emphasis on clinical inappropriateness and its impact on claims processing. She drew attention to common errors, including treatment-diagnosis mismatch, missing attachments, and system-related duplicates. She stressed the need for accuracy, compliance, and integrity to ensure that claims submitted by facilities are legitimate and justified.

Day Two: Systems Support Updates – E-claims Management, Cross-Cutting Operational Issues, Code of Conduct, Ethics and Disciplinary Procedures

On the second day, Mr. Eric Kobla Nazar, e-Support Manager at the CPC in Accra, led participants through a session on electronic claims management under the topic Systems Support Updates. His presentation focused on recent developments, challenges, and solutions within the support systems, highlighting practical ways to enhance efficiency, strengthen data security, and ensure seamless service delivery. He also introduced staff to the new Patient Call-Out feature, an innovation designed to improve communication, facilitate claims verification, and enhance overall efficiency in claims management.

Ms. Mariam Musah, Acting Director of Operations, outlined the NHIA’s three strategic priorities under the Chief Executive’s vision: supporting government initiatives such as free primary healthcare and the Ghana Medical Trust Fund (MahamaCares) initiative, eliminating illegal out-of-pocket payments and fraudulent claims to restore confidence, and prioritising staff welfare.

She identified illegal payments, fraud and abuse, and tariff review/system integrity as pressing challenges being addressed by management and urged staff to be vigilant in detecting discrepancies. She also announced the Authority’s shift toward advanced tools, saying "beyond audits, we are moving towards the use of artificial intelligence and fraud detection systems in both our claims management and data analysis processes."

Ms. Musah further explained that Executive Management’s focus is on preventive, promotive, and essential curative services. She said this rollout will be anchored through CHPS compounds, schools, pharmacies, and community facilities, supported by technology-driven solutions such as the National Electronic Health Insurance Strategy (NEHSA) and the National Electronic Pharmacy Platform (NEPP) to ensure secure and transparent reimbursements.

Mr. Isaac Gideon Akonde, Acting Director of the Co-payment Taskforce, presented on the conduct claims verification guidelines, stressing diligence, accuracy, and consistency in reviewing claims. He also stressed integrity and professionalism in the NHIA claims staff’s interaction with providers.

The training also featured Mr. Dickson Nuku Dansu, Deputy Director of Training and Development, who walked staff through the NHIA Code of Ethics and disciplinary procedures. He reminded participants of their responsibility to uphold professionalism, accountability, and adherence to the highest standards of conduct in their duties.

Participants were given the opportunity to ask questions and seek clarifications, fostering open discussions that allowed them to share experiences, address concerns, and deepen their understanding of the issues raised. The training is expected to continue with the second batch participating in the same programme on Wednesday and Thursday, September 17 to 18, 2025, ensuring wider coverage and effective engagement across the Centre.

Source: Vivian Arthur

Photo: Ebenezer Danso and Samuel Larbi