NAIROBI, Kenya – The Social Health Authority (SHA) has launched a nationwide training programme to help hospitals and clinics improve compliance with its medical claims review process.
Beginning Wednesday, August 27, SHA will host virtual “Provider Clinics” to guide health facilities through claims submission, review mechanisms, and documentation requirements under the Social Health Insurance Fund (SHIF) and Primary Health Care (PHC).
The sessions, which run until Monday, September 1, will address the basis for approvals, rejections, surveillance referrals, and compliance expectations.
SHA Chief Executive Officer Dr. Mercy Mwangangi said the phased training will cover all levels of facilities.
Level Four hospitals across all counties are scheduled for Thursday, followed by Level Three facilities on Friday, while Level Two facilities will undergo training on Monday.
“Training is a critical step in ensuring facilities understand the requirements for proper claims management and can avoid unnecessary rejections or delays,” said Dr Mwangangi in a statement.
The move follows an audit of medical claims submitted since the rollout of SHIF and PHC. According to SHA, health facilities have so far lodged claims worth KSh 91.7 billion.
Out of this, KSh 60.7 billion has been paid, while KSh 6.4 billion has been approved and awaits disbursement.
However, claims worth KSh 10.6 billion were rejected due to fraudulent practices or non-compliance, including upcoding of services, phantom billing, and unwarranted treatment.
A further KSh 3 billion is under re-evaluation due to missing documents, while KSh 2.1 billion has been flagged for surveillance and on-site verification.
SHA said the training is aimed at building transparency, protecting public funds, and ensuring patients receive legitimate and efficient services under Kenya’s new social health insurance model.
