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Why is NPHIES important for healthcare providers?

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.

NPHIES platform services:

NPHIES Insurance Services:
Aims to connect all stakeholders in healthcare from service providers (government or private), third party administrators, insurance companies and the patients.

NPHIES Clinical Service:
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.

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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.

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.

Insta integration with NPHIES

Insta HMS released NPHIES compliance, where providers can now submit the eligibility check and pre-authorization requests and receive responses. With Insta HMS integration with NPHIES, providers would now be able to submit 100% of all transactions to the NPHIES platform.

Why Insta

Insta is your one-stop solution for all hospital management system (HMS) related needs. We are spearheading this initiative by being one of the companies to tie up with NPHIES  to help integrate the system. We are completely secure and compliant hospital management software certified with the integrations by NPHIES.

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