A system failure at the National Health Insurance Fund (NHIF) which occurred today has affected 1,343 hospitals countrywide making them unable to make claims.
The state-owned insurance fund announced that the system failure had affected its Health Insurance Claims System (HICS).
In a statement, NHIF revealed that with HICS offline, healthcare providers across the country were unable to make claims for services rendered to patients.
"The HICS, which allows submissions of claims, is currently offline. This unexpected disruption has affected Health Care Providers," the statement from NHIF read in part.
“The Fund is working tirelessly to ensure services are up and running within the shortest time possible."
A long-term HICS failure has a danger of causing a health crisis in the country due to the paralysis of key health services offered by hospitals.
According to data from NHIF, over 31 million Kenyans are covered by the Fund. The majority of them are Kenyans working in the formal sector and their families.
Hospitals grant health services to covered patients and claim payment from NHIF after treatment.
With hospitals not being able to claim for costs incurred for treatment, millions of patients risk being turned away.
NHIF has profusely apologised to the hospitals for inconveniences that have been caused due to HICS failure and urged hospitals to exercise patience as they work to rectify the situation.
How the system works
When an active NHIF member visits a health facility, the hospital sends a pre-authorisation request online via the hospital portal.
After NHIF receives the request, it is reviewed and acted upon within 48 hours.
Within 48 hours, the member is notified via text or through the hospital on the outcome of the pre-authorisation.
If the request is successful, the hospital offers treatment to the patient and lays a claim for costs incurred.
NHIF offers both inpatient and outpatient coverage for its members who make monthly payments. The cover extends to approved dependants of the paying member.
Specialised health services covered under NHIF include; radiological services, cancer/oncology package, renal dialysis and kidney transplant package, surgical package and maternity package.
