# How to Submit SHA Claims Online in Kenya

> A practical walkthrough of submitting SHA claims online in 2026, from member eligibility checks to reimbursement tracking, and how to avoid the rejections that delay payment.

Source: https://www.afyaconnect.africa/resources/how-to-submit-sha-claims-kenya
Last updated: 2026-06-26
Publisher: AfyaConnect HMS (Neurobyte Technologies), Nairobi, Kenya

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*Claims & Insurance · 7 min read · Updated 2026-06-26*

A practical walkthrough of submitting SHA claims online in 2026, from member eligibility checks to reimbursement tracking, and how to avoid the rejections that delay payment.

Since the Social Health Authority (SHA) replaced NHIF, every Kenyan facility that wants to be reimbursed has had to relearn how claims work. The mechanics are different, the eligibility rules are stricter, and a single missing field is enough to push a claim back weeks. This guide walks through the full process and the mistakes that most often cause rejection.

## What changed when NHIF became SHA

The Social Health Insurance Fund (SHIF) is the financing arm; the Social Health Authority (SHA) is the body that administers it. For a facility, three practical things changed:

- **Real-time eligibility.** You are expected to confirm a member is active *before* the service, not after. Treating an inactive member is the single most common reason a claim is never paid.
- **Contracted facilities only.** Your facility must be registered and contracted with SHA. Claims from non-contracted facilities are rejected on submission.
- **Tighter coding.** Diagnoses and procedures must map to the approved benefit package. "General consultation" with no supporting diagnosis is a frequent rejection.

## Step 1, Verify member eligibility

Before any billable service, confirm the patient's SHA status using their national ID or SHA number. A good system does this lookup at registration so reception sees a clear "Active / Inactive" flag before the patient ever reaches a clinician. If the member is inactive, that is the moment to discuss cash or alternative cover, not after discharge.

## Step 2, Capture the encounter correctly

Every claim needs the clinical story to hold together:

- Presenting complaint and diagnosis (ICD-coded)
- Services and procedures actually rendered
- Prescriptions and investigations ordered
- The treating clinician's details and registration number

If your records live in paper files or a separate billing book, this is where errors creep in. Capturing the encounter in the same system that submits the claim removes the re-keying step where most mistakes happen.

## Step 3, Generate and submit the claim

The claim bundles the encounter, the costed line items, and the member details into the SHA-required format. Submit it within the allowed window, late claims are routinely rejected regardless of validity. Track the submission so you know it was *received*, not just sent.

## Step 4, Track, reconcile, and resubmit

A submitted claim is not a paid claim. Build a habit around three states:

1. **Pending**  submitted, awaiting adjudication.
2. **Approved**  reconcile the paid amount against what you billed.
3. **Rejected**  read the reason code, fix it, and resubmit before the window closes.

The facilities that get paid fastest are the ones that review rejections daily, not monthly.

## The most common SHA claim rejections

- Member inactive at the time of service
- Diagnosis not supported by the services billed
- Service outside the member's benefit package
- Missing or invalid provider registration details
- Claim submitted after the allowed window

## How AfyaConnect handles SHA claims end to end

AfyaConnect was built for the Kenyan claims reality. Eligibility is checked at registration, the encounter is captured by the clinician, and the claim is generated from that same record, so there is no re-keying. Claim status (pending / approved / rejected) is tracked in one dashboard, and rejected claims surface with their reason codes so your team can fix and resubmit quickly.

If SHA claims are slowing down your cash flow, [register your facility](/hospital-signup) and see how much faster reconciliation gets when claims, records, and billing live in one system.

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**Author:** The AfyaConnect Clinical & Product Team — Health systems and product engineering, Neurobyte Technologies

The team that builds and supports AfyaConnect writes these guides. Everything here is written against software we actually ship and support in live Kenyan facilities — the SHA claims flow, the PPB controlled substances register and the eTIMS invoicing described in these guides are modules we maintain, not features we read about. Where regulation is still moving, we say so rather than guessing.

- Supports 40+ healthcare facilities across Kenya and East Africa
- Builds and maintains the SHA/NHIF claims, PPB register and KRA eTIMS modules described in these guides
- Works to the Kenya Data Protection Act 2019 and Digital Health Act 2023 requirements for patient data

Last reviewed: 2026-06-26