The National Health Insurance Scheme (NHIS) in the Central Region has urged health service providers to help the Scheme manage cost by ensuring that only legitimate claims are submitted for payment.

“This is because each cedi saved could help save the life of one more client,” Mr. Emmanuel Mensah-Frimpong, the Manager of Central Regional Claims Processing Center (CPC) of the National Health Insurance Authority (NHIA) Claims Directorate said.

He made the call at a stakeholder’s forum organized by Awutu-Effutu-Senya District NHIS at Akweley in Awutu-Senya East Municipality.

The forum was on the theme: “The collaborative efforts of all stakeholders in achieving quality base health care towards Universal Health Coverage as the ultimate goal.”

It was attended by pharmacists and other medical staff from clinics, polyclinics and hospitals in the operational areas of the Municipal NHIS.

Also present were officials from Central Regional Directorate of the NHIA, Awutu-Senya District, Awutu Senya East and Effutu Municipal Assembles, Department of Social Welfare, National Commission on Civic Education and Ghana Education Service.

The participants were taken through the common reasons for adjustment which highlighted treatment or medicines mismatch, misapplication of tariff, over billing of medicines and over prescription of medicines.

Others included; duplication of claims, inappropriate filling of claims forms, billing for items already covered, billing for conditions outside the NHIS benefit package, prescribing without diagnostic confirmation and no diagnosis stated on claim forms.

Mr. Mensah-Frimpong recommended health providers engaged permanent and trained claims officers, set up vibrant vetting committee to pre-vet claims before submission, while management paid attention to the monthly vetting report.

CPCs should vet and make the necessary adjustment based on information provided on the claim forms and providers should strictly ensure accuracy and completeness on the claim forms.

In order not to blame anyone, he said: “You should also put in place proper supervision of your facility’s claims staff and ensure validation of clients eligibility to guarantee that they are eligible at the day of service to avoid any disparities in the payment of their claims”.

Mr Christopher Oddoye, the District Manager AES District NHIS, stated that the long-term goal of NHIA, was to provide financial risk protection against cost of quality primary healthcare for all in in an equitable manner.

“This together with other strategies and activities will serve as catalyst for achieving Universal Health Coverage,” he said.

He mentioned frequent system and network breakdowns, difficulty in securing permanent registration center for Bawjiase and high utilization rate and claims payment as challenges facing the scheme.

He appealed to the authorities to take the necessary steps to address them for constant and smooth work.

He also called on providers to continue recommending to the NHIS the Ghanaians who have not joined it, to do so for access to affordable healthcare.


Send your news stories to [email protected] and via WhatsApp on +233 234-972-832 


Please enter your comment!
Please enter your name here

This site uses Akismet to reduce spam. Learn how your comment data is processed.