The government intends to invest Sh5 billion in creating a unified digital platform for handling medical insurance claims within the mandatory social health plan.
According to the Ministry of Health (MoH), the proposed Centralised Healthcare Provider Management System (CHPMS) outlined in the draft Social Health Insurance (General) Regulations, 2023, will manage claims and counteract fraud in the healthcare sector.
This initiative is expected to collect substantial monthly contributions from Kenyans.
“In its regulatory impact disclosure, the Ministry of Health reveals plans for CHPMS, a system designed for hospitals to submit, verify, and receive payments for claims as part of the State’s ambitious healthcare program. Kenyans will fund this initiative with a 2.75 percent deduction from their monthly income, contributing a total of Sh133 billion annually,” Business Daily reported.
The MoH states, “The proposed regulations aim to establish a centralized digital platform accessible to empanelled and contracted healthcare providers for claims administration, beneficiary data recording, healthcare service delivery data input, and maintaining providers’ data.”
Additionally, the system will grant authorized user rights, with applications for access aligning with the Data Protection Act 2019 and the Digital Health Act, 2023.
The comprehensive CHPMS will encompass beneficiary data, hospital information, and services provided.
This development is part of Kenya’s efforts to combat medical insurance fraud, incorporating features such as maintaining an audit trail for all processes and facilitating data retrieval.
The Ministry estimates that implementing this system will reduce fraud-related losses to 10-20% of total claims paid, aligning with global estimates where errors and fraud typically account for 3-15% of claim costs.
