The Ministry of Health Principal Secretary for Medical Services Harry Kimtai has admitted challenges in the transition from the National Hospital Insurance Fund (NHIF) to the Social Health Authority (SHA) while appreciating service users for their patience during this period.
In a statement on Friday, October 4, 2024, Kimtai said that the Ministry was conducting training on the claims portal to health facilities across the country during the coming week.
He also revealed that the SHA claims system was now fully operational after a system failure nearly paralysed healthcare facilities in the last three days after the official rollout of the SHA.
The hitch had several patients detained in hospitals across the country when their payments could not be processed in time. In extreme circumstances, other patients were forced to pay from their own pockets when the Claims Management System (CMS) failed.
SHA claims management system
“Operational SHA Claims System: We are pleased to confirm that the SHA claims system is fully operational. Training for health facilities on the claim’s portal has commenced today at 3:00 pm and will continue throughout the coming week,” PS Kimtai said in a statement.
Kimtai also said that paid-up patients from the NHIF scheme would not require pre-authorisation when seeking renal and oncology healthcare in 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.
In terms of patient data security, Kimtai noted that the migration of patient data from NHIF to SHA was conducted securely through the National Health Information Exchange (NHIE) system.
Digitization
This is in line with section 47 of the Social Health Insurance Act of 2023 which requires the digitization of all processes of SHA including registration, member identification, contributions, empanelment of facilities, execution of contracts, notification & pre-authorisation, claims management and settlement of claims.
The Act spells punishments of up to 5 years and Ksh10 million shillings to individuals convicted for various offences including misappropriating funds or providing false information.
Kimtai also said all public health facilities have been empanelled in the new system and 1577 more private and faith-based health facilities had also been empanelled, noting that the process was ongoing.
This comes after the Clinical Officers Union threatened to down their tools over the delayed empanelment of accredited health facilities by the body.
