The Social Health Authority (SHA) has instructed Level 5 and Level 6 healthcare providers to organize and submit all relevant documentation for verification of pending National Health Insurance Fund (NHIF) claims amounting to Sh10 million and above.
SHA Chief Executive Officer Mercy Mwangangi announced that the verification exercise will involve thorough medical surveillance and validation to ensure the accuracy, authenticity, and eligibility of the claims before any payments are made.
Healthcare providers are required to prepare invoices, service delivery records, claim submission documents, and other supporting materials previously submitted to NHIF. The authority emphasized that this process will be conducted transparently and accountably as part of government efforts to enhance healthcare service delivery and promote Universal Health Coverage (UHC).
SHA also indicated that similar communication will be issued for Level 3 and Level 4 providers regarding their pending claims.
Commitment to Transparency and Efficiency
The authority reaffirmed its commitment to conducting the verification exercise with fairness and transparency. Regular updates on progress will be shared through SHA's official channels.
Since its inception, SHA has processed payments totaling Sh178.4 billion to healthcare providers from collections of Sh203.7 billion, covering 32 million registered Kenyans. The authority boasts one of the fastest claims settlement records in Kenya’s insurance sector, typically resolving claims within 90 days.
Mercy Mwangangi further disclosed that Sh17 billion in claims have been outrightly rejected, while Sh13 billion were returned to providers due to missing documentation. Providers have 14 days to address and resubmit returned claims for reconsideration.
Primary healthcare remains a key focus, with over 10 million Kenyans accessing services at Level 2 and 3 facilities without payment, underscoring the importance of accessible health services under SHA.
