Health Cabinet Secretary Aden Duale has attributed delays in payments to healthcare providers under the Social Health Authority (SHA) to incomplete and improperly filled claim documents.
According to Duale, the Social Health Insurance Regulations, 2025 stipulate that all verifiable claims should be settled within 90 days from the date of submission.
He said SHA has been processing and paying claims every 14th day of the month after verification and adjudication.
The CS was responding to questions from the National Assembly Departmental Committee on Health, on Tuesday.
Duale said some claims remain unsettled because of missing signatures, incorrect patient details, or incomplete medical records, which prolong the verification process or lead to claim rejection.
“Delays in settlement are largely occasioned by submission of incomplete or improperly filled claim documents,” he said.
The Cabinet Secretary further noted that the slow resubmission of missing documentation by some healthcare providers has also contributed to delays.
“Some providers take too long to re-submit missing documents, extending the turnaround time for processing claims,” Duale explained.
Data from SHA shows that the overall settlement rate currently stands at 59 percent for the Social Health Insurance Fund (SHIF) and the Emergency, Chronic and Critical Illness Fund (ECCIF).
Faith-based organizations have the highest settlement rate at 64.56 percent, followed by national referral hospitals at 61.71 percent, county government facilities at 59.62 percent, and private hospitals at 56.55 percent.
To address the payment delays, SHA has embarked on a comprehensive arrears verification exercise jointly with healthcare providers to review resubmitted claims and ensure accuracy and fairness.
The authority is also conducting regular sensitization and feedback meetings to enhance the quality of claim submissions and reduce documentation errors.
Duale said SHA is strengthening its Claims Management Office to reduce the backlog. He explained that recruitment of skilled officers had been delayed by ongoing court cases, but the process has now resumed, with nine case management officers recruited in September and October.
The authority plans to have 15 case managers, 47 county claims officers, and 47 quality assurance officers across the country.
In addition, SHA has appointed relationship managers at the county level and set up a relationship management unit in collaboration with the Digital Health Authority (DHA) to track and resolve pending claims.
Duale said SHA is also working to strengthen its financial stability, revealing that the Social Health Insurance Fund has collected Sh79.2 billion so far.
To enhance flexibility for informal sector contributors, the authority has introduced the Lipa Pole Pole platform, allowing contributors to make manageable instalment payments and ensuring consistent enrolment and timely reimbursements.