Duale Attributes Delays in SHA Claims to Incomplete Hospital Documentation


Health Cabinet Secretary Aden Duale has attributed the delays in processing claims under the Social Health Authority (SHA) to incomplete or incorrectly filled hospital documents, as well as the late re-submission of necessary information.

  Click here to connect with us on WhatsApp While addressing the National Assembly Departmental Committee on Health, Duale stated that the Social Health Insurance Regulations, 2025, stipulate that verifiable claims should be settled within ninety days from the submission date. Nevertheless, he noted that SHA has been disbursing payments to providers every 14th day of the month, emphasizing that claims must first be verified and adjudicated by SHA to ensure they are complete, accurate, and adequately supported. "Certain claim documents have been found to lack signatures, contain incorrect patient information, or have incomplete medical records, which has prolonged the review process or resulted in claim rejections," Duale informed the MPs. "This prolongs the turnaround time for processing claims." Last month, over 700 hospitals declined payments through SHA due to a debt exceeding Sh7 billion. As per the Rural and Urban Private Hospitals Association of Kenya (Rupha), the outstanding payments have placed their members in financial distress, adversely affecting service delivery. "We are conducting a thorough verification of arrears, which includes reviewing resubmitted claims that were missing documentation. This exercise is being conducted collaboratively with providers to ensure both accuracy and fairness," Duale remarked. "We are also holding regular sensitization and feedback meetings with providers nationwide to foster open communication and enhance the quality of claim submissions. Continuous capacity building for providers regarding claims processing will thus address the issue of missing documentation.

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