The National Health Insurance Authority (NHIA) engages healthcare providers to offer services to insured members through a process called credentialing. The credentialing process is to ensure that healthcare providers are in a position to provide basic quality health services to insured members in Ghana in accordance with the Benefit Packages within the National Health Insurance Scheme and/or Private Health Insurance Scheme. Credentialing promotes quality improvement in health care delivery, nurtures a healthy competition among service providers as well as grows public confidence in the health system
For a healthcare provider to be credentialed with NHIA, the provider must complete an application, with the requisite documentation.
Documents required must have the following;
- Current primary regulators certificate and copy of retention indicating healthcare provider is in good standing. Example: HeFRA, Pharmacy Council certificate
- Current certificate from Register- General (where applicable) and proof of renewal for Private Providers.
- Current Association membership certificate and proof of renewal of membership. Example: CHAG
- Must pay required fees for requested level of credentialing.
- Photo copies of certificates of professionals practicing at the facility and proof of retention with their appropriate regulatory bodies.
The National Health Insurance Authority (NHIA) wishes to bring to the attention of the general public and healthcare providers that it has completed processes to receive and process applications for credentialing of healthcare providers on an online platform, which will ease provider experience with the credentialing process
Healthcare providers who wish to acquire new credential or renew their existing credential are to follow the steps below:
- 1. Providers are to send an email to the address firstname.lastname@example.org
- 2. The email as stated above should indicate the following;
- a. Name of facility
- b. Name of an officer from the facility that will manage the facility’s account on the online platform
- c. An official email address of the facility that will be used to create a user account for the facility
- d. The type of credentialing the facility seeks to acquire i.e., NHIS or PHIS credentialing or both
- e. The telephone number of the facility
- f. A copy of the HeFRA/CHAG certificate of the facility attached as a pdf (where applicable)
- g. A copy of the business registration documents of the facility attached as a pdf (where applicable)
Please note that an invoice will be generated upon completion of the application online with the instructions to complete payment.
Download the Credentialing Application Guide for more details
CREDENTIALING APPLICATION PROCESSING FEES FOR THE VARIOUS FACILITY LEVELS
| TYPE OF FACILITY||AMOUNT (GH¢)
|CHPS COMPOUND WITH MIDWIFE||600.00
|CHEMICAL SHOP ||600.00
|LABORATORY, ULTRASOUND (STAND ALONE) ||1,050.00
|MATERNITY HOME, HEALTH CENTRE ||1,200.00
|DIAGNOSTIC SERVICES ( X-RAY,+ LABORATORY, + ULTRASOUND) ||2,000.00
|PRIMARY HOSPITAL, POLYCLINIC ||3,000.00
Health Care facility of any ownership (public, private, mission, quasi-public) or type that is willing to operate with a Health Insurance scheme in Ghana can apply for credentialing.
All public healthcare providers that are recognized by Ghana Health Service/Ministry of Health
All mission healthcare providers that have registered with the state as well as their primary regulators and are in good standing with Christian Health Association of Ghana (CHAG) /Ahmadiyya Health Services
All private healthcare providers that have registered with the state as well as their primary regulators and are in good standing.
All new applicants must:
- Have operated for at least six months
- Have good record of service provision
- Accept the quality assurance standards, utilization review and the payment mechanism by the Authority
- Have formal quality assurance program in place
- Permit the Authority or any person authorized by the Authority inspect facility premises and records
The stages involved in the Credentialing process are as follows:
- Completion and submission of credentialing application form with relevant documents and approved fees.
- Verification and authentication of the documents submitted.
- Receiving of credentialing tools and manuals.
- Assessment of the facility.
- Submission of the assessment report.
- Authority’s decision on the application.
- Applicant informed accordingly in writing.
To begin the process of online Credentialing Application, please send the following details to email@example.com for an account creation.
- Facility name
- Portal manager(name)
- Portal manager(phone number)
- Insurance Type(NHIS/PHIS/BOTH)
- A copy of the HeFRA/CHAG certificate of the facility attached as a pdf (where applicable)
- A copy of the business registration documents of the facility attached as a pdf (where applicable)
Four (4) Years initially, and renewable every two (2) years.
- Non-compliance with any of the requirements and conditions of credentialing.
- Revocation, non-renewal or non-issuance of license to operate or practice as a health care facility by the relevant regulatory authority.
- Fraudulent activities.
- Change in the ownership of a health care facility for the purposes of evading the consequences of impropriety or violations of requirement or conditions previously committed.
- Non-compliance with any safeguards provided under the Act or Regulations.