After entering in the list of NABIDH (Network Analysis Backbone Integrated Dubai Health), Malaffi and Riayati connected EMRs in the UAE, Insta HMS is in the process of testing and certification for NPHIES compliance in KSA.
What is NPHIES?
National Platform for Health and Insurance Exchange Services (NPHIES) is a unified electronic services platform launched by the Cooperative Health Insurance Council (CCHI) and the National Center for Health Information (NHIC) and led by the Sehati Company. There are two platform services offered by NPHIES:
- NPHIES Insurance Services:
Aims to connect all stakeholders in healthcare from service providers (government or private), third party administrators, insurance companies and the patients. It is equivalent to an electronic smart courier service, and does not process or adjudicate transactions or take the role of a healthcare provider, insurance company or third party administrator.
Aims to provide a unified digital health record for patients in the Kingdom of Saudi Arabia, to improve healthcare decision making by improving the efficiency, quality, cost and time of providing these services.
NPHIES Insurance Services
The healthcare providers have been segregated such that they can be onboarded in a phased manner to adopt only NPHIES Insurance Services as of now. That is, providers identified in Wave 2, have to gradually adopt and comply with sending insurance transactions via NPHIES and have 100% compliance by May 2022.
The type of transactions that NPHIES will support:
- Eligibility Check Cycle: A transaction allows a provider to request for identifying the patient’s insurance and other insurance details to which the insurance company would respond with errors of the respective insurance details.
- Pre-Authorization: A transaction which allows a provider to request for prior authorization of products or services.
- Claim Submission: A transaction where the provider makes a claim request for adjudication of products or services rendered to the beneficiary.
- Claim Communication: A request from the insurance company for additional supporting documents/information to a claim request.
- Payment Reconciliation: A transaction which provides the details of payment allocations to the respective claims being settled.
- Payment Notification: A notification of the current status of claim related payments.
Conclusion
Insta HMS is now going to be NPHIES compliant in the Kingdom Of Saudi Arabia after its integration with NABIDH (Network Analysis Backbone Integrated Dubai Health), Malaffi and Riayati connected EMRs in UAE
Not only this, Insta HMS offers more in its hospital management system and can give you the full-fledged package of a cloud-based clinic management system.
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