Selected Level 4 hospitals face verification of outstanding NHIF claims under a revised SHA schedule.
Facilities with outstanding NHIF claims of Sh10 million or more must check their revised verification dates and prepare supporting documents.
The Social Health Authority (SHA) has changed the verification dates for selected Level 4 hospitals with unpaid claims inherited from the defunct National Hospital Insurance Fund (NHIF).
In a notice issued on Monday, SHA Chief Executive Officer Dr Mercy Mwangangi informed affected healthcare providers that their surveillance and verification visits had been rescheduled. The exercise covers facilities with outstanding NHIF claims of Sh10 million or more.
The hospitals are required to consult the revised programme and ensure that documents supporting their claims are ready for inspection when verification teams arrive.
Hospitals directed to check new dates
The rescheduling follows an earlier SHA notice dated September 18, 2026, which set out the facilities targeted for verification. The updated list and visit schedule are available on the Authority’s website.
SHA said the notification was intended to give affected providers adequate opportunity to prepare for the exercise. Hospitals seeking clarification have been directed to the Authority’s Benefits and Claims directorate.
The visits will focus on the documentation behind outstanding claims as SHA works through financial obligations carried over from NHIF. For affected providers, the immediate requirement is to confirm their new dates and have the relevant records available.
Verification to establish validity of claims
The exercise forms part of the government’s wider process of reconciling and settling legitimate medical claims left by the former insurer. Verification is intended to establish whether the claims are accurate and valid before payment.
The Ministry of Health has previously explained that the process includes examining hospital records, confirming that patients received the services billed for, and checking compliance with financial and audit requirements.
In April 2025, the ministry established a committee to examine pending NHIF medical claims submitted between July 1, 2022 and September 30, 2024. Its mandate included making recommendations on the settlement of claims that passed verification.
The government has adopted a phased approach to the inherited liabilities. Claims of Sh10 million and below are among those that have already undergone reconciliation and sign-off, while the larger claims remain part of the continuing review.
Payments made under phased settlement
By August 2026, the Ministry of Health said 3,526 facilities had completed reconciliation and sign-off for claims in the Sh10 million-and-below category. Of those, 3,058 facilities had received payments amounting to Sh3.63 billion.
Health Cabinet Secretary Aden Duale told the Senate in April that the government had allocated Sh4 billion to begin paying verified NHIF claims, particularly those ranging from zero to Sh10 million.
Duale said the allocation was meant to rebuild confidence among healthcare providers and support the transition to SHA. The rescheduled Level 4 hospital visits continue that reconciliation effort, with scrutiny of supporting records remaining a requirement before outstanding claims can be settled.
