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The Director of Claims at the National Health Insurance
Authority (NHIA), Dr. Abigail C. Derkyi-Kwarteng, has reiterated the need for
service providers under the National Health Insurance Scheme (NHIS) to acquaint
themselves with the new Claims Manual to ensure the smooth implementation of
the revised tariffs.
She said a thorough understanding of the manual would enable
providers to file their claims correctly and avoid rejections or under-claims
for services rendered.
The manual, she noted, outlines all services provided by
health facilities, grouped under the Ghana Diagnostic Related Groupings
(G-DRGs).
Dr. Derkyi-Kwarteng made the call on Thursday, November 28,
2025, during the New Tariffs Engagement Training held for service providers
from the Upper East Region.
According to her, the training formed part of the
Authority’s preparations ahead of the rollout of the revised tariffs next year.
Participants included district directors of health, medical
superintendents, representatives of private healthcare providers, officials
from the Christian Health Association of Ghana (CHAG), and the Regional
Director of Health. Staff of the Upper East Regional Directorate of the NHIS
were also in attendance.
While presenting guidelines on the application of the G-DRG
payment method, Dr. Derkyi-Kwarteng encouraged participants to share the
knowledge acquired with their colleagues to promote proper claims processing
across facilities.
She added that aside from the upward review of tariffs, the
NHIS benefits package had also been expanded to reduce the likelihood of
members making out-of-pocket payments when accessing healthcare.
The Upper East Regional Director of the Ghana Health
Service, Dr. (Med) Braimah Baba Abubakari, commended the NHIA for equipping
service providers with the necessary skills to file claims appropriately. He
said the intervention would strengthen the relationship between the Scheme and
healthcare providers for the benefit of members.
Dr. Abubakari, however, raised concerns about the use of the
Biometric Member Authentication System (BMAS) and the One-Time Password (OTP)
verification method. He said poor network connectivity and interference from
neighbouring countries could affect verification and also noted that some
members had registered with phone numbers that do not belong to them.
In response, the NHIA’s Deputy Director of MIS, Mr. Orison
Afflu, assured the participants that the BMAS would be deployed only in
high-volume facilities where network connectivity is stable. In areas where
connectivity is a challenge, the OTP option will be used.
He added that the Authority is currently updating members’
records at district offices and that the scheme’s USSD system will soon be
upgraded to allow members to update their phone numbers.
The new verification
measures, he explained, are aimed at eliminating “ghost” members and improving
the accuracy of membership data for future planning.
Also present at the engagement were the Director of Special
Projects, Dr. Francis Assenso-Boadi, and the Director of Actuarial Services,
Mr. Magnus Owusu-Agyemang.
Source: Kwadwo Baffoe Donkor
Photo credit: Sylvester Pappoe
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