The Ministry of Health Principal Secretary for Medical Services, Harry Kimtai, acknowledged the challenges faced during the transition from the National Hospital Insurance Fund (NHIF) to the Social Health Authority (SHA) and expressed gratitude to service users for their patience throughout this period.
In a statement on Friday, October 4, 2024, Kimtai said, “The Ministry is conducting training on the claims portal for health facilities across the country during the coming week.” He also announced that the SHA claims system was now fully operational after experiencing a system failure that nearly paralyzed healthcare facilities for three days following the official rollout of the SHA.
“This hitch resulted in several patients being detained in hospitals nationwide due to delays in processing their payments. In extreme cases, some patients were forced to pay out of pocket when the Claims Management System (CMS) failed,” he explained.
“Operational SHA Claims System: We are pleased to confirm that the SHA claims system is fully operational. Training for health facilities on the claims portal began today at 3:00 pm and will continue throughout the coming week,” Kimtai stated.
He added that paid-up patients from the NHIF scheme would not need pre-authorization when seeking renal and oncology healthcare within the SHA. “Currently, 232 out of 353 renal and oncology providers have committed to delivering services under SHA, and this list will be published online today. Pre-authorization is not required for service provision to previously paid-up NHIF members seeking renal and oncology care since they transitioned to SHA,” he said.
Regarding patient data security, Kimtai noted, “The migration of patient data from NHIF to SHA was conducted securely through the National Health Information Exchange (NHIE) system.”
Digitization
This initiative aligns with Section 47 of the Social Health Insurance Act of 2023, which mandates the digitization of all processes related to the Social Health Authority (SHA). These processes include registration, member identification, contributions, empanelment of facilities, execution of contracts, notifications and pre-authorizations, claims management, and the settlement of claims.
The Act stipulates penalties of up to 5 years in prison and fines of Ksh 10 million for individuals convicted of various offenses, including misappropriating funds or providing false information.
Kimtai further mentioned that all public health facilities have been empaneled in the new system, along with 1,577 additional private and faith-based health facilities, emphasizing that this process is ongoing. This announcement follows a threat from the Clinical Officers Union to down tools due to the delayed empanelment of accredited health facilities by the authority.
