Nairobi, Kenya| The Social Health Authority (SHA) has rolled out a series of measures aimed at improving healthcare financing efficiency and ensuring the timely reimbursement of claims to hospitals.
This initiative comes as the government commits to settling all legitimate debts under the National Hospital Insurance Fund (NHIF) while transitioning to the new SHA framework.
Commitment to Financial Stability and Universal Health Coverage
In a recent media briefing, the Ministry of Health reaffirmed its dedication to maintaining financial stability within the healthcare sector by implementing stringent financial controls and oversight mechanisms.
These measures are designed to enhance accountability in claims processing and prevent the recurrence of financial bottlenecks that previously affected healthcare providers.
The Ministry disclosed that between October 1, 2024, and December 31, 2024, SHA collected KSh 20.9 billion, with disbursements totaling KSh 18.2 billion as of January 31, 2025. Of this amount:
- KSh 16.97 billion was allocated for Social Health Insurance Fund (SHIF) payments.
- KSh 1.33 billion was directed toward Primary Health Care capitation under the Taifa Care program.
This financial commitment underscores the government’s dedication to ensuring that both public and private healthcare facilities receive timely payments, thereby preventing service disruptions and reinforcing Kenya’s Universal Health Coverage (UHC) agenda.
Enhancing Efficiency Through Digital Claims Processing
To streamline payment workflows, SHA has prioritized digital claim processing systems that allow real-time tracking of claims.
The Ministry highlighted that this innovation has significantly reduced delays and inefficiencies, ensuring that healthcare providers operate with greater financial stability.
Although the law stipulates a 90-day credit period for claim settlements, SHA has consistently processed and disbursed payments within 30 days.
This accelerated turnaround time reflects the government’s proactive approach to strengthening healthcare financing, reducing financial strain on hospitals, and improving the overall responsiveness of the health system.
“By maintaining a rapid and transparent payment system, SHA is fostering trust and confidence among healthcare providers, encouraging greater participation in the new health financing model,” the Ministry stated.
Addressing Pending Claims and Strengthening Compliance
Despite SHA’s efforts, some claims remain pending due to incomplete documentation, ongoing verification, or pre-authorization challenges.
The Ministry assured that it is working closely with hospitals to expedite these processes, ensuring that all valid claims are settled promptly.
Hospitals facing claim submission issues have been encouraged to engage with SHA for assistance in correcting errors and improving accuracy.
The Ministry further emphasized that all claims are undergoing clinical audits to verify that pre-authorized procedures were correctly approved and performed before payments are processed.
In cases where claims have been rejected, the Ministry cited documentation errors, duplicate entries, or missing authorizations as the primary reasons.
To minimize rejections and enhance efficiency, SHA is launching training programs for hospital administrators on proper claim submission procedures. These training sessions aim to:
- Reduce administrative errors in claim filings.
- Enhance compliance with SHA reimbursement guidelines.
- Ensure hospitals receive timely payments, ultimately strengthening service delivery under the Taifa Care model.
Government’s Assurance to Healthcare Providers
The Ministry reaffirmed its commitment to a transparent and accountable healthcare financing system.
It encouraged hospitals and private providers to submit verified NHIF debt records for cross-checking and validation. The verification process includes:
- Cross-referencing patient records.
- Confirming service provision dates.
- Ensuring past claims meet financial and audit standards.
By implementing these reforms, the government aims to restore confidence in Kenya’s healthcare financing system, eliminate inefficiencies, prevent financial burdens on hospitals, and establish a more robust and transparent SHA reimbursement framework moving forward.
Looking Ahead: A More Sustainable Healthcare System
Through SHA and Taifa Care, the government remains committed to strengthening Kenya’s healthcare infrastructure, ensuring healthcare providers receive timely reimbursements, and guaranteeing uninterrupted access to quality healthcare for all citizens.
As SHA continues to refine its payment processes and enhance oversight mechanisms, healthcare providers are urged to collaborate with the government to improve claim accuracy and compliance, paving the way for a more sustainable and efficient healthcare financing system in Kenya.
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