SHA flags Ksh3 billion in claims
The Social Health Authority (SHA) has flagged more than Ksh3 billion worth of claims for missing documentation
The Social Health Authority (SHA) has flagged more than Ksh3 billion worth of claims for missing documentation.
In a statement on Monday, September 15, SHA CEO Mercy Mwangangi said the authority has given providers until the end of September to resubmit the required papers or risk rejection.
“As part of the routine claims adjudication exercise, SHA has flagged over Ksh3 billion worth of claims that require more documentation to assist the review teams to adjudicate the claim.
“These documents are in addition to the 3 mandatory documents which are the dully filled claim form, itemized invoice and discharge summary/case summary,” the statement read.
According to Mwangangi, the flagged claims will now be processed under a newly activated resubmission module.
“This is therefore to notify you that for claims marked ‘missing documents’ the Missing Documents Resubmission Module will now be enabled in the system from 16th September 2025,” the statement added.
According to SHA, the resubmission process will operate under strict conditions to ensure accountability and transparency.
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Key features of the system include a 14-day countdown window, meaning providers have limited time to comply; integrity of submissions, since providers cannot replace or delete original documents; and patient notifications, where patients will receive alerts once a claim is resubmitted.
“Providers are encouraged to act promptly to avoid expiry of the resubmission window before 30th September 2025. On expiry of the same period these claims will transition to rejected,” the statement further read.
To ensure compliance, Mwangangi further announced that the authority will carry out monitoring visits.
“Further, SHA will conduct routine surveillance to support compliance. County teams will begin facility visits on 16th September 2025, and providers are urged to cooperate,” the statement concluded.
The required documents include, duly filled claim form signed by claimant and provider, comprehensive discharge summaries, theatre notes where applicable, medical/imaging reports where applicable and imaging/prescription/lab order requests where applicable.
Others are case summaries or medical report where requested, itemized invoices where applicable, birth notification for deliveries, histopathology results for oncology and anti-D rhesus factor test results.
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