SHA settles Sh27.9 billion in county health claims as Sh6.96 billion awaits review

SHA CEO Mercy Mwangangi, flanked by senior Ministry of Health officials, during the announcement of the immediate suspension of 40 hospitals from taking part in the Social Health Authority on August 8, 2025. (Photo: SHA)

By Rachael Mutabasi
Friday, July 3, 2026

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According to the Authority, Tana River recorded the highest settlement rate at 87 per cent, followed by Laikipia at 86.1 per cent, Baringo and Siaya at 85.4 per cent each, and Kisumu at 85 per cent.

The Social Health Authority (SHA) has paid Sh27.91 billion to county government health facilities out of Sh40.91 billion in claims submitted by the end of June 2026, while claims worth Sh6.96 billion remain under review.

In a statement on Thursday, SHA said it had received claims worth Sh40.91 billion from 8,349 county government health facilities across the country as of June 30.

Of the total claims, Sh27.91 billion had been paid, Sh6.96 billion was undergoing review, Sh1.97 billion had been returned to health facilities for correction or completion, Sh646.2 million was awaiting mandatory supporting documents, while Sh3.43 billion had been rejected for failing to meet applicable benefit, contractual or regulatory requirements.

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Explaining why some claims had not been paid, SHA said: "Returned claims require action by the healthcare facility to correct coding, complete missing information or provide the required documents. Rejected claims are not payable because they do not meet the applicable legal, regulatory, contractual or benefit-package requirements."

SHA said it has been conducting claims clinics with healthcare providers across the country to improve the quality of claims submitted and reduce processing delays.

It added that the initiative has led to an increase in clean claims and a reduction in the number of claims returned or rejected, and pledged to continue working with county governments and healthcare providers to ensure timely payment of all valid claims.