Healthcare providers with outstanding claims from the defunct National Hospital Insurance Fund (NHIF) have received a fresh boost after the Social Health Authority (SHA) announced the resumption of verification of pending claims worth Ksh10 million and above.
In a notice issued on Sunday, October 25, SHA said the surveillance and verification exercise targeting Level 2, Level 3 and Level 4 healthcare facilities will resume on October 26, 2026.
SHA directed affected facilities to take note of their scheduled visitation dates and ensure all documents needed for the exercise are available for inspection.
The required records include invoices, evidence of services rendered, claims records, and other supporting documents related to the outstanding claims.
The latest move is part of the government’s ongoing effort to clear liabilities inherited from NHIF following the transition to the new health insurance system under SHA.
SHA Resumes Verification of High-Value NHIF Claims
SHA said healthcare facilities affected by the exercise should prepare all relevant documentation to facilitate the verification process.
The authority also advised providers to review the verification schedule available on its website and ensure the required records are ready when verification teams visit their facilities.
The exercise is expected to determine the accuracy, authenticity and eligibility of the claims before any payments are approved.
The announcement continues a process that began earlier this year as the government sought to verify the validity of high-value claims before settling them.
Authorities have subjected large claims above Ksh10 million to a separate verification exercise from smaller claims as they work to reconcile inherited NHIF debts.
Healthcare providers have repeatedly called for faster settlement of pending claims, arguing that delayed payments have strained operations and affected service delivery in some facilities.
High-Value NHIF Claims Still Await Settlement
Following the transition from the defunct National Hospital Insurance Fund (NHIF) to the Social Health Authority (SHA), the government adopted a phased plan to clear inherited medical debts owed to healthcare providers.
In July this year, the government released Ksh4 billion to settle verified NHIF claims of Ksh10 million or less, with SHA saying 3,527 healthcare facilities were expected to benefit from the programme.
SHA later reported that 3,526 facilities completed the reconciliation and sign-off process, while 3,058 facilities received payments totalling KSh3.63 billion.
The initial settlement programme excluded claims above Ksh10 million and subjected them to a separate verification process before payment.
In August, SHA launched a surveillance and verification exercise targeting high-value claims of KSh10 million and above inherited from the defunct NHIF.
The authority said the claims involve 451 healthcare facilities and would require additional Treasury funding before settlement.
The government initially rolled out the verification exercise for Level 5 and Level 6 facilities before expanding it to Level 4 hospitals in September, as it intensified efforts to reconcile outstanding health insurance debts.
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