SHA begins verification of Sh10m-plus NHIF legacy claims

The Social Health Authority (SHA) has begun verifying pending claims of Sh10 million and above owed to Level 5 and Level 6 healthcare providers under the defunct National Health Insurance Fund (NHIF).

In a notice dated August 12, SHA said the medical surveillance and verification exercise had commenced to establish the accuracy, authenticity and eligibility of the outstanding claims before payment is processed.

Healthcare providers affected by the exercise have been directed to prepare documents supporting their claims, including invoices, service delivery records, claim submission records and other supporting documents previously submitted to the former NHIF.

The verification is expected to establish which claims qualify for settlement and the amount payable to individual facilities.

The exercise comes as SHA moves to the next batch of NHIF legacy claims, with the Government having earlier indicated that verification of the larger claims would take place in July and August.

The first phase focused on verified claims of up to Sh10 million, with Sh4 billion set aside for settlement of the debts owed mainly to Level 2, 3 and 4 healthcare facilities.

The larger outstanding claims were estimated at between Sh10 billion and Sh15 billion, according to the earlier plan.

SHA said the latest exercise is being undertaken in a transparent and accountable manner as part of efforts to strengthen healthcare service delivery and advance Universal Health Coverage.

The authority also added that further communication would be issued on the verification of pending claims for Level 3 and Level 4 healthcare providers.

Providers have therefore been asked to make available the records required to support the claims, allowing SHA to verify whether the services billed were delivered and whether the claims meet the requirements for settlement.

SHA said the exercise will be undertaken as part of efforts to address outstanding liabilities inherited from the defunct NHIF and support healthcare providers affected by the unpaid claims.