SHA Gives Hospitals 15 Days to Justify Ksh3 Billion in Flagged Claims
The Social Health Authority (SHA) has issued a stern warning to hospitals across Kenya. They now have just 15 days to verify over Ksh3 billion worth of flagged claims. This directive follows a routine adjudication exercise that uncovered widespread documentation gaps.
“As part of the routine claims adjudication exercise, SHA has flagged over 3 billion worth of claims that require more documentation,” SHA CEO Mercy Mwangangi stated on Monday, September 15.
Missing Documents Trigger New Protocols
According to SHA, most flagged claims lacked essential paperwork. These include itemised invoices, completed claim forms, and discharge summaries. Without these, the claims cannot be processed.
“Claims missing these and other supporting documents will henceforth be subjected to new procedures,” the Authority announced.
To address this, SHA will activate a Missing Documents Resubmission Module on the provider portal starting September 16. This system aims to streamline corrections and enhance transparency.
Countdown Begins—No Room for Delay
Once notified, hospitals will have exactly 14 days to resubmit missing documents. A countdown timer will appear on each claim, reminding providers of the ticking clock.
“Quick action will be of the essence,” SHA warned. “Claims not submitted within 14 days will automatically transition to the ‘rejected’ status.”
Importantly, providers cannot delete or replace previously uploaded files. They can only add missing information as outlined in the system notes.
Patients to Be Notified Too
In a bid to promote transparency, SHA will also alert patients about the status of their claims. This move ensures that both providers and beneficiaries stay informed throughout the process.
“Patients will receive alerts about the need for claim resubmission,” SHA confirmed.
The deadline for all corrections is September 30. After that, incomplete claims will be permanently ineligible for processing.
Surveillance Teams Mobilized
To reinforce compliance, SHA announced that county health teams will begin routine surveillance visits starting Tuesday, September 16. Hospitals are urged to cooperate fully during these inspections.
“Service providers are encouraged to cooperate fully,” the Authority emphasized.
“We are committed to transparency and integrity in healthcare,” Mwangangi affirmed.
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SHA Gives Hospitals 15 Days to Justify Ksh3 Billion in Flagged Claims
