The Social Health Authority (SHA) Chief Executive Officer Mercy Mwangangi/FILE
The Social Health Authority (SHA) will begin a new surveillance and verification exercise for pending claims worth Sh10 million and above owed to Level 4 healthcare providers under the defunct National Hospital Insurance Fund (NHIF) from September 21.
SHA said the exercise will target healthcare facilities with outstanding high-value claims inherited from NHIF as the authority continues efforts to clear legacy obligations following the transition to the new health insurance system.
In a notice dated September 18, SHA Chief Executive Officer Mercy Mwangangi said affected facilities should prepare all documents required to support the verification process.
The documents include invoices, service delivery records, claim submission records and other supporting documents previously submitted to the former NHIF.
“SHA remains committed to conducting this exercise to the highest standards of transparency, accountability, and fairness,” Mwangangi said.
SHA said the schedule of healthcare providers covered by the exercise is available on its website.
The authority said the verification will focus on Level 4 healthcare providers, while details on the verification of pending claims for outstanding Level 3 providers would be communicated separately through its official channels.
The latest exercise forms part of efforts to settle financial obligations inherited from NHIF, which was replaced by SHA in October 2024.
SHA had earlier said it was seeking funding from the National Treasury in the 2026/27 financial year to settle verified outstanding NHIF claims exceeding Sh10 million per healthcare facility. The authority said the funding request covered claims owed to 451 healthcare facilities.
In July, the government released Sh4 billion to begin settling verified NHIF claims of Sh10 million and below, with SHA saying the money would benefit 3,527 healthcare facilities. The lower-value claims went through a sign-off process before payments were released.
SHA later announced payments to facilities whose verified claims of Sh10 million and below had been signed off.
The authority had also announced in August that it had commenced surveillance and verification of pending NHIF claims worth Sh10 million and above, asking affected providers to review an issued schedule and prepare the necessary documentation.
The September exercise therefore comes as SHA continues processing the higher-value category of claims while working through outstanding financial obligations inherited from the former insurer.
The claims backlog has remained one of the challenges accompanying the transition from NHIF to SHA, with healthcare providers seeking payment for services provided under the former insurance scheme.
In July that SHA was seeking budgetary support for the higher-value claims after the government set aside funds to begin clearing the lower-value verified claims.
SHA said healthcare facilities covered by the September exercise should ensure their supporting records are properly organised before their verification dates.
The authority said regular updates on the progress of the exercise would be issued through its official communication channels.
