Insurance

SHA / NHIF Claims Integration

Submit, track and reconcile Social Health Authority and NHIF claims directly from ClinixCore — fully audit-ready.

Overview

Government Schemes, Without the Backlog

Whether your facility is contracted under SHA, the legacy NHIF schemes or programmes like Linda Mama and EduAfya, ClinixCore handles the entire claim journey — from membership verification at the gate to reconciliation when payment lands.

Member verification and benefit lookup
Pre-authorisation requests where required
Outpatient and inpatient claim submission
Linda Mama, EduAfya and other special schemes supported
Claim status dashboard and rework workflow

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SHA NHIF claims integration with ClinixCore

Key Capabilities

What SHA & NHIF Integration Delivers

Member Verification

Confirm SHA / NHIF membership and active benefits at the front desk before services are rendered.

Pre-Authorisation

Raise pre-auth requests for surgeries, admissions and high-cost services within the doctor's workflow.

Claim Submission

Bundle daily / weekly claims and submit them with all required attachments (discharge summary, lab reports, etc.).

Claim Status Tracking

Live dashboard showing approved, queried, partially-paid and outstanding claims by age and amount.

Rework Workflow

Queries and rejections are routed to the right team for fixing and resubmission in one place.

Settlement Reconciliation

Match settlement schedules against submitted claims, line by line, surfacing any unpaid items.

Use Cases

SHA & NHIF Scenarios We Handle

Linda Mama

Free maternity scheme — claims for ANC, delivery, postnatal and newborn care submitted automatically.

Standard Outpatient

SHA outpatient package with capitation and FFS components — invoiced and submitted correctly.

Inpatient Admissions

From admission to discharge — pre-auth, daily updates, surgery authorisations and discharge claim.

Take the Pain Out of SHA & NHIF

Submit cleaner claims, track them in real time and get paid faster — talk to us about onboarding your facility.

Book Free Demo Call: +254 700 000 000