The National Platform for Health and Insurance Exchange Services (NPHIES) was launched by the Cooperative Health Insurance Council (CCHI) and the National Center for Health Information (NHIC), aiming to transform the healthcare sector in the Kingdom of Saudi Arabia.
This innovative national e-health program aims to achieve full transparency in all healthcare transactions, increase efficiency and reliability for healthcare providers and insurance companies, and provide the citizens and residents of Saudi Arabia with an enhanced healthcare experience.
NPHIES platform will serve multiple stakeholders in the healthcare industry:
▪️ Healthcare providers (HCPs): hospitals, clinics, laboratories, medical centers, pharmacies, and other entities licensed by CCHI.Healthcare insurance companies.
▪️ (HICs): healthcare services insurers licensed by CCHI.
▪️ Third-party administrators (TPAs): service providers and claim administrative entities that assist health insurance companies in administering their policies and networks.
Benefits of NPHIES for healthcare providers
▪️ Only one unified platform that houses the entire portfolio.
▪️ Automated rules reduce the claim rejection rate.
▪️ Minimize manual work and management cost.
▪️ Enhance the quality of the patient experience.
▪️ Increase compliance
▪️ Faster claims processing
▪️ Secure transactions
NPHIES is designed to be secure and to comply with international healthcare interoperability standards. Every organization receives a Private Key Identifier (PKI) that will authenticate all transactions coming from it. By March of 2023, the CCHI announced it had reached 100 million insurance transactions through NPHIES.
How to become a NPHIES-compliant healthcare provider?
Each healthcare provider must:
▪️ Develop application changes as per the NPHIES Implementation Guide (Major development for current hospitals with its own organizational system).
▪️ Conformance testing against NPHIES transactional use cases.
▪️ Production testing.
The Ministry of Health will notify the due date for transition into NPHIES. Once every organization has received this date, it is mandatory to comply with it, or the organization could face delays in claim reimbursements, penalties, or sanctions.
NPHIES is an obligatory step for all healthcare providers towards improving each organization's efficiency and accuracy of insurance claims and reimbursement processes. Hospitals and clinics that are not integrated and compliant with the standard on time will be fined. At NPHIES' go-live time, only compliant hospitals will be able to submit claims and get paid. All services will be done to insured patients and will only be reimbursed if submitted through the NPHIES portal.
Depending on the size of every organization and the communication received from the Ministry of Health, organizations will either need to complete a direct integration of the HIS to NPHIES or if organizations will be able to use a clearing house solution to handle their Insurance Cycle.
Providers like Ecaresoft offer a HIS solution already certified and compliant with NPHIES flows.
Ecaresoft provides NPHIES-compliant solutions
Ecaresoft helps healthcare providers be eligible with NPHIES criteria, making processes easier with a ready-to-use platform for all the use cases NPHIES offers.
Ecaresoft has two solutions: Cirrus for hospitals and Anytime for primary care. These two software-as-a-Service (SaaS) products are always up-to-date with NPHIESand any other regulations at no extra cost.
Cirrus and Anytime systems are NPHIES-ready by enabling and facilitating
▪️ All hospital internal codes are to be mapped with NPHIES codes.
▪️ NPHIES codes are reflected in the Coding and abstracting module for claim preparation.
▪️ Ecaresoft Billing structure is CCHI-BS code compatible.
▪️ SFDA codes are to be reflected in pharmacy & billing.
Ecaresoft presents the best-in-class EHR, HIS, ERP, and RCM solutions that help hospitals and clinics manage every aspect of their business.
