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Al Mishari Hospital, KSA: SAP Integration with Waseel and NPHIES
Overview
To comply with the Kingdom's national health insurance exchange mandate and accelerate its revenue cycle, Al Mishari Hospital engaged DigiMed to integrate its SAP solution with Waseel and NPHIES — the Saudi national platform for health insurance eligibility, authorization and claims exchange.
The Challenge
The hospital's insurance processes were largely portal-based and manual:
The Solution
DigiMed connected SAP to the national ecosystem through Waseel's accredited gateway:
Benefits Achieved
The Waseel/NPHIES integration turns compliance into advantage for Al Mishari Hospital — a faster, cleaner revenue cycle operated entirely from SAP, aligned with the Kingdom's national digital health insurance vision.
To comply with the Kingdom's national health insurance exchange mandate and accelerate its revenue cycle, Al Mishari Hospital engaged DigiMed to integrate its SAP solution with Waseel and NPHIES — the Saudi national platform for health insurance eligibility, authorization and claims exchange.
The Challenge
The hospital's insurance processes were largely portal-based and manual:
- Manual submissions: RCM staff re-entered claims into payer portals, duplicating work already done in SAP.
- High rejection rates: Data mismatches between SAP and portal entries drove avoidable claim rejections and resubmissions.
- Slow eligibility checks: Front-desk staff verified coverage manually, delaying patient registration.
- No real-time visibility: Claim status lived outside SAP, making receivables follow-up reactive.
The Solution
DigiMed connected SAP to the national ecosystem through Waseel's accredited gateway:
- Eligibility at registration: Coverage verification runs from within SAP at patient registration, returning policy and benefit details in real time.
- Prior authorization: Authorization requests and responses flow electronically, attached to the patient case.
- Claims submission: Claims generate from SAP billing and submit through Waseel to NPHIES in the mandated FHIR-based format, with validation before transmission.
- Status & remittance: Claim status updates and remittance information post back into SAP for reconciliation and denial management.
- Compliance alignment: Message content mapped to CCHI and NPHIES specifications, with DigiMed and Waseel jointly certifying the flows.
Benefits Achieved
- Fewer rejections: First-pass claim rejections reduced by approximately 13% through validated, single-source submissions.
- Faster cash: Reimbursement cycle time shortened by an estimated 32% with electronic submission and status tracking.
- Front-desk speed: Eligibility confirmed onlineduring registration saving time for the users on the phone or portal.
- Mandate-ready: The hospital meets the NPHIES integration mandate with a certified, future-proof connection.
The Waseel/NPHIES integration turns compliance into advantage for Al Mishari Hospital — a faster, cleaner revenue cycle operated entirely from SAP, aligned with the Kingdom's national digital health insurance vision.
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Sales@dmtech.me
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B-18, Business Center, Sharjah Media City (Shams),
Al Messaned, Al Bataeh, Sharjah,
United Arab Emirates, PO Box 51500.