Kenya: Duale Blames SHA Claim Delays On Incomplete Hospital Documents

Nairobi — Health Cabinet Secretary (CS) Aden Duale has attributed delays in processing Social Health Authority (SHA) claims from health facilities to incomplete or improperly filled documents, as well as late re-submission of missing information.

Appearing before the National Assembly Departmental Committee on Health, the CS said that the Social Health Insurance Regulations, 2025 provide that verifiable claims be settled within ninety days from the date of submission.

However, he said that SHA has been paying providers every 14th day of the month, adding that before settlement, claims must be verified and adjudicated by SHA to confirm that they are complete, accurate and properly supported.

“Some claim documents have had missing signatures, incorrect patient details or incomplete medical records which has lengthened the claim review times or led to a claim being rejected,” Duale told MPs.

“This extends the turnaround time in the processing of claims.”

Last month, more than 700 hospitals rejected payments through SHA over Sh7 billion debt.

According to the Rural and Urban Private Hospitals Association of Kenya (Rupha), unpaid money had exposed their memebers into financial challenges, impacting service deliveries.

“Conducting a comprehensive arrears verification exercise, which includes reviewing resubmitted claims that had missing documentation. This process is being carried out jointly with providers to ensure accuracy and fairness,” He said.

“Undertaking regular sensitization and feedback meetings with providers across the country to promote open communication and improve claim submission quality. The continuous capacity building for providers on processing of claims will therefore address the issuing of missing documentation.”

By Capital FM.