The Social Health Authority (SHA) has confirmed the resumption of verification of pending claims from the defunct National Hospital Insurance Fund (NHIF), targeting healthcare facilities owed at least Ksh10 million.
According to SHA, the exercise will resume on Monday, October 26, and will cover Level 2, Level 3, and Level 4 healthcare facilities with outstanding claims from the former insurer.
SHA announced the development in a notice dated Sunday, October 25, as seen by Kenyans.co.ke, asking affected facilities to prepare for the verification process as the government works to clear legacy debts.
“The Social Health Authority (SHA) informs Level 2, Level 3 and Level 4 healthcare facilities that the surveillance and verification exercise for pending claims of KSh 10 million and above relating to the defunct National Health Insurance Fund (NHIF) will resume on 26 October 2026,” SHA stated.
Social Health Authority CEO Mercy Mwangangi during an engagement in June 2025.
Photo
Ministry of Health
The authority directed healthcare providers to check the visitation schedule published on its official website to establish when verification teams are expected at their respective facilities.
Facilities are also required to prepare claims records, invoices, evidence of services rendered, and other supporting documents to help establish the validity of outstanding payments.
The verification exercise focuses on high-value claims that require additional scrutiny before payment, with 451 healthcare facilities previously identified for the process involving claims exceeding Ksh10 million.
The government has been addressing approximately Ksh33 billion in legacy debt inherited from the defunct NHIF, which was wound up following the transition to the new health financing system from October 1, 2024.
Claims amounting to Ksh10 million and below have reportedly been settled, covering about 91 per cent of previously contracted healthcare facilities.
However, facilities with larger claims must undergo verification before their outstanding payments can be processed, making the resumption an important step for providers awaiting reimbursement.
The delays have placed financial pressure on some healthcare facilities, particularly those struggling to meet operational costs while waiting for payments for services previously provided to NHIF members.
The transition from NHIF to SHA has also faced challenges, including digital system failures, difficulties verifying patient records and delays in processing reimbursements to healthcare providers.
To further streamline the transition, the government has also digitised hospital operations through the Health Management Information System (HMIS), enabling biometric patient verification, shared electronic medical records, easier referrals and reduced paperwork, supported by a digital infrastructure and 24-hour service centre.
Under Taifa Care, the government increased ICU and HDU coverage limits sixfold to Ksh28,000 daily, expanded oncology benefits to Ksh550,000 per household, introduced free maternal and reproductive healthcare for vulnerable teenagers, and streamlined employer registration, bulk uploads, dependent verification and informal-sector contributions through means testing, with premiums starting at Ksh300.
Health CS Aden Duale during a meeting with teachers on September 17, 2026
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