NHIF to implement E-Claim system to minimize fraud

The National Hospital Insurance Fund (NHIF) has developed an E- Claim system that is meant to minimize fraud in the claims processes.

The electronics claims system will do away with the current manual system and replace it with an efficient, faster and convenient online system that will eliminate fraud across the institution’s supply chain.

The new system has already been rolled out across 500 health facilities in Nairobi, with plans to roll out to other hospitals countrywide by the end of September.

“Going forward, all our accredited hospitals will now interface with our systems and will be able to make their claims through the electronic system. We will then make the payments electronically from our end, minimizing time wastage and fraud,”’ said Geoffrey Mwangi, the NHIF CEO.

Mwangi said the new synergy between NHIF and health providers in tracking claims through the system will be faster and easier to handle from a computerized environment, compared to the earlier manual system.

Further, to increase accessibility to services, Mwangi said NHIF had so far accredited 7,800 facilities with 67% of these being GOK, 21% private and 4% mission hospitals. To achieve universal health coverage, Mwangi added, the fund plans to come up with a cover that is family-based, with no screening on pre-existing conditions upon registration.

Mwangi was speaking on the sidelines of a stakeholders engagement forum with FOPA Association Kenya, which brings together all former Members of Parliament of Kenya, including Senators, Women Representatives, and Governors at the Safari Park Hotel, Nairobi

The NHIF said that the organization had developed a comprehensive medical insurance cover for the former members of parliament in a bid to achieve the set out targets in the universal health coverage plan of ensuring every Kenyan has access to affordable medical coverage.

The agreement between NHIF and FOPA Association has seen the former Members of Parliament covered up to a tune of Kshs 7.5 Million and Kshs.300, 000 for in-patient and out-patient services respectively since January 2018.

The enhanced package custom made for FOPA ensures that NHIF covers the Principal Members on a family shared basis covering the Principal Member and the dependents.

The eligible beneficiaries are members of the FOPA Association Kenya, a spouse declared by the principal member and the children to 21 years of age and/or to 25 years if in full-time formal education.

For the premium charged, the members can access an enhanced benefit package that includes; inpatient services, outpatient services, local ambulance services, emergency air rescue, laboratory and X-ray services, optical cover, maternity cover, dental cover, substance abuse and rehabilitation, diabetes, renal dialysis, cancer treatment and last expense and group life cover.

NHIF key achievements include the expanded benefits package tailor-made to meet member’s needs; biometric registration, electronic claims processing, implementation of Linda Mama for expectant mothers, the launch of the customer relationship management system, among others.


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