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Saudi health insurance exchange Available

NPHIES integration

BeHighCare sends and receives NPHIES transactions directly from the visit, the approval desk and the claims office, so insurance work happens where the patient is, not in a separate portal.

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How it works

  1. Step 1

    Eligibility

    Check coverage at registration and keep the reference with the visit.

  2. Step 2

    Prior authorization

    Request approval for services, follow up and resubmit when needed.

  3. Step 3

    Claims

    Submit claims individually, in batches or in pools.

  4. Step 4

    Communication

    Answer payer requests for information and poll for responses.

  5. Step 5

    Payment

    Receive payment notices and reconcile them against claims.

Capabilities

Eligibility

  • Eligibility check from registration
  • Eligibility history per patient
  • Reference number kept with the visit

Prior authorization

  • Requests from the doctor side or approval desk
  • Batch and pool authorization
  • Resubmission and cancellation

Claims

  • Claim bundles and batches
  • Direct submission after approval
  • Claims dashboard and submitted lists

Follow-up

  • Communication requests and replies
  • Polling for responses
  • Status checks and recall

Payment

  • Payment notices
  • Reconciliation against claims
  • Outstanding claim tracking

Code sets

  • SBS procedure codes
  • SNOMED, LOINC and ICD-10
  • NPHIES medications and devices
Onboarding

What your facility needs

BeHighCare provides the integration. Registration with the authority stays with your facility, and our team supports you through it.

  1. 1Your facility's NPHIES registration and licensing
  2. 2Credentials and certificates issued for your facility
  3. 3Payer contracts and price lists configured in BeHighCare
  4. 4Testing in the NPHIES test environment before go-live

Questions

Day-to-day transactions are sent from BeHighCare. Your team may still use official portals for registration and administrative tasks.

SBS, SNOMED, LOINC, ICD-10, NPHIES medications and medical devices can be imported and maintained in the system.

Yes. Claims can be submitted individually, in batches or through pools, and tracked until payment.

Used in these solutions

Hospital Management System Clinic Management System Electronic Medical Records Patient Management Appointment and Queue Management Inpatient and Outpatient Management Laboratory Information System Radiology Information System Insurance and Revenue Cycle Business Intelligence and Reporting

Other national integrations

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All integrations

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