SHA Preauthorisation Explained: What Gets Approved and How
SHA preauthorisation is the approval step that confirms a planned treatment is covered before it happens. Not every treatment needs one, and the route depends on the service. This guide explains which treatments need SHA preauthorisation, how the normal and elective routes differ, what doctor consent does, what each status means, and what to ask when approval stalls.
SHA preauthorisation is an approval SHA gives before certain treatments, so the claim can be paid later. It only applies to services flagged as needing one. There are two routes: a normal preauth raised during the visit, and an elective preauth for planned, non-urgent care that SHA approves before the visit. Surgical, renal, oncology, imaging and optical treatments use their own forms.
Does your treatment need SHA preauthorisation?
Preauthorisation is decided per intervention, not per hospital or per patient. Each SHA intervention carries a flag that says whether it needs a preauth, and the facility checks that flag before starting care. Two patterns are worth knowing. Imaging interventions are elective, so approval must come before the scan. Surgical interventions always need doctor authorisation. The SHA rules we reviewed also state that inpatient care under SHIF does not need a preauthorisation. Confirm this for your own package and treatment with the facility rather than assuming.
Normal or elective: two routes for SHA preauthorisation
| Normal SHA preauthorisation | Elective SHA preauthorisation | |
|---|---|---|
| Used for | Standard services handled as a same-day request | Planned, non-urgent care that SHA must approve before the visit |
| Consent | Taken as part of the visit it belongs to | Taken before the visit by OTP or biometric match |
| Timing | Submitted during the visit | Approved before the patient attends |
| Extra requirement | Diagnoses, items, doctors and any required documents | The same, plus a planned service start date |
| If plans change | Handled within the visit | Cancel the approval, or it lapses after 7 days |
How the elective SHA preauthorisation route works
The elective route is for planned care only. Emergency and urgent cases are not accepted through it. The steps run in this order.
- The facility confirms the intervention is elective, meaning its manual approval flag is true.
- Before the visit, you consent by OTP sent to your registered contact, or by biometric match. This creates an authorisation waiting for SHA approval.
- The facility submits the preauth with the diagnosis, items, doctors, documents and the planned start date.
- SHA reviews the request. Once it is approved, the approval is held against your cover.
- On the day of the visit, a fresh OTP or biometric check links the visit to the existing approval. You do not need to start again.
Specialised SHA preauthorisation forms
Some interventions use a purpose-built form that asks for extra clinical detail. The flag on the intervention decides which form the facility uses. If none of the flags applies, the standard form is used.
| Form | What it asks for |
|---|---|
| Surgical | Chief complaint, surgery date, anaesthesia type, vitals, history of the illness, examination and investigation report |
| Renal | Sessions required, cost per session, frequency, start date and clinical indications, for example dialysis |
| Oncology | Carcinoma staging, metastases, treatment setting, sessions required and cost per session |
| Imaging | Clinical indications for the scan |
| Optical | Lens prescription, lens, frame and examination amounts, and whether it is new or a replacement |
Doctor consent in SHA preauthorisation
If an intervention needs doctor authorisation, the consent request goes to the named doctor as soon as the preauth is created. It is sent by two-way SMS, the Practice360 app, or email. While the doctor has not replied, the request sits in PENDING_DOCTOR_APPROVAL. Once the doctor approves, it moves to ACTIVE, which means it has been submitted to SHA. You do not request consent separately. If a doctor says they never received the request, the facility can ask for it to be sent again.
SHA preauthorisation statuses in plain English
| Status | What it means |
|---|---|
| DRAFT or PENDING_SUBMISSION | The request is still being prepared or is waiting to be sent to SHA |
| PENDING_DOCTOR_APPROVAL | The request is waiting for the named doctor to approve it |
| ACTIVE | The doctor has approved, and the request is with SHA for review |
| CLARIFICATION_AFTER_AUTOMATIC_CHECKS | The request is paused because SHA needs more information. Ask the facility what is missing |
| FINALISED | SHA has reviewed and approved the request, so the treatment can go ahead and be covered |
| CANCELLED | The request has been closed. A cancelled approval releases the balance it was holding |
How long a SHA preauthorisation approval lasts
An elective approval expires 7 days after SHA responds if no visit has been created against it. An expired approval cannot be extended or reused, so the patient needs a fresh preauth and new consent. If the procedure is postponed or cancelled, the facility should cancel the approval rather than let it lapse, because cancelling releases the balance held against the cover. The SHA technical documentation we reviewed does not publish a turnaround time for a decision, so this guide does not quote one. Ask the facility for the preauth reference and check the position with SHA.
Documents and cost limits for SHA preauthorisation
The clinical documents required for a preauth are set by the intervention, and the facility’s system attaches them from the patient record. The regulators require that clinical documents are attached this way rather than uploaded by hand. The exceptions are the claim form, the preauth form and the birth notification. For UHC cover, the total bill for the preauth must sit within the facility-level tariff or the overall tariff for the service. For PMF covers, it must sit within the remaining PMF balance plus any ex-gratia amount. A request above these limits cannot go through as it stands, so the facility may need to adjust it before submitting.
When SHA preauthorisation is delayed, refused or cancelled
- Was a preauth raised, and what is its reference?
- Which route is it on, normal or elective?
- Has the doctor received the consent request, and have they approved it?
- What is the current status, and is anything outstanding?
- If the approval is elective, what is the planned service start date?
Also check that your cover is active. If your cover has lapsed, a preauth can fail regardless of the treatment. See what to do when SHA cover has lapsed. If the facility asks you to pay before a decision, read what to do when a hospital refuses SHA. For the SHA customer care line, call toll-free 0800 720 601 or email customercare@sha.go.ke. If it is a claim that has been rejected rather than a preauth, see how to appeal a rejected SHA claim.
Common SHA preauthorisation mistakes
- Assuming every treatment needs a preauth, when the intervention flag decides it.
- Booking a planned procedure before the elective approval is in place.
- Letting an approval expire after a visit is postponed, instead of cancelling it.
- Not checking that the doctor has replied to the consent request.
- Ignoring a cover that has lapsed or a name and ID that do not match SHA records.
A note for facility staff on SHA preauthorisation
Read the flags on the intervention, not the package code. The fields that decide the route are needsPreauth, needsManualPreauthApproval and needsDoctorAuthorization. The specialised form is chosen by the requires-form flags, and the documents by requiredPreauthDocumentTypes. Facility portal access is covered in SHA provider portal login.
Waiting on an approval? Send us the details.
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SHA preauthorisation: frequently asked questions
Do all treatments need SHA preauthorisation?
No. Each intervention carries a flag that says whether it needs a preauth. Your facility checks that flag before care starts.
Who submits the SHA preauthorisation, me or the hospital?
Usually the facility submits it. For elective care you give consent before the visit, by OTP or biometric match.
Does imaging need SHA preauthorisation?
Imaging interventions are elective, so approval must come before the scan.
Can I start a planned surgery without approval?
Surgical interventions need doctor authorisation, and planned care that is flagged as elective needs SHA approval before the visit. Do not book the surgery until the facility confirms the approval is in place.
What happens if my elective approval expires?
It cannot be extended or reused. You need a fresh preauth and new consent before the visit goes ahead.
How long does a SHA preauthorisation decision take?
The official technical documentation we reviewed does not publish a turnaround time, so we do not quote one. Ask the facility for the reference and check with SHA.
Is a preauthorisation the same as a claim?
No. A preauthorisation is the approval given before treatment. A claim is the request for payment that follows.
Related guides on SHA preauthorisation
Sources for this SHA preauthorisation guide
- Digital Health Agency, HIE technical documentation at hie-docs.dha.go.ke: Preauths Process Overview, Normal Preauth, Elective Preauth, Preauth Doctor Consent, Cancel Preauth, Intervention Coverage, Adding Attachments and Special Benefit Rules.
- Social Health Authority, toll-free customer care line 0800 720 601 and customercare@sha.go.ke.
Disclaimer: MyCyber is an independent digital assistance service, not affiliated with SHA, the Digital Health Agency or any government body. This page explains the preauthorisation process and is not legal or medical advice. Confirm current rules and any individual case with the facility, sha.go.ke or 0800 720 601.
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