The Social Health Authority (SHA) has resorted to having claims forms manually filled out by healthcare providers after its digital claims management system (CMS) suffered a series of setbacks.
The Content Management System (CMS), a digital database for processing and contributions, has faced hurdles since August, prompting the SHA to integrate different systems in a race against time to meet the October rollout.
The communication he saw Daily chores It showed that the SHA resorted to manual claims forms amid persistent failures in the CMS platform.
The three-page Healthcare Provider Form (HCPS) template consists of several sections, including healthcare provider and patient details and the Healthcare Benefit SHA, which healthcare providers will manually complete on behalf of patients.
“Please use capital letters and tick the appropriate boxes. Submit this form with supporting documents within seven (7) days of your discharge date. All fields on this form are mandatory. Incomplete forms will not be processed,” the manual form provided by the SHA said.
SHA’s acting CEO, Elijah Wachira, did not respond to text messages and Business Daily’s call to comment on the latest developments.
Insiders said the manual forms will be used as a temporary measure while the SHA works to smooth out the glitches in the CMS.
The current CMS database was developed by Savanna Informatics and is the latest of the three claims systems being tested, all of which have faced issues since August, exposing a major gap in the security of millions of Kenyans’ contributions.
SHA initially combined apeiro, a subsidiary of an Abu Dhabi-based investment firm, and eOxegen from India, which failed to deliver after SHA’s October 1 launch, before switching to one developed by Savanna Informatics, which also exposed vulnerabilities.
The shift to manual claims forms comes after protests from healthcare providers who were unable to access the CMS.
A survey conducted by the SHA Engagement Forum on October 7, to gather real-time feedback from providers on the progress of the transition, revealed that hospitals are experiencing difficulties logging into the system, pre-authorizing claims, and accepting patients.
The SHA Healthcare Providers Association survey shows that 64 percent of healthcare providers do not have credentials to log into the SHA system, meaning that none of the providers were able to visit and treat a patient in the new system.
The survey results also show that no Level 1, 2 and 3 hospitals were assigned to a Level 2 Primary Care Network (PCN 2) and none were able to verify patients.
The forum includes members of the SHA and private and faith-based organizations, including SHA President Abdi Mohamed, SHA Director of Beneficiary and Provider Management Hazel Koitaba, SHA Board Member who represents providers, and SHA Director of Benefits and Claims Management.
Other participating organizations are the Kenya Association of Private Hospitals (KAPT), Kenya Rural and Urban Private Hospitals Association (RUPHA), Kenya Healthcare Federation (KHF), Kenya Conference of Catholic Bishops (KCCB) and Christian Health Association. Kenya (Chuck).
According to health service providers, the Ministry of Health wants hospitals to treat patients first and then submit claims, which they say will worsen the situation with outstanding bills.
“There is a precedent here where hospitals have lost a lot of revenue during the biometric switchover, and millions of lost shillings have not been paid yet,” said a doctor who spoke on condition of anonymity because he was in a position to disclose the information.
The change also comes hours after public sector unions have since threatened industrial action in the next 14 days if the government fails to address challenges reported by Kenyans and various stakeholders with regard to the implementation of the SHA.
The unions, led by Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) Secretary-General Davji Atillah, accused the government of failing to resolve the crisis affecting access to healthcare.
They stressed that the transition from NHIF to SHA has created significant challenges for civil servants, public sector workers and the general public.
According to Mr. Atilla, the government’s hasty implementation of the Health Insurance Law has slowed access to health services that were previously available to National Health Insurance cardholders, without clear clarity on what the Health Insurance Law will offer.
“The SHA cuts more from workers’ pay but provides less. This is unacceptable because workers pay more for substandard services and their well-being is at risk. With the rising cost of living, the SHA places an unnecessary financial burden on families.” He said.
Union leaders also claimed that the move from the National Health Insurance Fund to the SHA threatened the jobs of workers under the old health scheme, creating further insecurity.
“We are also calling for 100 percent transition for previously employed NHIF employees with full benefits. If these concerns are not addressed within 14 days, public sector unions will have no choice but to go ahead with industrial action,” the statement read in part. .