SHA Compliance Checklist for Healthcare Providers in Kenya

1. SHA Registration & Accreditation

Facility registered on the SHA portal (sha.go.ke)Operating license submitted (hospital/clinic/pharmacy/lab)KRA PIN certificate submittedFacility details completed (name, location, services, capacity)SHA provider agreement signedUnique facility identifier receivedSHA API credentials received (sandbox + production)

2. System Readiness

HMIS/LIS/Pharmacy system supports API integrationSystem supports HL7 or FHIR data exchange standardsPatient registration module captures SHA member numbersBilling module can generate SHA-compliant claim formatsService/drug/test codes mapped to SHA standard codesReliable internet connection (minimum 5-10 Mbps)System tested in SHA sandbox environment

3. Integration & Claims Processing

Real-time eligibility verification configured at registrationElectronic claims submission module configuredPre-authorization workflow set up for applicable proceduresClaim validation implemented (errors caught before submission)Claim status tracking enabled (pending/approved/rejected)Rejected claim re-submission workflow configuredReconciliation reports set up (SHA payments vs submitted claims)Duplicate claim prevention controls implemented

4. Data Security & Privacy

TLS 1.2+ encryption for all data transmitted to SHAAES-256 encryption for data at restRole-based access controls implementedAudit logging enabled for all SHA transactionsData Protection Impact Assessment (DPIA) completedCompliance with Kenya Data Protection Act 2019 verifiedCompliance with Digital Health Act 2023 verifiedBackup and disaster recovery plan documentedSecurity certificates and API credentials regularly updated

5. Staff Training & Readiness

Front desk staff trained on SHA eligibility verificationBilling staff trained on electronic claims submissionClinical staff trained on pre-authorization workflowsIT staff trained on API monitoring and troubleshootingQuick-reference guides created for each departmentMock patient journey conducted (registration → service → claim → payment)Support channel established for staff questions

6. Go-Live & Monitoring

Sandbox testing completed successfullyProduction API credentials configuredSmall batch of real claims tested firstAPI response time monitoring set upError rate monitoring set upClaim approval rate tracking enabledAutomated alerts for API downtime configuredWeekly review meetings scheduled for first monthProcess for staying updated on SHA regulation changes established

SHA Compliance Checklist for Healthcare Providers in Kenya

1. SHA Registration & Accreditation

2. System Readiness

3. Integration & Claims Processing

4. Data Security & Privacy

5. Staff Training & Readiness

6. Go-Live & Monitoring

Detailed SHA Compliance Guides by Facility Type

How to Make Your Hospital SHA Compliant

How to Make Your Clinic SHA Compliant

How to Make Your Pharmacy SHA Compliant

How to Make Your Lab SHA Compliant

Not Sure Where You Stand?