The National Health Insurance Authority (NHIA) has outlined a phased roadmap for the implementation of its revised service tariffs, linking the rollout to the introduction of new risk-control systems aimed at safeguarding the National Health Insurance Scheme (NHIS).
The Authority says the accompanying accountability measures are necessary to curb financial leakages within the claims management system, which it estimates could significantly undermine the sustainability of the Scheme if left unchecked.
The roadmap was presented during a courtesy call by the Private Health Facilities Association of Ghana (PHFAoG) on the Executive Management of the NHIA in Accra.
Discussions focused on key concerns, including delayed tariff implementation, irregular claims payments, clinical audit processes, credentialing challenges affecting facilities led by Physician Assistants, and issues relating to illegal co-payments and enforcement disparities.
The NHIA indicated that full implementation of the revised tariffs is expected in October 2026, contingent on the successful rollout of its One-Time Attendance Code (OTAC) system. A partial rollout is being considered for August 2026 as a fallback option.
According to the Authority, the delay is informed by data suggesting that at least 15 percent of claims paid may be ineligible, representing about GH¢400 million annually. It warned that without corrective systems, losses could potentially rise to nearly GH¢1 billion per year once the new tariffs take effect.
NHIA Chief Executive Victor Asare Bampoe said the Authority must be able to account for every reimbursed claim to ensure funds are used strictly for service delivery.
He stressed that implementing the new tariffs without proper safeguards would be unsustainable, adding that the roadmap was designed to ensure transparency and protect the integrity of the Scheme.
Deputy Chief Executive in charge of Operations Senanu Kwesi Djokoto explained that the tariff adjustment is unprecedented and could worsen existing inefficiencies if controls are not strengthened.
He said the OTAC system will first be piloted in the Ahafo Region, beginning with the Asunafo North District from June to August 2026, before being expanded to other regions. A national rollout is expected by September 2026, with full implementation of the revised tariffs targeted for October 2026.
He added that contingency plans include a partial tariff adjustment in August 2026 or full implementation by the end of the year if delays occur, stressing that proceeding without controls would not be viable.
Deputy Chief Executive in charge of Administration and Human Resources, Raphael Segkpeb, urged stronger collaboration between the NHIA and private providers to improve compliance and accountability within the system.
On claims management, Deputy Chief Executive in charge of Finance and Investment, Anatu Anne Seidu Bogobiri, encouraged providers to improve the accuracy and timeliness of claims submissions, noting that errors and delays remain major contributors to payment challenges.
She reaffirmed the Authority’s commitment to settling claims on the last Friday of every month, while encouraging providers to ensure proper documentation and data accuracy.
President of PHFAoG, Kwame Buabeng-Frimpong, welcomed the engagement and commended the NHIA for consistent claims payments but called for urgent implementation of the revised tariffs to support the sustainability of private health facilities.
The association also expressed support for the OTAC system, describing it as a necessary step toward improving efficiency and accountability within the health insurance system.
