The Social Health Authority (SHA) has launched nationwide virtual trainings for hospitals and clinics on the handling of medical claims under the Social Health Insurance Fund (SHIF) and Primary Healthcare (PHC).
The sessions, which began this week and will run until September 1, are aimed at guiding health facilities on claims approvals, rejections, compliance requirements, and proper documentation procedures.
According to SHA data, health facilities have so far filed claims worth KSh 91.7 billion. Out of this, KSh 60.7 billion has been paid, KSh 6.4 billion approved for payment, while KSh 10.6 billion was rejected due to fraud or non-compliance.
SHA Chief Executive Officer Mercy Mwangangi said the training initiative is expected to streamline the claims process and minimize disputes between hospitals and the authority.
“These sessions will help reduce errors and delays in claims processing, while also ensuring that facilities adhere to compliance standards,” Dr. Mwangangi said.
The virtual program comes at a time when hospitals and clinics are transitioning to the new SHIF framework, which replaced the National Health Insurance Fund (NHIF). Stakeholders have been calling for greater clarity on claims management to safeguard both patients and healthcare providers.
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