The Social Health Authority (SHA) has initiated a verification exercise targeting pending claims inherited from the defunct National Hospital Insurance Fund (NHIF), focusing on those valued at Sh10 million and above.
Healthcare providers with claims included in the exercise have been urged to review the schedules issued by SHA and prepare the necessary documentation to facilitate the verification process.
Background and Process
- SHA is addressing outstanding liabilities from the transition to the new health insurance system.
- The current verification targets claims above Sh10 million per healthcare facility ahead of planned payments in the 2026/27 fiscal year.
- Previously, SHA sought budgetary support from the National Treasury to clear verified claims for 451 healthcare facilities.
- The authority had already verified claims for 3,527 facilities with amounts below Sh10 million and began settling those in July with a Sh4 billion government release.
Next Steps for Healthcare Providers
- Facilities with claims above Sh10 million should consult the official schedule and prepare required documents.
- SHA will conduct surveillance and verification exercises before authorizing payments.
- Healthcare providers will be required to sign agreements confirming that their verified claims have been fully settled.
The SHA deployed teams to county offices to assist healthcare providers during the sign-off process, which was conducted regionally across the country. The list of eligible facilities is available on SHA's website and county offices.
This verification phase is a critical step as SHA moves towards clearing outstanding NHIF claims and ensuring a smooth transition to the new health insurance framework.
