Healthcare providers with pending NHIF claims worth Sh10 million and above are set for a fresh verification exercise as the Social Health Authority (SHA) moves to establish and process the high-value debts inherited from the former insurer.
The verification targeting Level 4 healthcare providers will start on September 21, with SHA requiring facilities affected by the exercise to produce records showing the services provided and claims submitted under the defunct National Hospital Insurance Fund (NHIF).
SHA Chief Executive Officer Mercy Mwangangi, in a notice dated September 18, directed the facilities involved to put together all documents that may be needed during the verification.
Among the records required are invoices, service delivery documents, claim submission records and other supporting paperwork that had been submitted to NHIF.
“SHA remains committed to conducting this exercise to the highest standards of transparency, accountability, and fairness,” Mwangangi said.
The authority said it has published a schedule showing the healthcare providers that will take part in the exercise.
SHA clarified that the current process will cover Level 4 facilities, with separate details on the verification of pending claims owed to Level 3 providers to be issued through its official communication channels.
The latest exercise is part of the wider process to deal with outstanding financial obligations left behind by NHIF following its replacement by SHA in October 2024.
The authority had earlier disclosed plans to seek funding from the National Treasury during the 2026/27 financial year to pay verified NHIF claims exceeding Sh10 million for each healthcare facility.
The funding request covers outstanding amounts owed to 451 healthcare facilities.
SHA is also dealing with a separate category of smaller claims. In July, the government released Sh4 billion to start paying verified NHIF claims of Sh10 million and below.
The funds were expected to benefit 3,527 healthcare facilities, with the claims first subjected to a sign-off process before payment.
SHA subsequently announced that facilities whose verified claims of Sh10 million and below had been approved through the sign-off process had begun receiving payments.
The authority had also announced in August that it had launched surveillance and verification of NHIF claims valued at Sh10 million and above.
Healthcare providers affected by that process were asked to check the schedule issued by SHA and prepare the necessary supporting records.
The exercise scheduled to begin on September 21 therefore advances the authority's work on the higher-value claims as it continues examining financial obligations carried over from NHIF.
The claims have remained an issue for healthcare providers following the shift to SHA, particularly for facilities that say they are still awaiting payment for services delivered under the former insurance fund.
In July, SHA said it needed budgetary support to deal with the claims above Sh10 million after the government made funds available to begin clearing the verified lower-value claims.
Facilities included in the September exercise have been asked to make sure their records are complete and well organised ahead of their assigned verification dates.
SHA said it will provide regular information on the progress of the exercise through its official communication channels.