The Director of Claims at the National Health Insurance Authority (NHIA), Dr. Abigail C. Derkyi-Kwarteng, has reiterated the need for service providers under the National Health Insurance Scheme (NHIS) to acquaint themselves with the new Claims Manual to ensure the smooth implementation of the revised tariffs.
She said a thorough understanding of the manual would enable providers to file their claims correctly and avoid rejections or under-claims for services rendered. The manual, she noted, outlines all services provided by health facilities, grouped under the Ghana Diagnostic Related Groupings (G-DRGs).
Dr. Derkyi-Kwarteng made the call on Thursday, November 28, 2025, during the New Tariffs Engagement Training held for service providers from the Upper East Region.
According to her, the training formed part of the Authority’s preparations ahead of the rollout of the revised tariffs next year.
Participants included district directors of health, medical superintendents, representatives of private healthcare providers, officials from the Christian Health Association of Ghana (CHAG), and the Regional Director of Health. Staff of the Upper East Regional Directorate of the NHIS were also in attendance.
While presenting guidelines on the application of the G-DRG payment method, Dr. Derkyi-Kwarteng encouraged participants to share the knowledge acquired with their colleagues to promote proper claims processing across facilities.
She added that aside from the upward review of tariffs, the NHIS benefits package had also been expanded to reduce the likelihood of members making out-of-pocket payments when accessing healthcare.
The Upper East Regional Director of the Ghana Health Service, Dr. (Med) Braimah Baba Abubakari, commended the NHIA for equipping service providers with the necessary skills to file claims appropriately. He said the intervention would strengthen the relationship between the Scheme and healthcare providers for the benefit of members.
Dr. Abubakari, however, raised concerns about the use of the Biometric Member Authentication System (BMAS) and the One-Time Password (OTP) verification method. He said poor network connectivity and interference from neighbouring countries could affect verification and also noted that some members had registered with phone numbers that do not belong to them.
In response, the NHIA’s Deputy Director of MIS, Mr. Orison Afflu, assured the participants that the BMAS would be deployed only in high-volume facilities where network connectivity is stable. In areas where connectivity is a challenge, the OTP option will be used.
He added that the Authority is currently updating members’ records at district offices and that the scheme’s USSD system will soon be upgraded to allow members to update their phone numbers. The new verification measures, he explained, are aimed at eliminating “ghost” members and improving the accuracy of membership data for future planning.
Also present at the engagement were the Director of Special Projects, Dr. Francis Assenso-Boadi, and the Director of Actuarial Services, Mr. Magnus Owusu-Agyemang.
Story by: Kwadwo Baffoe Donkor
Photo credit: Sylvester Pappoe
