Hospitals have lodged claims worth Sh16 billion through SHA; MoH
The Ministry of Health says a total of Sh16 billion in claims by hospitals have been lodged with the Social Health Authority (SHA) portal since October 1
The Ministry of Health says a total of Sh16 billion in claims by hospitals have been lodged with the Social Health Authority (SHA) portal since October 1.
In a statement on the status update, Ministry of Health Director-General Patrick Amoth said the amount is a computation from 735,931 claims for the period.
“Cumulatively, since 1 October 2024, 735,931 claims have been submitted amounting to KES 16.5 billion,” Amoth said.
He noted that the claims do not include those from the primary Health Facilities which most offer services for free.
Additionally, the ministry said that a total of 8,761 health facilities, representing 55 percent of active health facilities in Kenya, have enrolled in the Health Provider Portal.
The ministry said that 88 of the health facilities have had successful log-ins to the Health Provider Portal.
“SHA is able to monitor claims value by services and as expected inpatient services account for the highest claims value, followed by renal care services,’’ Amoth said.
According to Amoth, 1,000,106 people have received primary health care services since October 1, 2024, with the number steadily increasing over the months.
“Cumulatively, 335,278 pre-authorizations have been raised. The majority of these have been raised by Level 4 and Level 5 health facilities,’’ Amoth said.
The official said that the average turn-around time for pre-authorization processing is 355 minutes, slightly under 6 hours.
“The SHA is working to substantially reduce this turn-around time as part of increasing efficiency,’’ Amoth said.
In this month, Amoth said, the average turnaround time for preauthorization processing is 87.6 minutes.
He said outpatient-related pre-authorizations take 12.9 minutes and inpatient-related is down from 6 hours to 3 hours.
The government says it is doing everything possible to ensure the success of SHA, even as it urged Kenyans who are yet to enrol to register.
To ensure patients receive timely and appropriate care, the Ministry, in consultation with relevant regulatory bodies, is optimising the process of specialist preauthorisations.
This will be for advanced medical procedures based on the scopes of practice approved by the Ministry.
Amoth said that the streamlined system is to ensure that qualified specialists in recognized specialities approve necessary interventions promptly, reducing delays and removing unnecessary administrative hurdles.
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“The goal is to enhance quality patient outcomes by ensuring access to critical care without compromising on efficiency or accountability,’’ Amoth said.
To achieve this, the Ministry said it is in the advanced stages of drafting a Quality of Care Policy and Bill aimed at strengthening the empanelment process and improving preauthorisations.
This legislative framework will establish clear standards for healthcare quality, fostering accountability and transparency in healthcare delivery.
“By aligning healthcare services with the objectives of the Social Health Authority (SHA), the policy will support the provision of high-quality, patient-centred care and ensure consistent improvements in service delivery,’’ Amoth said.
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