Healthcare facilities with outstanding claims of more than Sh10 million from the defunct National Hospital Insurance Fund (NHIF) are set to undergo a fresh verification exercise as the Social Health Authority (SHA) moves to address the health insurer’s inherited financial obligations.
The exercise will begin on September 21, 2026, and will target Level 4 healthcare providers with high-value claims that remain unpaid following the transition from NHIF to SHA.
SHA Chief Executive Officer Mercy Mwangangi said affected facilities must have the necessary records ready to support the verification process.
The documents include invoices, records showing services provided, claim submission records and other supporting documentation previously presented to NHIF.
“SHA remains committed to conducting this exercise to the highest standards of transparency, accountability, and fairness,” Mwangangi said.
What healthcare facilities need to prepare
The verification exercise is intended to establish which outstanding claims can be validated before payments are processed.
Healthcare providers included in the exercise have been directed to check the schedule issued by SHA and prepare the relevant documentation ahead of their verification dates.
SHA said the exercise will initially focus on Level 4 facilities. Information on verification of outstanding claims for Level 3 providers will be issued separately through the authority’s official communication channels.
The process is part of the government’s wider effort to clear financial obligations inherited when NHIF was replaced by SHA in October 2024.
Government funding for outstanding claims
SHA had earlier sought funding from the National Treasury in the 2026/27 financial year to settle verified NHIF claims exceeding Sh10 million per healthcare facility.
The funding request covered claims owed to 451 healthcare facilities, subject to verification.
The authority has already started addressing the lower-value category.
In July, the government released Sh4 billion to begin paying verified NHIF claims of Sh10 million and below. SHA said the funds were expected to benefit 3,527 healthcare facilities.
Those claims underwent a sign-off process before payments were released, after which SHA announced payments to facilities whose claims had been verified and approved.
Why the verification matters
The transition from NHIF to SHA left healthcare providers dealing with claims accumulated under the former insurance scheme.
For facilities awaiting payment, verification is an important step because only claims that can be supported and validated can proceed through the settlement process.
SHA had also announced in August that surveillance and verification of claims worth Sh10 million and above had begun, with affected facilities asked to review the relevant schedule and organise their records.
The latest exercise continues that process, focusing on high-value claims as the authority works through the remaining NHIF liabilities.
The exercise also seeks to establish a documented basis for any eventual payments by matching claims against invoices, service records and other supporting evidence.
SHA said healthcare providers covered by the September exercise should ensure their records are properly organised before their scheduled verification dates.
The authority is expected to provide further updates through its official communication channels as the verification and settlement process progresses.
