SHA directs healthcare providers to submit queries on defunct NHIF claims

SHA directs healthcare providers to submit queries on defunct NHIF claims
SHA directs healthcare providers to submit queries on defunct NHIF claims - Social Health Authority (SHA) headquarters in Nairobi. (Photo: SHA)
Social Health Authority (SHA) headquarters in Nairobi. (Photo: SHA)

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Healthcare providers have until July 31 to submit their requests for clarification, after which SHA will review the submissions and communicate its findings to the affected facilities.

The Social Health Authority (SHA) has directed healthcare providers with outstanding defunct National Hospital Insurance Fund (NHIF) claims valued at Sh10 million and below to submit requests for clarification over the verified claim amounts by July 31.
In a notice issued on July 24, the Authority said the clarification process is open to healthcare facilities that have not yet completed the sign-off process for the verified defunct NHIF claims.
"The Social Health Authority (SHA) wishes to inform healthcare providers that have not yet completed the sign-off process for verified defunct NHIF claims valued at Sh10 million and below that they may submit any concerns or requests for clarification to the Authority for review," said SHA.

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Facilities seeking clarification are required to submit a written request to [email protected], providing the facility name, former NHIF facility code, pending claims amount, relevant claim reference numbers, a clear explanation of the grounds for concern, and supporting documents, including claims statements and claims reconciliation statements.
"The Authority will review all submissions within three weeks after the deadline and communicate the outcome to individual facilities via the appropriate channels," the notice states.
SHA said the clarification process is intended to address concerns over the communicated claim amounts while ensuring that all reviews are conducted based on verified records.

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The Authority reaffirmed its commitment to a transparent process, stating that it "remains committed to ensuring that the review process is fair, transparent, and based on verified claim records".
Healthcare providers have until July 31 to submit their requests for clarification, after which SHA will review the submissions and communicate its findings to the affected facilities.
The exercise is part of the Authority's ongoing efforts to resolve outstanding claims inherited from the defunct NHIF as it continues implementing reforms under Kenya's social health insurance system.

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