The Social Health Authority (SHA) has paid county government health facilities Ksh27.91 billion in healthcare claims, representing about 80 per cent of all claims that have completed or progressed through the adjudication process.
In a statement on Thursday, SHA said it had received claims worth Ksh40.91 billion from 8,349 county government health facilities across the country as of June 30, 2026.
Besides the Ksh27.91 billion already paid, claims worth Ksh6.96 billion are undergoing review, Ksh1.97 billion have been returned to health facilities for correction or completion, while claims valued at Ksh646.2 million are awaiting mandatory supporting documents.
The Authority added that claims worth Ksh3.43 billion were rejected after failing to meet applicable benefit, contractual or regulatory requirements.
According to SHA, the average settlement rate across counties stands at approximately 80.5 per cent.
Tana River recorded the highest settlement rate at 87 per cent, followed by Laikipia at 86.1 per cent, Baringo and Siaya at 85.4 per cent each, and Kisumu at 85 per cent.
The Authority also disclosed that counties with the highest volumes of paid claims include Nakuru, which received Ksh1.93 billion, Nairobi (Ksh1.57 billion), Homa Bay (Ksh1.54 billion), Mombasa (Ksh1.41 billion) and Kiambu (Ksh1.27 billion).
SHA noted that under the Facilities Improvement Financing Act No. 14 of 2023, payments to county public health facilities are made directly into designated Facility Improvement Financing accounts.
“This allows facilities to retain revenue received for services rendered and use it to support operations and improve healthcare delivery, subject to approved plans and financial controls,” SHA stated.
The Authority clarified that claims under review have not yet been approved for payment as they must undergo mandatory verification of patient eligibility, benefit entitlement, applicable tariffs, clinical information and supporting documentation.
It added that claims returned to healthcare facilities require corrections such as coding errors, missing information or additional supporting documents before they can be reconsidered, while rejected claims do not qualify for payment because they fail to meet legal, contractual, regulatory or benefit package requirements.
