Only 34 percent of hospital claims officers and administrators countrywide have logged in to the Social Health Authority’s (SHA) claims portal since it was launched on October 1, underscoring the challenges facing healthcare providers under the new system.
Claims officials investigate payment requests by policyholders to confirm their accuracy and determine payouts. As claims representatives, they are mandated to interview providers and process all paperwork related to the dues.
Data from the SHA portal shows that between October 1 and 13, of the 18,996 users enrolled in the system, only 6,464 successfully logged in, leaving over 12,000 stranded.
Despite having the largest population, Nairobi has only 1,636 users with 871 successfully login to the system, representing a 53.24 percent successful activity.
Of the selected counties, Makueni recorded the lowest number of claimants who were able to log in with 21.34 percent. The county has a total of 105 successful logins with 492 users. This means that many patients are unable to access health care.
In terms of provider enrollment, Nairobi has the highest number of healthcare providers who have joined the SHA system, while Kericho has the lowest with 152 providers. At the national level, the country has 6,952 healthcare providers on the SHA system, with 3,998 able to log in to the system, representing 57 percent.
Over the period, the SHA portal has received over 3,641 claims from 757 transacting providers totaling Sh53,461,794 marking a significant increase from the reported figures.
Kenyatta Hospital leads in the number of claims. However, patients across the country are still decrying the unbearable process of accessing treatment at various hospitals, with some forced to pay cash, claiming the systems are yet to be updated.
Renal Society of Kenya president John Gikonyo noted that some hospitals in Nakuru are not offering dialysis services, including all level four dialysis centres, and patients are being asked to pay cash.
“It is true that in some hospitals the system is working, but in others it is so affected that we have had to move our patients from one hospital to another in search of care,” said Mr Gikonyo.
As of October 12, the Rural-Urban and Private Hospitals Associations (RUPHA) transition scorecard showed that only 35 percent of private hospitals in the country had fully transitioned to the SHA portal, with 97.2 percent of providers reporting challenges with patient verification and registration, indicating that the problem is worsening significantly.
