Hospitals will soon be able to generate Social Health Authority (SHA) claims directly from the records they create while treating patients, the Digital Health Agency (DHA) has told Parliament, in a shift it says will speed up payments and tighten controls against fraud.

DHA Chief Executive Antony Lenaiyara explained the change during an engagement with the National Assembly's Health Committee, chaired by Seme MP Dr James Nyikal, according to reports by Kenyans.co.ke and Kenya Today on Wednesday.

One record, one claim

At present, many facilities treat patients in one system and then re-enter the same information in a separate claims process before seeking reimbursement from SHA. Under the new approach, the claim will be produced from the patient-care record at the point of service.

The agency listed several expected benefits:

  • Faster submission and processing, since data will no longer have to be linked across separate systems
  • Fewer errors, because details are captured only once
  • Better fraud detection through data traceability and built-in system controls
  • Stronger clinical and administrative checks on each claim
  • Less paperwork for health workers and greater auditability

DHA did not give a launch date or say how many facilities will be on the integrated system at the start.

A system under pressure

The briefing comes as the State continues to push hospitals onto a common digital platform. Facilities contracted by SHA have been ordered to move onto the government-backed Health Information Management System (HMIS), with faith-based providers reported to be working towards an October 30 deadline. Nation has reported that SHA will terminate the contracts of hospitals that miss the migration deadline.

Fraud has been one of the biggest headaches for SHA since it replaced the NHIF in October 2024, with facilities suspended over inflated or fictitious claims and the authority under pressure to pay hospitals promptly. Linking claims to the actual record of care is designed to make it harder to bill for services that were never offered.

Scale and cost

Speaking at the Kenya Health Summit in August, SHA chief executive Mercy Mwangangi said the authority was processing about 26,000 claims a day, close to one million a month, as reported by the Eastleigh Voice. At the same forum, Lenaiyara disputed claims of a Sh104 billion technology deal, saying about Sh500 million had been paid for the technology over two years.

Lenaiyara has also previously said health data held by the agency is stored and transmitted securely and accessed only by authorised people, an assurance likely to be tested as more patient information flows directly into the claims system.

Photos: Kenyans.co.ke / Ministry of Health; The Eastleigh Voice. Logo: Digital Health Agency. Thumbnail design: HAMASTA MEDIA.