Kenyans Take Note: From 11th July 2021 the New E-Claim system takes effect.
All National Health Insurance Fund (NHIF) members are advised that the switch from manual to electronic claims processing will be done immediately after the deployment of the E-Claim system which is planned for 11th July 2021. This being the last switch off date, henceforth all NHIF contracted hospitals will submit claims through the E-Claim platform to improve efficiency, reduce fraud, wastage and abuse.
The NHIF is implementing the digital transformation within the Universal Health Coverage (UHC) framework to ensure there are adequate measures to have their members receive efficient services. The undertaking is to ensure that ambitions set and conveyed by President Kenyatta when the UHC was being adopted in 2016, are met. President Kenyatta’s plan is for Kenyans to be supported to use the essential services they need for their health and wellbeing through a single unified benefit package without the risk of financial catastrophe by the year 2022.
The NHIF is sensitizing and urging their members through statements released to visit the nearest NHIF service points, or contracted hospitals countrywide to be biometrically enrolled. All NHIF members are also asked to go with their dependants.
How does NHIF work before and after 11th July 2021?
Until 10th July 2021, members use the National Identity Card and NHIF card as the modes of identification which will be replaced by a biometric mode of identification and verification.
The NHIF does adopt and implement national treatment protocols including availing the necessary drugs as per the Kenyan Essential Drug List of 2010, and the Clinical Guidance for Management and Referral of Common Illnesses Level 2-6 (2009).
NHIF members receive a package which is purchased by NHIF for its members from any health provider institution at a pre-determined cost, so long as the institution is registered and appropriately classified, regardless of the ownership of the institution. The NHIF benefit package is accessed uniformly by all members and is available to members everywhere within the republic of Kenya.
The Ministry of Health in Kenya has laid out a clear vision for delivery of the KEPH through the Kenya Health Policy, in which health and related services will be available to all Kenyans through four tiers of care: Community, Primary Care, County Services and National Services.
Digitization of the NHIF Process
The NHIF under the guidance of the Ministry of Health, has made strides in making their processes digital. These efforts are aimed at hastening the implementation of the UHC scale-up drive.
The NHIF has registered over 1 Million needy families from all the 47 counties in Kenya, in a collaboration activity undertaken with the National and County Governments.
Counties Implementing Mass Biometric Registration
The current move by the NHIF to do a mass biometric registration of its members including the 1 million needy families has been done in seven counties – Homabay, Kisumu, Laikipia, Nakuru, Nyeri, Taita Taveta and Tharaka Nithi Counties.
Counties Deploying the Electronic Claims Management Systems (E-Claim)
The NHIF has decided to do the mass biometric registration and the deployment of the E-Claim management system concurrently. The E-Claim is set to be rolled out to all NHIF contracted hospitals and has so far covered hospitals in Central, Coast, Eastern, parts of Nairobi, Nyanza, Rift Valley and Western regions. NHIF intends to cover the remaining regions in the next one month.
What is the Procedure for Biometric Registration?
The NHIF members and their dependants are to visit the nearest NHIF service point, or contracted health care provider and produce identification documents such as a copy of National ID/ NHIF card for verification in the database.
Once verified, members fingerprint details will be captured.
As for the new NHIF members, their registration will also be done biometrically to the NHIF database and issued with a registration number.
After 11th July 2021, when a member visits an accredited facility of choice, they will be identified using their fingerprint or One Time Password (OTP).