In a status update released on July 2, SHA said it had received claims worth Sh40.91 billion from 8,349 county health facilities as of June 30, 2026.
According to the authority, Sh27.91 billion had already been settled, while Sh6.96 billion was still undergoing review. Another Sh1.97 billion had been returned to health facilities for correction or completion, Sh646.2 million was awaiting mandatory supporting documents, and Sh3.43 billion had been rejected for failing to meet applicable benefit, contractual or regulatory requirements.
“SHA has therefore settled approximately 80 percent of the claim value that has completed or progressed through adjudication, while the average settlement rate across counties stands at approximately 80.5 per cent,” the authority said.
The update provides a snapshot of the financial flows under the country's social health insurance programme, which has been under scrutiny from healthcare providers and county governments over the pace of reimbursements.
Among counties recording the highest settlement rates were Tana River 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.
SHA also highlighted counties that had received the largest payments due to high claim volumes.
“These include Nakuru - Sh1.93 billion, Nairobi Sh1.57 billion, Homa Bay Sh1.54 billion, Mombasa - Sh1.41 billion and Kiambu - Sh1.27 billion,” the authority said.
The agency noted that reimbursements to county public health facilities are made directly to designated Facility Improvement Financing (FIF) accounts in accordance with the Facilities Improvement Financing Act No. 14 of 2023.
Under the law, public health facilities are allowed to retain revenue generated from services rendered and use the funds to support operations and improve healthcare delivery, subject to approved plans and financial controls.
SHA sought to explain the status of claims that have not yet been paid, noting that claims under review are still undergoing mandatory verification processes.
“To clarify, claims under review are not yet approved for payment. They are undergoing mandatory verification of patient eligibility, benefit entitlement, applicable tariffs, clinical information and supporting documentation,” the authority stated.
It added that returned claims require healthcare facilities to correct coding errors, provide missing information or submit additional documents before they can proceed for reassessment.
Meanwhile, rejected claims are considered ineligible for payment because they do not satisfy legal, contractual, regulatory or benefit-package requirements.
SHA said it has intensified efforts to improve claims quality and accelerate processing through targeted claims clinics conducted with healthcare providers across the country.
“The clinics guide providers on how to lodge clean and complete claims, correctly apply approved tariffs and benefit packages, submit the required documents and avoid common errors,” the authority said.
According to SHA, the engagements have already resulted in an increase in clean claims and a reduction in the number of submissions being returned or rejected. The authority said it will continue working with county governments and healthcare providers to strengthen claims management and ensure timely payment of valid claims.