Insurance, billed at the till.
Member verification, copay split, batch submission, capitation tracking. SHA and the major private schemes — wired in. The till knows what insurance covers before you dispense.
SHA. NHIF capitation. Private schemes.
Omnix talks to each scheme directly. No claims clearing-house, no per-claim fee. The patient walks out, the receipt prints, and the queue carries the claim line for batch submission.
SHA
Member status, benefits, copay rate, dependents — verified in under 5 seconds. Claim batches submitted daily.
NHIF capitation
Legacy capitation runs still being settled. Omnix tracks unsubmitted claims through to payment.
AAR
Member verification + claim submission. Real-time eligibility check before dispensing.
Britam
Hospital + outpatient cover lookup. Pre-auth flow for high-value claims.
Jubilee
Outpatient + inpatient cover. Co-pay and per-visit limits enforced at the till.
Madison · Heritage · CIC
Mid-tier private cover. Same verification + claim flow.
From counter to claim, one screen.
- 01
Verify the patient.
Type the SHA number (or scan the card). Active → benefits and copay rate display. Suspended → the till blocks the claim line and proposes cash payment with a printed reason.
- 02
Add the prescription / service.
Each line gets the SHA-billable category and the appropriate price. Items outside cover (e.g. cosmetics) auto-route to cash.
- 03
The till splits the bill.
Insurance share to a queued claim line. Copay share to the customer to settle by M-Pesa, cash, or card. Two lines on the receipt; one transaction.
- 04
End-of-day batch.
Omnix submits every queued line to SHA in one batch. Each line confirms accepted or rejected with a translated reason.
- 05
Settlement tracking.
Claims queue moves through Submitted → Accepted → Paid. Settlement matches against the SHA payout statement automatically.
Every claim, on letterhead.
Each batch prints to a single PDF in your facility’s name. Insurer reads one document instead of stapled receipts.
Claims batch PDF
Member name, claim number, diagnosis, copay, claim amount, paid-to-date — one row per claim, totals at the bottom.
Download sample →Approval + payment trail
Submitted → approved → partially paid → paid. Every state stamped with the actor + timestamp so when SHA disputes a figure you have the receipts.
Questions before you switch.
What's the difference between SHA and NHIF?
SHA — the Social Health Authority — replaced NHIF in October 2024 as Kenya's primary health insurance scheme. NHIF capitation is being wound down. New claims go through SHA. Omnix handles both: SHA claims to the new portal, NHIF claims to the legacy capitation runs that are still being settled.
Does Omnix verify SHA membership?
Yes. Type the patient's SHA number → Omnix calls the SHA verification endpoint → the patient's status (Active / Suspended / Defaulted), benefits, copay rate, and dependents come back in under 5 seconds. The till knows what the insurance covers before you dispense.
How does copay work?
If the SHA cover is 80% of a KES 1,000 prescription, the till splits the bill automatically: KES 800 to insurance (queued for batch submission), KES 200 copay to the patient. The patient pays the KES 200 by M-Pesa, cash or card; the till prints two lines on the receipt.
Do I have to submit claims one by one?
No. Omnix queues claims locally and submits them in daily batches at the time you choose. End-of-day batch is the most common. Each batch confirms back with line-by-line acceptance status. Failed lines stay in the queue with the rejection reason translated to plain English.
What about private insurance?
Omnix supports the major private schemes (AAR, Britam, Jubilee, Madison, Heritage, etc.) through a member-verification template. Each scheme's API is wired in by us; you just turn it on and paste the merchant credentials.
Does this work for clinics or only pharmacies?
Both. The Dawa variant is purpose-built for pharmacies and dispensaries; the Hospitality variant covers small clinics. Multi-branch hospital chains run on Pro with the SHA + private rails active across every branch.
The patient walks out. The claim files itself.
30 days · no card · KES 30,000 once if you keep it