NHIA begins 50% NHIS tariff increase, introduces digital claims verification

The National Health Insurance Authority (NHIA) has started rolling out revised service tariffs for healthcare providers, starting with a 50 percent hike in current NHIS tariffs. This phased implementation began in August 2026 and is expected to be fully implemented by October. The NHIA cites a nationwide stakeholder review as the reason for this move, which is meant to improve provider reimbursement, boost healthcare delivery, and ensure the long-term sustainability of the National Health Insurance Scheme.

The Authority plans to strengthen financial and accountability controls during this gradual adjustment period to prevent any potential issues when the full tariff increase is applied. According to the NHIA, around 15 percent of claims currently reimbursed might be ineligible, leading to an estimated GH¢400 million in annual losses.

If no corrective actions are taken, these losses could swell to nearly GH¢1 billion annually once the complete tariff hike is implemented. To combat claims leakages, the NHIA is introducing the One-Time Attendance Code (OTAC), a digital verification system. This system will verify whether patients attended health facilities and received the services claimed for reimbursement.

Currently, the OTAC is being tested in the Ahafo and Western North Regions before being applied nationwide. The NHIA believes the OTAC system will enhance transparency, curb fraud, and protect NHIS funds. Simultaneously, the Authority remains focused on improving the quality of claims and ensuring prompt payments for validated claims, working closely with healthcare providers to achieve this goal.