NHIF Claims Processing & Reconciliation Automation
Claims that should take days are taking weeks. Revenue you have already earned is sitting in a manual queue.
Kenyan private hospitals and clinics enrolled with the National Hospital Insurance Fund face a familiar cycle: patient is treated, claim is assembled manually, submitted, and then tracked through a process that offers minimal visibility. Rejections arrive without clear reasoning. Resubmissions require starting over. The result is a cash flow gap that grows with the size of the facility. The more patients, the more claims. The more claims, the more admin load. And the more admin load, the more errors — which create more rejections.
The automation behind the outcome.
Membership Verification
Patient NHIF membership verified before treatment — no surprises at submission.
Claim Auto-Assembly
Claim documentation assembled from existing records — no manual rebuild.
Submission Tracking
Every submission tracked end-to-end with automated status updates.
Rejection Workflow
Rejections logged, categorised, and routed into a re-submission workflow.
Monthly Reconciliation
Monthly reconciliation report: submitted vs. paid vs. outstanding — at a glance.
Facilities recover delayed revenue faster, reduce admin time on claims significantly, and gain visibility into their NHIF pipeline that manual tracking cannot provide.
Does this look like your NHIF process?
Free assessment. We map your current claim workflow and show you exactly where automation pays off.