Kenya’s Social Health Authority has announced a new medical surveillance and verification exercise targeting Level 4 healthcare facilities with large pending claims inherited from the defunct National Hospital Insurance Fund.
In a notice issued on Thursday, September 17, 2026, SHA Chief Executive Officer Dr Mercy Mwangangi said the exercise will begin on September 21, 2026. It will focus on Level 4 providers with outstanding NHIF claims of Ksh10 million and above as the Authority works to establish the validity of the claims before payment decisions are made.
Affected hospitals have been directed to prepare all documents related to the claims. SHA said providers will be required to produce invoices, service delivery records, claim submission records and any other supporting documents previously submitted to the former NHIF.
The Authority said those records will be used to establish the authenticity and validity of the outstanding claims. SHA also said it remains committed to conducting the process with transparency, accountability and fairness.
The schedule of affected healthcare providers has been published through the SHA website, and facilities included in the exercise are expected to organise their records before the start date to avoid delays. The September 21 verification will not cover Level 3 hospitals.
SHA said Level 3 healthcare providers with outstanding NHIF claims will go through a separate verification process. Details for those facilities will be communicated later through official channels, meaning they are excluded from the Level 4 exercise now being launched.
The verification is part of the government’s broader effort to clear financial obligations inherited after NHIF was replaced by SHA under Kenya’s new health financing framework. The transition has required reconciliation and verification of outstanding debts owed to healthcare providers.
The Ministry of Health recently said reconciliation and sign-off had been completed for NHIF-related claims of Ksh10 million and below involving 3,526 healthcare facilities. Of those, 3,058 facilities had received payments totalling KSh3.63 billion.
The government has previously indicated that claims above KSh10 million would require additional checks before payment. A Ministry of Health newsletter published in 2025 said the state had begun addressing Ksh5.3 billion in outstanding NHIF debts, with claims between KSh1 million and KSh10 million prioritised at that time.
The focus on large claims reflects SHA’s push to strengthen controls around healthcare reimbursements. The Ministry has previously linked pending claims to issues such as incomplete documentation, verification needs and pre-authorisation challenges, while also calling for stronger claims audits, utilisation reviews and fraud-detection systems.
SHA’s claims processes form part of wider digital reforms in the move from NHIF to the new insurance system. The government has connected digitised records and claims validation to efforts to reduce fraud, billing irregularities and leakages in health financing.