SHA gives hospitals 15 days to verify Sh3 billion flagged claims
The missing details include essential attachments such as itemised invoices, claim forms, and patient discharge or case summaries. Without these, the Authority said, the claims cannot proceed under the new rules.
The Social Health Authority (SHA) has ordered hospitals to submit supporting documents for over Sh3 billion in flagged claims within 15 days or risk automatic rejection.
In a statement issued on September 15, the Authority explained that the bulk of the claims could not be processed because they lacked key details.
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“As part of the routine claims adjudication exercise, SHA has flagged over Sh3 billion worth of claims that require more documentation to assist the review teams to adjudicate the claim,” read the statement signed by SHA CEO Mercy Mwangangi.
The missing details include essential attachments such as itemised invoices, claim forms, and patient discharge or case summaries. Without these, the Authority said, the claims cannot proceed under the new rules.
To address this, SHA announced that starting September 16, hospitals will use a new Missing Documents Resubmission Module available on the provider portal.
The tool will allow facilities to upload any missing information directly, and once notified, they will have 14 days to comply. Each claim will carry a countdown timer showing the time left before the deadline lapses.
The Authority clarified that original submissions will remain intact, with hospitals only allowed to add the missing paperwork highlighted in the system’s notes.
Patients will also receive alerts notifying them of claims that need resubmission, ensuring openness and accountability.
SHA stressed that claims not updated within the stipulated 14 days will automatically be marked as rejected.
Hospitals must therefore complete all pending submissions by September 30, after which incomplete claims will no longer be considered.
To make the process smoother, SHA has published a step-by-step manual on its official portal to guide service providers through the new system.
Alongside the digital changes, the Authority also announced that county health teams will begin regular surveillance visits from September 16.
Facilities were urged to cooperate with the inspections as part of broader efforts to ensure order in the government healthcare system, which has faced numerous controversies.
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