• The new system will also speed up approvals for patients and reimbursements for health facilities.
• The fund covers about 25 million Kenyans who include about seven million principal members and their dependants.
Image: FILE/ DOUGLAS OKKIDY
The National Hospital Insurance Fund has asked health facilities to stop accepting its cards beginning July 11, so members can use fingerprints.
Members and their dependants will use fingerprints for identification when they seek health services.
The fund says it expects to enrol all its remaining members and their dependants on its biometric system before folding the manual system.
The fund covers about 25 million Kenyans, of whom seven million are principal members.
“Members and their dependants can visit the nearest NHIF service points or contracted hospitals countrywide to be biometrically enrolled,” CEO Peter Kamunyo said.
Previously, members used the national identity card and their NHIF card to get services.
This was linked to increased fraud and several people have been prosecuted for sharing cards.
The new system will also speed up approvals for patients and reimbursements for health facilities.
NHIF said so far, mass biometric registration has been carried out in Laikipia, Nakuru, Homa Bay, Kisumu, Tharaka Nithi, Taita Taveta and Nyeri counties.
Although the NHIF performance indicator shows approvals for patients should be done within hours, sometimes it drags on for days.
“We actually attend to close to one million patients right now per month. We're talking about close to 200,000 inpatients per month, and another maybe 600,000 to 700,000 outpatients per month. So this is voluminous. And to be able to have efficiency and accuracy, automation is key,” Kamunyo said.
The fund is also automating details of service providers up to granular levels— details of the number of beds, and the type of facilities available – through its new Electronic Claims Management System (E-Claim).
“So that once it is in the system, as we do the authorisation, you cannot claim outside those parameters,” Kamunyo said.
The E-Claim enrolment has so far covered health facilities in Western, Nyanza, Central, Coast, parts of Nairobi, Eastern and, Rift Valley regions. The remaining regions will be covered in the next one month.
“All NHIF contracted hospitals will submit claims through the E-claim platform to improve efficiency, reduce fraud, wastage and abuse,” Kamunyo said.
In the 2019-20 financial year, the fund collected Sh60.81 billion from its 8.998 million members at that time and paid out Sh54.3 billion in claims.
The biometric registration is not new, having began in 2015 among civil servants and security officers before it stalled.
Private insurers have also adopted the use of biometric identification.
In 2009, medical fraud in the private sector constituted 40 per cent of all claims, amounting to Sh1.6 billion.
A study by Juran Institute in 2002 said globally, about 20 to 30 per cent of what is paid out by medical insurers is actually waste.
Edited by P.O