The Social Health Authority (SHA) has paid Sh27.91 billion to county government health facilities after receiving claims worth Sh40.91 billion by the end of June, according to the authority’s latest payment status update.
SHA said it had received claims from 8,349 county government health facilities across the country as of June 30, 2026. Of the total claims submitted, Sh27.91 billion has been paid, while Sh6.96 billion remains under review.
The authority said claims worth Sh1.97 billion had been returned to health facilities for correction or completion, while Sh646.2 million was awaiting mandatory supporting documents.
Claims amounting to Sh3.43 billion were rejected for failing to meet applicable benefit, contractual or regulatory requirements.
According to SHA, approximately 80 per cent of claims that have completed or progressed through the adjudication process have been settled. The average settlement rate across counties stands at 80.5 per cent.
Tana River recorded the highest settlement rate at 87 per cent, followed by Laikipia (86.1 per cent), Baringo (85.4 per cent), Siaya (85.4 per cent) and Kisumu (85 per cent).
In terms of total payments, Nakuru County received the highest amount at Sh1.93 billion, followed by Nairobi Sh1.57 billion, Homa Bay Sh1.54 billion, Mombasa Sh1.41 billion and Kiambu Sh1.27 billion.
SHA said payments to county public health facilities are made directly into Facility Improvement Financing (FIF) accounts in line with the Facilities Improvement Financing Act No. 14 of 2023. The arrangement allows public health facilities to retain revenue earned from services provided and use the funds to support operations and improve service delivery, subject to approved financial plans and controls.
The authority clarified that claims currently under review have not yet been approved for payment because they must undergo verification of patient eligibility, benefit entitlement, approved tariffs, clinical information and supporting documentation.
It added that claims returned to healthcare providers require corrections such as coding errors, missing information or additional documentation before they can be reconsidered. Rejected claims, SHA said, do not qualify for payment because they fail to meet legal, contractual, regulatory or benefit package requirements.
To improve claims processing, SHA has been conducting claims clinics with healthcare providers across the country. The sessions focus on helping facilities submit complete and accurate claims, correctly apply approved tariffs and benefit packages, and avoid common errors.
According to the authority, the initiative has led to an increase in clean claims and a reduction in the number of claims being returned or rejected.
SHA said it will continue working with county governments and healthcare providers to strengthen claims management and ensure timely payment of valid claims.
By Joseph Ng’ang’a
