SHA reschedules verification of Level 4 hospitals over unpaid NHIF claims

NAIROBI, Kenya, Sep 28 – The Social Health Authority (SHA) has rescheduled a verification exercise targeting selected Level 4 health facilities with outstanding claims inherited from the defunct National Hospital Insurance Fund (NHIF).

In a notice issued on Monday, SHA Chief Executive Officer Dr Mercy Mwangangi said the surveillance and verification dates for the affected facilities had been changed.

The exercise targets Level 4 facilities with pending defunct NHIF claims of Sh10 million or more, according to an earlier notice issued by the Authority on September 18, 2026.

SHA has asked the affected healthcare providers to consult the revised schedule and take note of their new verification dates.

The facilities have also been directed to ensure that all supporting documentation relating to the outstanding claims is available when verification teams visit.

“The Social Health Authority (SHA) informs Level 4 healthcare facilities listed in the revised schedule that their surveillance and verification dates have changed,” Dr Mwangangi said in the notice.

The Authority said the changes were being communicated to ensure that facilities affected by the revised programme are adequately prepared for the exercise.

The verification process is expected to scrutinise documentation supporting the outstanding claims as SHA continues to address pending obligations inherited from NHIF.

The revised list of facilities and the new verification schedule have been made available through the SHA website.

Healthcare providers seeking clarification have been advised to contact the Authority through its Benefits and Claims directorate.

The development comes as SHA continues to manage the transition from NHIF to the new health insurance system while dealing with claims and other obligations carried over from the former insurer.

The verification exercise is part of a wider government effort to reconcile and settle legitimate medical claims inherited from the defunct NHIF following the transition to the Social Health Authority.

In April 2025, the Ministry of Health established a committee to scrutinise pending NHIF medical claims submitted between July 1, 2022 and September 30, 2024 and make recommendations on the settlement of verified claims.

The government has since adopted a phased approach to clearing the inherited liabilities, with claims of Sh10 million and below among those already subjected to reconciliation and sign-off. By August 2026, the Ministry said 3,526 facilities had completed reconciliation and sign-off for claims in that category, with 3,058 facilities having received payments totalling Sh3.63 billion.

Health Cabinet Secretary Aden Duale told the Senate in April that the government had allocated Sh4 billion to begin settling verified claims under the defunct NHIF, particularly claims ranging from zero to Sh10 million. He said the move was intended to restore confidence among healthcare providers and support the transition to SHA.

The larger claims now being subjected to verification are therefore part of the continuing reconciliation process for obligations inherited from NHIF. The exercise is intended to establish the legitimacy and accuracy of claims before payments are made.

The Ministry has previously said verification involves checking hospital records, confirming that services were actually provided and ensuring claims meet financial and audit requirements.