The Digital Health Agency (DHA) is changing how hospitals submit claims to the Social Health Authority (SHA) by enabling claims to be generated directly from patient-care records during service delivery, a move expected to reduce paperwork, speed up processing and strengthen fraud detection.

The new system will allow healthcare facilities to submit claims using information captured during patient treatment, eliminating the need to recreate the same details through a separate claims process.

DHA Chief Executive Officer Eng. Antony Lenaiyara explained the changes during an engagement between the agency and the Parliamentary Health Committee, chaired by Dr James Nyikal.

The transition is expected to improve efficiency in claims processing while enhancing transparency and accountability in the management of public healthcare funds.

According to DHA, being able to integrate patient records with claims management is expected to connect clinical and administrative processes, which allows for information to be captured when the patient is receiving treatment to support subsequent claims submission.

It is expected that the integration will reduce delays in submitting and processing claims by eliminating the need to relate information in a separate system.

Additionally, using information recorded at the point of care is expected to improve claims accuracy by reducing inconsistencies that can arise when data is entered again through a separate process.

Moreover, the systems, according to DHA, could help strengthen fraud prevention through improved data traceability and system controls, which makes it easier to track the information supporting claims submitted by healthcare facilities.

Clinical and administrative validation is expected to improve, which will help improve the checks applied to claims before they are processed.

Administrative workload in Healthcare facilities is also presumed to reduce, especially work associated with claims preparation, allowing staff to rely more directly on information that is already captured during patient care.

Further, DHA expects the integration to improve accountability and auditability across the claims management process, supporting efforts to make healthcare financing more transparent.

The engagement with the Parliamentary Health Committee reaffirmed DHA’s commitment to using digital health solutions to improve service delivery and support the implementation of Universal Health Coverage in Kenya.