SHA clears Ksh.27 billion in health claims, rejects Ksh.3.4B over compliance issues

In a press statement on Thursday,  SHA revealed that by June 30, 2026, a total of 8,349 health facilities had issued claims worth Ksh.40.91 billion. 

Out of this, Ksh.6.96 billion were undergoing claims review while Ksh.197 billion had been returned to facilities for correction or completion. Further, Ksh.646.2 million was awaiting mandatory supporting documents. 

According to SHA, claims worth Ksh.3.43 billion had been declined due to failing to meet contractual or regulatory requirements during the application stage. 

In the claim value reports from the press statement, SHA said the average settlement rate in the counties stood at approximately 80.5 per cent with Tana River accounting for the allocation with 87 per cent followed by Laikipia at 86.1 per cent. 

Baringo and Siaya scored 85.4 per cent each while Kisumu rounded up the top five counties with 85 per cent. 

Additionally, SHA also made substantial payments for counties with high volume of claims including Nakuru (Ksh.1.93 billion), Nairobi (Ksh.1.57 billion), Homa Bay (Ksh.1.54 billion), Mombasa (Ksh.1.41 billion) and Kiambu (Ksh.1.27 billion).

With this allocation, the Authority highlighted that county health facilities would access revenue for their medical services. 

“This allows facilities to retain revenue received for services rendered and use it to support operations and improve healthcare delivery, subject to approved plans and financial controls,” read part of the statement.

To health facilities whose claims are pending, SHA revealed that the verification of patient eligibility, benefit entitlement, applicable tariffs, clinical information and supporting documentation is still ongoing. 

Further, returned claims needed action from the healthcare facility which involved correct coding, complete missing information and delivery of documentation.

SHA recorded an increase of clean and complete claims following targeted efforts to sensitise health facilities on how to file and lodge the applications by providing the required documentation.