NHIA Starts Partial Implementation of Revised Service Tariffs

The National Health Insurance Authority (NHIA) has commenced the partial implementation of the revised NHIS service tariffs for credentialed healthcare providers, beginning with a 50 per cent increase in current service tariffs.

The partial implementation started in August 2026 and marks the beginning of the rollout of the revised service tariffs, with full implementation expected by October this year.

The tariff adjustment followed a comprehensive, all-inclusive nationwide stakeholder review process.

The upward review forms part of ongoing measures to improve provider reimbursement by ensuring that payments better reflect the prevailing cost of delivering healthcare services.

The Chief Executive of the NHIA, Dr Victor Asare Bampoe clarified that the decision to commence with a partial implementation of the 50 per cent increase is informed by anecdotal evidence that not less than 15 per cent of claims currently paid may be ineligible, representing approximately GH¢400 million in potential losses annually.

He warned that if the existing leakages continued and the full tariff increase was implemented without corrective measures, the financial exposure of the Scheme could rise to nearly GH¢1 billion annually, posing a significant threat to the sustainability of the National Health Insurance Scheme (NHIS).

He said full deployment of the service tariffs is therefore subject to the successful deployment of strict financial and accountability controls, including the One-Time Attendance Code, to curb current leakages and safeguard the NHIS, as demanded by the government.

He explained that the evidence had made it necessary for the payer, the government, to demand the introduction of strict financial and accountability controls to seal the leakages before the full implementation of the revised tariffs.

Dr Bampoe said a major component of the implementation process is the deployment of the One-Time Attendance Code (OTAC), a digital claims management intervention designed to strengthen verification and accountability within the NHIS payment system.

He explained that OTAC would provide an additional layer of validation by confirming patient attendance and verifying that healthcare services were delivered before claims were processed and reimbursed.

He said the system is expected to reduce claims leakages, improve transparency, minimise fraudulent practices and ensure that NHIS funds are channelled towards genuine healthcare delivery.

He said the introduction of OTAC alongside the tariff increase has become necessary to ensure that additional payments to healthcare providers translate into improved services for NHIS members while protecting the financial integrity of the Scheme.

Dr Bampoe said the partial deployment therefore forms part of broader reforms to improve provider confidence, strengthen collaboration between the NHIA and healthcare facilities, and ensure that NHIS members continue to access quality healthcare services without financial barriers.

He said the phased approach was therefore not due to reluctance on the part of the Authority to implement the increase, but a necessary measure to ensure that adequate systems and safeguards were in place before the full additional financial commitment was introduced.

The partial implementation which began in August, therefore, provides an opportunity for the Authority to continue strengthening the necessary controls while gradually introducing the revised tariffs, ahead of the expected full implementation by October 2026.

Providing more information on OTAC implementation, Dr Bampoe said the OTAC system is being piloted and commenced in the Ahafo and Western North Regions , where the Authority is assessing the effectiveness of the system to gather feedback from healthcare providers and members ahead of a nationwide rollout.

Additional regions include Western North, Oti and Northeast Regions ahead of the nationwide implementation.

Dr. Bampoe, said the Authority recognised the important contribution of private and public healthcare providers to Ghana’s healthcare delivery system and appreciated their patience and constructive engagement throughout the tariff review process.

He said the NHIA remained committed to improving provider relationships while ensuring that resources allocated to the Scheme were used efficiently and responsibly.

“We must account for every reimbursed claim and ensure that resources are directed towards actual healthcare delivery,” he said.

He stressed that implementing the full tariff increase without the necessary accountability measures would expose the Scheme to inefficiencies that could undermine its sustainability.

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