According to the statement, SHA remains solely responsible for receiving, reviewing, approving and paying eligible claims under the Social Health Insurance Act, 2023.
It also explained that the DHA’s role is to support the digital systems used by healthcare facilities to submit and process claims electronically and securely.
The authority noted that Taifa Care’s digital platform was developed under a government contract with a consortium, which allows the engagement of specialised subcontractors in line with procurement laws.
SHA further addressed concerns over the 2 per cent transaction fee cited in the report, saying it is a system service fee provided for under the Digital Health Act, 2023.
The fee was said to support electronic claims processing, patient and provider verification, and secure sharing of health information across healthcare facilities.
SHA added that the charge is only applied to claims that have already been approved for payment and is processed automatically through the system.
The allegations emerged as SHA continues processing and settling hospital claims, with the authority recently announcing that it had cleared 80 per cent of pending payments to counties.
SHA urged healthcare providers to submit complete documentation, obtain required pre-authorisations where applicable and keep facility and banking details updated to facilitate timely claims processing.
