SHA: Reschedules Level 4 Hospital NHIF Claims Verification for Sh10M+ Claims

• The Social Health Authority (SHA) has rescheduled the verification of outstanding NHIF claims for selected Level 4 health facilities.
• This exercise targets facilities with pending defunct NHIF claims of Sh10 million or more.
• Hospitals must ensure all supporting documentation is available for the audit, which aims to confirm claim legitimacy and accuracy.
• The rescheduling allows facilities adequate time to prepare for the comprehensive audit.
• This is part of a broader government effort to reconcile and settle inherited NHIF liabilities, with Sh4 billion previously allocated for smaller claims.

Compliance officers within these facilities must recognize the critical importance of the rescheduled SHA verification dates and ensure that all supporting documentation is meticulously prepared and readily available for the audit teams.

The Social Health Authority (SHA) has announced a revised schedule for a crucial verification exercise targeting specific Level 4 health facilities in Kenya. This audit focuses on outstanding claims inherited from the now-defunct National Hospital Insurance Fund (NHIF). According to a notice issued by SHA Chief Executive Officer Dr. Mercy Mwangangi on Monday, the dates for surveillance and verification for these facilities have been adjusted.

This verification initiative specifically targets Level 4 hospitals that hold pending claims from the defunct NHIF amounting to Sh10 million or more. An earlier communication from the Authority, dated September 18, 2026, initially outlined the scope of this exercise. Healthcare providers impacted by this change are now directed to consult the newly released schedule to ascertain their updated verification dates.

The SHA's directive also mandates that all pertinent supporting documentation related to these outstanding claims must be readily available when the verification teams visit the facilities. This rescheduling aims to ensure that all affected institutions are adequately prepared for the comprehensive audit. The SHA continues to oversee the intricate transition from the former NHIF system to Kenya's new health insurance framework, including managing the financial obligations carried over from the previous insurer.

The core objective of this verification process is to scrutinize the documentation underpinning the substantial outstanding claims, as the SHA systematically addresses the liabilities inherited from the NHIF. The Authority has clarified that the changes to the verification dates were communicated precisely to allow facilities sufficient time to prepare for the exercise, ensuring a smooth and thorough audit.

The verification teams will undertake a detailed examination of hospital records, confirm that the claimed services were indeed provided, and ensure that all claims adhere to established financial and audit requirements. This rigorous approach is designed to establish the legitimacy and accuracy of each claim before any payments are disbursed.

For healthcare providers seeking further clarity or assistance regarding the rescheduled SHA verification dates, the Authority advises contacting its Benefits and Claims directorate. The revised list of facilities slated for verification, along with the updated schedule, has been made accessible through the official SHA website, providing essential resources for affected institutions.

This targeted verification of larger claims forms an integral part of a broader governmental strategy to reconcile and settle legitimate medical claims that were inherited from the defunct NHIF following the transition to the Social Health Authority. The government has adopted a phased methodology to systematically clear these inherited financial liabilities.

A significant step in this process occurred in April 2025, when the Ministry of Health established a dedicated committee. This committee was tasked with meticulously scrutinizing pending NHIF medical claims submitted between July 1, 2022, and September 30, 2024, with the mandate to recommend settlements for all verified claims.

Earlier phases of this initiative have already seen considerable progress. Claims amounting to Sh10 million and below have undergone reconciliation and sign-off. By August 2026, a total of 3,526 facilities had successfully completed this reconciliation and sign-off for claims within that category. Furthermore, 3,058 of these facilities had already received payments, collectively totaling Sh3.63 billion. Health Cabinet Secretary Aden Duale informed the Senate in April that an allocation of Sh4 billion had been made to commence settling these verified claims, specifically those ranging from zero to Sh10 million, aiming to restore confidence among healthcare providers and facilitate the Kenya health insurance transition claims process.

The ongoing verification exercise for outstanding NHIF claims exceeding Sh10 million holds significant implications for Level 4 hospitals. Compliance officers within these facilities must recognize the critical importance of the rescheduled SHA verification dates and ensure that all supporting documentation is meticulously prepared and readily available for the audit teams. Failure to meet these stringent requirements could lead to substantial payment delays or disputes, impacting the financial stability and operational continuity of these vital healthcare institutions.

Legal professionals advising Level 4 facilities should proactively guide their clients through this complex process, ensuring full compliance with the SHA's evolving requirements during this critical verification period. The government's commitment, as articulated by Health Cabinet Secretary Aden Duale, to allocate funds for settling verified claims underscores the intent to restore confidence among healthcare providers. This verification is a crucial step in ensuring the legitimacy and accuracy of claims, which is fundamental to the successful transition to the new health insurance system and the long-term sustainability of healthcare provision in Kenya.

Compliance officers in Level 4 hospitals must note the rescheduled SHA verification dates and ensure all supporting documentation for outstanding NHIF claims exceeding Sh10 million is meticulously prepared for audit, to avoid payment delays or disputes. Lawyers advising these facilities should guide them on compliance with SHA's requirements during this critical verification process.

Source: Original reporting via scraped news source.