The Social Health Authority (SHA) has introduced new guidelines for contracted healthcare providers aimed at improving the processing of healthcare claims for children living under alternative care arrangements.
In a notice dated July 16, 2026, SHA said it had identified inconsistencies in the documentation submitted by healthcare facilities when filing claims for children under alternative care, prompting the introduction of standardized documentation requirements.
“The Social Health Authority has observed inconsistencies in the documentation submitted in support of claims for children under alternative care arrangements,” the notice states.
New Documentation Requirements Introduced
According to SHA, the guidelines are intended to promote consistency in claims processing and ensure eligible children continue accessing healthcare services without disruption.
“To promote consistency in claims processing and ensure uninterrupted access to healthcare services for eligible beneficiaries, the Authority hereby guides the minimum documentary requirements applicable to the various categories of alternative care,” the notice adds.
Healthcare providers will now be required to verify and submit specific legal documents depending on the type of alternative care arrangement involved.
Documents Required for Different Care Arrangements
Under the new guidelines, healthcare facilities must provide a Certified adoption orders for adopted children, guardianship orders or guardianship deeds for children under legal guardianship, custody orders or letters from Children’s Officers for children under kinship care arrangements, and foster care placement approvals or court orders for children placed in foster care.
The guidelines also cover children living in charitable institutions, those placed with relatives through court directives, children under parental responsibility agreements, and children under Kafaalah, an Islamic child care arrangement recognized under Kenyan law.
Reduce Claims Delays
The Authority said the new requirements are expected to reduce delays caused by incomplete, inconsistent, or inadequate documentation submitted during claims processing.
By standardizing documentation requirements, SHA hopes to improve efficiency and accelerate reimbursement processes across contracted healthcare facilities.
The move is also aimed at protecting vulnerable children by ensuring they continue receiving healthcare services without unnecessary interruptions due to administrative challenges.
Providers Advised to Seek Clarification
Healthcare providers requiring further guidance on the new requirements have been advised to contact SHA through its toll-free customer service line, 147.
The notice was signed by SHA Chief Executive Officer Mercy Mwangangi, who reaffirmed the Authority’s commitment to ensuring all eligible beneficiaries access healthcare services seamlessly.
The latest directive forms part of ongoing efforts by SHA to strengthen healthcare administration and improve service delivery under Kenya’s social health insurance framework.
