SHA resumes verification of pending NHIF claims worth Sh10 million

The Social Health Authority (SHA) will resume the surveillance and verification of pending claims worth Sh10 million and above from the defunct National Hospital Insurance Fund (NHIF) on Monday, October 26, 2026.

In a notice signed by SHA Chief Executive Officer Dr Mercy Mwangangi on Sunday, SHA asked affected Level 2, Level 3, and Level 4 healthcare facilities to check their scheduled visitation dates and prepare the required documentation for the exercise.

The verification process targets outstanding claims submitted under the former NHIF system, and healthcare providers must produce records supporting the amounts they seek to recover.

SHA said the affected facilities should consult the visitation schedule published on its official website to establish when verification teams are expected to visit them.

The authority also directed healthcare providers to prepare claims records, invoices, evidence of services rendered and any other supporting documents relevant to the pending claims.

The notice stated that the exercise would resume on October 26 and asked all affected facilities to take note of their respective visitation dates.

The surveillance and verification exercise is intended to examine pending claims of Sh10 million and above linked to the defunct NHIF.

Under the notice, healthcare facilities must make the relevant documentation available to support the claims submitted for payment.

The required records include invoices and evidence showing that the services for which reimbursement is sought were provided. The facilities are also expected to produce other supporting documents that may assist the verification process.

The exercise places the responsibility on affected healthcare providers to ensure their records are accessible and correspond with the claims under review.

Facilities that fail to consult their schedules or prepare the necessary documents could face difficulties during the verification process.

SHA has directed providers seeking clarification to contact its Director of Benefits and Claims through directorbenefitsandclaims@sha.go.ke.

The exercise concerns claims arising from the defunct NHIF, which previously administered Kenya's public health insurance arrangements before the transition to the new social health insurance framework.

The government established SHA as part of reforms to change how healthcare financing and access to services are organised in Kenya.

The transition has required the authorities to address outstanding obligations associated with the former insurance system while implementing the new arrangements.

However, claims must be assessed against the relevant records and supporting evidence before payment can be processed.

SHA has directed healthcare facilities to consult the schedule available through its official website and prepare for the visits.

The authority's instructions require providers to make the relevant records available when verification teams arrive, allowing the claims to be examined against the services and invoices presented.

The resumption of the exercise on October 26 marks another step in the review of outstanding claims associated with the former NHIF system.

Healthcare providers affected by the process are expected to follow their assigned visitation dates and ensure that all supporting documents are ready.

The verification process will determine how the authority assesses the submitted claims, although the notice does not specify when it may pay approved claims.