Hospitals owed large sums by the defunct National Health Insurance Fund (NHIF) have a fresh chance at payment after the Social Health Authority (SHA) restarted the verification of pending claims worth Sh10 million and above on Monday, October 26.

In a notice issued on Sunday, October 25, the authority said it was resuming the "surveillance and verification exercise" for the high-value claims, covering Level 2, Level 3 and Level 4 health facilities with outstanding bills from the former insurer.

What facilities must do

SHA directed affected facilities to check a published visitation schedule on its website, www.sha.go.ke, to know when verification teams will arrive. Hospitals have been asked to prepare claims records, invoices, evidence of services rendered and any other supporting documents to prove that the amounts they are demanding are valid.

SHA Chief Executive Officer Dr Mercy Mwangangi urged facilities to "take note of their respective visitation dates as indicated in the schedule," Eastleigh Voice reported.

Providers with questions about the exercise have been asked to reach the authority by email.

A Sh33 billion hangover

The verification is part of the government's effort to clear debts inherited from NHIF, which was wound up when SHA took over national health insurance on October 1, 2024. Kenyans.co.ke reported that the government is grappling with about Sh33 billion in legacy NHIF debt.

Claims of Sh10 million and below have reportedly already been settled, covering about 91 per cent of the facilities previously contracted by NHIF. The larger bills, however, must be audited before any payment is made, and the delay has left some hospitals struggling to meet operating costs while they wait to be paid for services already offered to NHIF members.

A total of 451 facilities were previously identified for verification of claims above Sh10 million, according to Kenyans.co.ke and Kenya Today.

Eastleigh Voice reported that SHA intends to seek funding from the National Treasury in the 2026/27 financial year to pay verified NHIF claims above Sh10 million per facility. The authority has not publicly stated how long the current verification round will take or when hospitals should expect payments once their claims are cleared.

Pressure from private and faith-based hospitals

Pending NHIF bills have been a persistent complaint from private and faith-based hospitals, many of which rely heavily on insurance reimbursements. The transition to SHA has also been dogged by complaints over digital system failures, difficulties verifying patient records and delayed reimbursements under the new scheme.

The government has defended the reforms, pointing to digitisation of hospital operations through a Health Management Information System that it says enables biometric verification of patients, shared electronic medical records and easier referrals. It has also expanded some benefits under the Taifa Care package, including raising daily ICU and HDU cover to Sh28,000 and extending oncology cover to Sh550,000 per household.

For hospitals owed the largest sums, the resumption of verification is a first step. Whether it translates into money in their accounts will depend on how quickly the audits are completed and whether Treasury releases the funds needed to settle the claims.

Photos: Eastleigh Voice (SHA offices, Nairobi); The Kenya Times (SHA CEO Dr Mercy Mwangangi)