National Health Insurance Unit

The NHI Unit is responsible for coordinating the resolution of National Health Insurance Scheme issues at the national level.

The Unit has programme coordinators and officers for claims, credentialing, clinical audit and provider payment respectively.

The Unit provides technical advice on health insurance issues to the Director General and other Directors in the Service. Each Regional Directorate has a Focal Person for Health Insurance to see to the implementation of Health Insurance activities. The District Directorates have similar structures as that of the regions.

The core functions of the Unit include:

  • Representing GHS interest with NHIA, Private Health Insurance Schemes and other stakeholder provider associations.
  • Serving as safe haven for facilities towards speedy resolution of health insurance issues
  • Coordinating and ensuring adequate licensing or credentialing of health facilities with appropriate regulatory bodies to ensure standardized healthcare delivery.
  • Preparing database of credentialing expiry dates of all GHS facilities and prompt them timely.
  • Coordinating reimbursement to facilities by channeling all payments through ODG and following up on delay reimbursement.
  • Communicating updates on reimbursement methods, tariffs and medicine list to facilities.
  • Monitoring compliance with levels of care and use of appropriate tariffs by facilities.
  • Collaborating with NHIA in the timely review of tariffs/medicine list appropriate to the needs of facilities.
  • Monitoring compliance to credentialing status, resolve dis-accreditation and re-accreditation issues
  • Reducing to the barest minimum adjustment from NHIA Clinical/Compliance Audit and claims vetting
  • Enhancing the timely submission of genuine and adjustment-free claims
  • Monitoring claims submission, analyzing and providing feedback to outlier health facilities
  • Coordinating the formation, revival and activities of vibrant institutional vetting committees across all levels of healthcare
  • Developing and constantly reviewing guidelines for the formation and activities of institutional vetting committees