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SHA Compliance Checklist for Healthcare Providers in Kenya

A comprehensive checklist to verify your facility's readiness for Social Health Authority integration — registration, system integration, claims processing, data security, staff training, and go-live requirements for hospitals, clinics, pharmacies, and labs.

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Checklist Sections
1. Registration & Accreditation 2. System Readiness 3. Integration & Claims 4. Data Security & Privacy 5. Staff Training 6. Go-Live & Monitoring

1. SHA Registration & Accreditation

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

2. System Readiness

  • HMIS/LIS/Pharmacy system supports API integration
  • System supports HL7 or FHIR data exchange standards
  • Patient registration module captures SHA member numbers
  • Billing module can generate SHA-compliant claim formats
  • Service/drug/test codes mapped to SHA standard codes
  • Reliable internet connection (minimum 5-10 Mbps)
  • System tested in SHA sandbox environment

3. Integration & Claims Processing

  • Real-time eligibility verification configured at registration
  • Electronic claims submission module configured
  • Pre-authorization workflow set up for applicable procedures
  • Claim validation implemented (errors caught before submission)
  • Claim status tracking enabled (pending/approved/rejected)
  • Rejected claim re-submission workflow configured
  • Reconciliation 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 SHA
  • AES-256 encryption for data at rest
  • Role-based access controls implemented
  • Audit logging enabled for all SHA transactions
  • Data Protection Impact Assessment (DPIA) completed
  • Compliance with Kenya Data Protection Act 2019 verified
  • Compliance with Digital Health Act 2023 verified
  • Backup and disaster recovery plan documented
  • Security certificates and API credentials regularly updated

5. Staff Training & Readiness

  • Front desk staff trained on SHA eligibility verification
  • Billing staff trained on electronic claims submission
  • Clinical staff trained on pre-authorization workflows
  • IT staff trained on API monitoring and troubleshooting
  • Quick-reference guides created for each department
  • Mock patient journey conducted (registration → service → claim → payment)
  • Support channel established for staff questions

6. Go-Live & Monitoring

  • Sandbox testing completed successfully
  • Production API credentials configured
  • Small batch of real claims tested first
  • API response time monitoring set up
  • Error rate monitoring set up
  • Claim approval rate tracking enabled
  • Automated alerts for API downtime configured
  • Weekly review meetings scheduled for first month
  • Process for staying updated on SHA regulation changes established
Ticking every box above yourself can take months. Comptracks Systems runs this exact checklist against your HMIS as part of a free SHA compliance assessment, then handles the integration end-to-end. Get your free assessment.