Macmillan Medica Training College
- info@macmillancollege.ac.ke
Health Insurance and SHA Billing Procedures
Course Overview
This comprehensive training program provides healthcare professionals with in-depth knowledge of Kenya's health insurance systems and SHA billing procedures. Participants will gain practical skills in claims processing, medical coding, and financial reconciliation to enhance efficiency in healthcare administration.
Target Audience
- Health records and information officers
- Billing clerks and front office personnel
- Hospital administrators and accountants
- Clinical officers and nurses
- Healthcare practitioners in financing roles
Entry Requirements
Minimum Qualification:
KCSE Certificate or equivalent
Preferred Qualifications:
Certificate, diploma, or relevant work experience in healthcare or administration
Recommended Skills:
Basic computer literacy for billing sessions
Course Curriculum
Week 1: Health Insurance in Kenya (20 Hours)
Module 1.1 History and Need for Health Insurance in Kenya
History of medical covers in Kenya
The burden of out-of-pocket healthcare spending
Why health insurance is essential for UHC and health equity
Module 1.2 NHIF – Structure, Benefits & Reforms
NHIF registration, contribution and benefits
NHIF claim processes and e-claims system
SHA transition and NHIF's transformation under SHIF Act 2023
Week 2: SHA Billing Procedures & Practice (20 Hours)
Module 2.1 Introduction to the SHA Framework
What is SHA? Overview of SHA 2011 structure
Health expenditure classifications and categories
Role of SHA in policy, planning, and reporting
Module 2.2 Billing Procedures in Healthcare
Patient intake, preauthorization, eligibility verification
Medical coding systems: ICD-10, CPT, HCPCS
Invoicing and claim preparation
Assessment & Certification
Continuous Assessment
Class exercises, case analysis, and quizzes
Final Assessment
Written test and practical billing exam (2 hrs)
Certification
Certificate of Completion from MMTC (with CPD points if applicable)
Course Fees
Registration Fee:
KES 2,500
Tuition Fee:
KES 12,000
Certification Fee:
KES 1,500
Total Payable:
KES 16,000
Includes course materials, practical sessions, and certification