The Social Health Authority (SHA) has directed healthcare providers with verified claims inherited from the defunct National Hospital Insurance Fund (NHIF) valued at Sh10 million and below to submit any concerns or requests for clarification by July 31 before the claims are processed for payment.
In a notice issued on July 24, SHA said the review process targets healthcare facilities that have not yet completed the sign-off process for their verified defunct NHIF claims.
The Authority said the exercise is intended to address any concerns over the communicated claim amounts while ensuring payments are based on verified records.
"The Social Health Authority (SHA) wishes to inform healthcare providers that have not yet completed the sign-off process for verified defunct NHIF claims valued at Sh10 million and below that they may submit any concerns or requests for clarification to the Authority for review," the Authority said.
Healthcare facilities seeking clarification have been instructed to submit written requests through the email address [email protected] by July 31.
According to SHA, each submission must include the health facility's name, the former NHIF facility code, the pending claims amount, relevant claim reference numbers, a clear explanation of the concerns raised and supporting documents. These documents include claims statements and claims reconciliation statements to help facilitate the review process.
"The Authority will review all submissions within three weeks after the deadline and communicate the outcome to individual facilities via the appropriate channels," the notice states.
SHA said the clarification window is aimed at resolving any discrepancies before payments are completed, adding that all reviews will be conducted using verified claim records.
The Authority also reaffirmed its commitment to ensuring that the review exercise is handled fairly and transparently.
"SHA remains committed to ensuring that the review process is fair, transparent, and based on verified claim records," the Authority said.
The latest directive forms part of the government's ongoing efforts to clear outstanding medical claims inherited from the defunct NHIF following the transition to the Social Health Authority.
Earlier this year, the government released Sh4 billion to begin settling verified NHIF claims owed to healthcare providers. At the same time, SHA launched a nationwide sign-off exercise to validate claims valued at Sh10 million and below before payments could be processed.
The programme targets 3,527 healthcare facilities across the country that were left with pending claims following the transition from NHIF to SHA.
Healthcare providers that have already completed the sign-off process are not affected by the latest notice. However, facilities that still have concerns over the verified amounts have been urged to submit their requests before the July 31 deadline to allow the Authority to review the claims.
SHA said the current review window provides an opportunity for healthcare providers to resolve any outstanding issues before the verification process is concluded and payments are finalised.
Once the review is complete, the Authority will communicate the outcome to each affected facility through the appropriate channels as it continues implementing reforms under Kenya's social health insurance system while working to settle outstanding obligations inherited from the defunct NHIF.