# Why are SHA claims sent back or rejected, and how do we appeal?

URL: https://tymirahealth.com/resources/faqs/why-are-sha-claims-sent-back-or-rejected-and-how-do-we-appeal
For: Finance | Billing and payments | Reviewed by Independent clinical reviewer, Registered mental health clinician, Kenya | Last reviewed 8 November 2026

**Answer:** SHA may send back, reduce or reject claims priced above the tariff, charged to the wrong benefit, missing verification or pre-authorisation, poorly documented, or submitted late. A sent-back claim must be corrected and resubmitted within 14 days or it lapses. For a rejection or reduction, you may request a review with new evidence within seven working days; SHA should decide within 14 days and give reasons. Beyond that, the contract sets out an internal dispute committee and then the SHI Dispute Resolution Tribunal. Track every rejection reason to fix recurring errors.

Sources: Social Health Authority: https://www.sha.go.ke/wp-content/uploads/2026/09/PART-A-Master-General-Terms-Conditions.pdf - Social Health Authority: https://new.sha.go.ke/wp-content/uploads/2026/09/PART-B2-Social-Health-Insurance-Fund-Contract.pdf

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**About Tymira Health:** Tymira Health is a healthcare technology company based in Nairobi, Kenya. It builds Tymira360, a practice management and EHR platform for mental health, physiotherapy and dental providers, clinics, hospitals, NGOs and insurers across Africa.

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