The National Health Insurance Authority (NHIA) Quality Assurance Directorate has concluded its nationwide training session on the Credentialling Electronic Payments System in Tamale, with a charge on healthcare providers to desist from illegal payments and fraudulent claims. The training, targeted at staff and credentialed healthcare providers, brought together participants from the Upper East, Upper West, North East, Savannah, and Northern Regions.

They comprised NHIA Regional Directors, Regional Monitoring and Evaluation Officers, Managers, Quality Assurance Managers, District Public Relations Officers, frontline staff, healthcare providers from the Ghana Health Service, Christian Health Association of Ghana (CHAG), and private health facilities. The training aimed to equip participants with the necessary skills and knowledge to effectively utilize the digital platform, ensuring seamless and efficient transactions.

Addressing Leakages and Abuse

In his remarks, the Acting Deputy Director of Credentialing, Mr. Eugene Segbefia, emphasized the Authority's zero-tolerance policy for illegal charges, often disguised as "co-payment" imposed on members of the National Health Insurance Scheme (NHIS) by service providers. He indicated that such practices undermine the trust and integrity of the scheme, hence the Chief Executive's efforts to block leakages and stop abuse, citing the establishment of a Co-Payment Committee to investigate and recommend solutions. He cautioned that any institution or individual found culpable would face strict sanctions, including mandatory refunds and possible prosecution.

"The CEO has also said that there is zero tolerance for misinformation and disinformation, which has led to what some people call co-payments. But for NHIA, we don't have co-payments in our dictionary. All we know is that they are illegal payments, and so we are not expecting our active members to be asked to make out-of-pocket payments for services that the NHIS is paying for. Anyone caught in this act going forward will face the full rigor of the law," he warned.

Enhancing Claims Reimbursement

Mr. Segbefia reiterated the Chief Executive's commitment to increasing the percentage of funds allocated to claims reimbursement to 65% this year and 75% next year, supported by the government's decision to uncap the NHIS levy. He said the Authority is also working on a new tariff review system to ensure more realistic and frequent updates.

Streamlining Credentialing Applications

Mr. Segbefia stressed that, as part of the Chief Executive's commitment, the Authority had developed an online payment system to reduce delays in credentialing application processing. He advised healthcare providers to submit applications at least six months prior to expiry to avoid disruptions. He noted that applications submitted within 12 months post-expiry would incur specified penalties. Furthermore, he warned that applications on hold for over 60 days or those with more than five unresolved issues would be terminated.

Key Features and Benefits

The Principal Manager at Quality Assurance, Mr. Samuel Augustus Abbey, presented the features and functionalities of the Credentialling E-payments system. He explained that the system aimed to address challenges, streamline payment processes, and deliver solutions for an efficient healthcare ecosystem. Highlighting the benefits, Mr. Abbey said it would ensure faster processing, reduce payment burdens, provide a clear audit trail, offer round-the-clock accessibility, and enhance user experience.

Bryan K. Danquah, a Software Developer from Super Tech Limited (STL), walked the participants through the test user application, demonstrating registration, claims submission, and payment processing. He also trained them on how to interact with the system, explore its features, and gain hands-on experience with the Credentialling E-payments platform.

Embracing Change

The Acting Deputy Director of Management Information System, Mr. Orison Afflu, urged participants to embrace the new system with optimism and leverage its features to enhance work efficiency, productivity, and overall experience. Participants shared insights and clarified doubts about the system, making the session engaging and informative.

Source: Vivian Arthur

Photo: Samuel Larbi