What is NPHIES?

The unified electronic services platform is National Platform for Health and Insurance Exchange Services launched by the Cooperative Health Insurance Council (CCHI) and the National Center for Health Information (NHIC) and led by the Sehati Company

Vision

Transforming the health care sector in the Kingdom of Saudi Arabia by using the latest technologies to enhance the level and quality of health services

Value Proposition

Consolidated, accurate and comprehensive data; supporting the achievement of Value Based Healthcare (VBHC ) and Diagnosis Related Group (DRG)

NPHIES Component

Insurance Services

Digital Standard insurance Services aims to govern health insurance services by connecting all stakeholders in health insurance (health service providers, health insurance companies).

Clinical Services

Unified digital health services (unified health record) for patients in the Kingdom of Saudi Arabia aims to improve the efficiency and quality of health care services provided, and also reduces the cost and time of providing health care services, which is a basis for improving healthcare decision-making

NPHIES Target Audience

Clinical Services

Financial Services

Healthcare Providers Governmental and Privet Sectors

Health Insurance Companies

Third Party Administrators

Eligibility Management Services

Check Eligibility

Pre-Authorize Health Service

Resubmit Pre-Authorization

Send Advanced Pre-Authorization

Nullify Pre-Authorization Request

Cancel Pre-Authorization

Retrieve Beneficiary Policy Details

Notify Pre-Authorization

User Management Services

Manage Enterprise

Block/Unblock Stakeholder

Manage User Registration

Manage Access to Enterprise Representative

Claim(s) Management Services

Process Claim(s)

Re-Adjudicate Claim(s)

Amend Claim

Revise Claim/Invoice Notification

Inquire Claim Status

Nullify Claim

Validate Claim Author Offline

CCHI Insurance Management Services

Send HCP Network

Send Policy to MOI

Report Fraud/ Misuse

Raise a Complaint

Track Complaint

Validate Health Practitioner Status

Detect Fraud/Misuse

Generate Reports

Request Claim Supporting Documents

Payment Management Services

Payment Advice Notification

Payment Confirmation Notification

Patient ID Management

Coded Lab Order

Medication Dispensation

Encounter Summary

Surgical Notes

Provide/ Organization Management

Sharing Diagnostic Imaging

Medication Prescription

Baby Discharge Summary

Referral Request/ Response

Coded Lab Results

Tele-Radiology Ordering

General Purpose Discharge Summary

Mother Discharge Summary

Immunization Record

Release 1

Insurance Component

Insurance Services
Registration Services*
Data Base and BI
Infrastructure Services

Release 2

NPHIES Clinical Services

Patient Portal with SSO **
Health Service Providers Portal
Photo viewer
Date of examination
Clinical documents (6 Use Cases)

Release 3

NPHIES Clinical Services

Healthy data warehouse
Other deferred services, such as (BAM, API manager)

Release 4

NPHIES Clinical Services

Clinical Documentation (9 Use Cases)

Notes:

The provided final list of services in release 2, release 3 and release 4 will be reviewed and approved before submission offers.
“NHIC” the existing registration services, will be used later to transfer both records and terminologies to the second version UniPlat Portal will be emerged with SSO's into release 2

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

General Circular Number 1 of 2020 (GC 01-2020)

General overview of NPHIES

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Policy Directive Number 1 of 2020 (PD 01-2020)

Mandatory participation in market assessment, awareness and training events

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Technical Update Number 1 of 2020 (TU 01-2020)

Portal participation: hardware and software requirements

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Technical Update Number 2 of 2020 (TU 02-2020)

Types of NPHIES Financial Services transactions

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

General Circular Number 2 of 2020 (GC 02-2020)

Roles and responsibilities

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Policy Directive Number 2 of 2020 (PD 02-2020)

Roles and responsibilities

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Technical Update Number 3 of 2020 (TU 03-2020)

Types of NPHIES Financial Services transactions

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

General Circular Number 3 of 2020 (GC 03-2020)

monitoring and compliance

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Policy Directive Number 3 of 2020 (PD 03-2020)

NPHIES fees

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Policy Directive Number 4 of 2020 (PD 04-2020)

Billing code sets

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

General Circular Number 4 of 2021 (GC 04-2021)

The Rollout plan of nphies platform

This billing procedure has been developed by CCHI to ease for health care providers coding health services as will billing their invoices insurance companies. It has been developed based on ACHI. This billing procedure are compatible with standards and classifications that are acceptable by SHC.

نظام مجلس الضمان الصحي التعاوني للفوترة (CCHI-BS).xlsx Standards and Guidelines of CCHI Billing System.pdf

Coding fields required Codes, classifications and terminologies to be used
Description
Diagnosis Codes, includes: Ophthalmology, Rehabilitation ICD-10-AM Tenth Edition
الترميز الطبي الأسترالي للأمراض والتشخيص
Procedures / Health interventions (in-patient) includes: Ophthalmology, Rehabilitation and allied health services CCHI Billing System (CCHI-BS) قائمة الترميز للإجراءات والعمليات
Outpatient Cost/ Ambulatory Services, Consultation, Room and Board, Inpatient Rounding CCHI Billing System (CCHI-BS) قائمة ترميز الإجراءات للعيادات الخارجية والتكلفة
Medical devices GMDN = classification of devices per intended use and specification التصنيف والترميز للمعدات والأجهزة الطبية ومجموعاتها
Oral Health
Inpatient: CCHI Billing System (CCHI-BS)

Outpatient: The Australian Schedule of Dental Services and Glossary (ADA)
قائمة الترميز للتنويم والعمليات لخدمات طب الأسنان

الترميز للعيادات الخارجية: جدول خدمات طب الأسنان الأسترالي
Laboratory tests, observations and Blood Bank products CCHI Billing System (CCHI-BS) الترميز للاختبارات التحليلية وبنوك الدم
Imaging Procedures CCHI Billing System (CCHI-BS) الترميز والتصنيف للأشعة
Packaged pharmaceuticals SFDA (GTIN) ترميز تصنيف الأدوية
Ambulance and Transportation Services (SRCA) CCHI Billing System (CCHI-BS) ترميز النقل الإسعافي للمرضى وحالاتهم

Clinical Standards

To ease the communication amongst health ecosystems harmonies, a unified language should exist to assure all speak to each other in an acceptable format. While CCHI is developing the national platform for the health insurance exchange system (NPHIES), it also has been investing with other stakeholders to make sure that all health services standards are in place and agreed through Saudi Health Council SHC. These standards besides the data that are provided by the national health information center (NHIC), (such as the Australian Diagnosis coding ICD-10-AM) will lead to a more effective and efficient healthcare system. Also, working with these standards will enhance the healthcare sector's transparency and sustainability.

For more information about medical standards please refer to the NHIC website
( please click here)

Coding fields required Codes, classifications and terminologies to be used Description
Demographics/Administrative Coding Saudi Health Data Dictionary (SHDD), V.2 المصطلحات الطبية والإدارية المستخدمة في المؤسسات الصحية
Diagnosis Codes, includes: Ophthalmology, Rehabilitation ICD-10-AM/ACHI/ACS Tenth Edition الترميز الطبي الأسترالي للأمراض والتشخيص
Procedures / Health interventions (in-patient) includes: Ophthalmology, Rehabilitation and allied health services ACHI Tenth Edition الترميز الطبي الأسترالي للإجراءات والعمليات
Allergies
SNOMED CT
Encode Allergies
نظام الترميز والمصطلحات الطبية
SNOMED CT
ترميز الحساسية
Emergency Department Principal Diagnosis
ICD-10-AM/ACHI/ACS Tenth Edition
MDC and URG
الترميز الطبي الأسترالي للحالات الإسعافية وتشخيصها
Medical devices GMDN = classification of devices per intended use and specification التصنيف والترميز للمعدات والأجهزة الطبية ومجموعاتها
Functional Assessments International Classification for Functioning, Disability and Heath (ICF), (FIM (Functionality Independence Measures)) الترميز والتصنيف للإعاقة والعلاج الوظيفي
Oral Health
Inpatient: ICD 10 AM + ACHI
Outpatient: The Australian Schedule of Dental Services and Glossary (ADA)
الترميز للتنويم والعمليات: نظام الترميز الأسترالي

الترميز للعيادات الخارجية: جدول خدمات طب الأسنان الأسترالي
Laboratory tests, observations and Blood Bank products LOINC and RELMA الترميز للاختبارات التحليلية وبنوك الدم
Imaging Procedures National Interim Clinical Imaging Procedure (NICIP) Code Set with Saudi Extensions الترميز والتصنيف للأشعة
Units of measures The Unified Code for Units of Measure (UCUM) Revision 2.1 التصنيف لمعيار الوحدات
Cause of Death / Morbidity ICD-10 WHO تصنيف أسباب الوفاة
Packaged pharmaceuticals SFDA (GTIN) ترميز تصنيف الأدوية
Herbal & Health Products SFDA Registration Number قائمة المستحضرات العشبية والصحية

NPHIES Champions

“NPHIES Champions (SPoC)” In line with the Kingdom's Vision 2030, and to create synergies within the Healthcare Ecosystem (Healthcare Providers and Health Insurance Co.), we are delighted to announce the launch of NPHIES champion initiative. Please provide information as detailed and accurate as possible to ease the communication and the onboarding process. For more information Click here

Vendors Certification Program

In order to become one of nphies certified vendors, kindly see below the requirements to get the certificate and have the ability to link nphies to the health care providers and the health care insurance:

Available Resources

Documentation

Implementation Guide that includes:

Information Exchange Construction and Flow

Use Cases

Data Model

API Specs and Documentation

Sample Messages

Training

Access to group integration and technical training sessions including:

INT-01 – WS Integration Training

INT-02 – Onboarding Integration Solution Training

Limited dedicated consultation sessions

Support

Access to nphies Reference Implementation to:

Test development efforts

Simulate market scenarios and use cases prior to go-live

Limited dedicated support session during testing and simulation

If you are a system vendor and want to get a certification of nphies certified system vendor kindly send an email to:

Or you can contact nphies contact center:

920004299

Implementation Guide

Implementation guide will be used by Insurance (including TPAs) and providers to integrate with nphies. The guide describes the information exchange construction and flow between different healthcare stakeholders and the solution, use cases, defines the message structure of profiles for FHIR implementation, and specifies the links to relevant FHIR artifacts and documentation.

The documents are now available on nphies Community Portal website using the following link: Link Documents can be found using the following pathway after logging into nphies Community Portal: Health Dictionary HD > Documentations > Technical Standards
If your entity is not part of wave 1 of nphies onboarding and you require access, please contact Link

Exchange Profiles

Standard profiles will define for each transaction the schema elements, fields, cardinality type, datatype, and minimum data sets. There are four major profiles as below each having sub-profiles:

· Eligibility Request
· Eligibility Response
· Authorization Request
· Authorization Response
· Claim Request
· Claim Response
· Payment Notification
· Payment confirmation

The documents are now available on nphies Community Portal website using the following link: Link Documents can be found using the following pathway after logging into nphies Community Portal: Health Dictionary HD > Documentations > Technical Standards
If your entity is not part of wave 1 of nphies onboarding and you require access, please contact Link

Business Rules and Validation Rules (BRVR)

The business and validation rules will be utilized to govern transaction use cases in line with the UniPlat use case profiles (such as eligibility checks, preauthorization requests, claims process cycle).

Business rules: Business rules will outline the workflows and business cycles governing the use of case transactions. For example, an eligibility check response cannot come before an eligibility check request.

Validation rules: Validation rules will govern the syntax, minimum data set, and values utilized within the fields of the transactions. For example, the encounter type field cannot be empty, and the value must be one of the predefined lists of values.

The documents are now available on nphies Community Portal website using the following link: Link Documents can be found using the following pathway after logging into nphies Community Portal: Health Dictionary HD > Documentations > Technical Standards
If your entity is not part of wave 1 of nphies onboarding and you require access, please contact Link

Denial Codes

When payers have a reason to reject a claim, a denial code will be applied to the transaction which will generate a message to the provider. The set of more than 80 denial codes are grouped into a benefit, clinical and operational and will cover a range of subjects such as:
·           Authorisation
·           Eligibility
·           Price
·           Claim
·           Coding
·           Dosage
·           Time

The documents are now available on nphies Community Portal website using the following link: Link Documents can be found using the following pathway after logging into nphies Community Portal: Health Dictionary HD > Documentations > Technical Standards
If your entity is not part of wave 1 of nphies onboarding and you require access, please contact Link

Use Cases

Use cases are a series of subroutines within the overall claims cycle. These subroutines are defined in the communication cycle between payers and providers within nphies.

The documents are now available on nphies Community Portal website using the following link: Link Documents can be found using the following pathway after logging into nphies Community Portal: Health Dictionary HD > Documentations > Technical Standards

If your entity is not part of wave 1 of nphies onboarding and you require access, please contact Link

NPHIES Training sessions

In the process of transitioning in NPHIES project from inception phase to activation phase, we are introducing series of training courses, to enable the market and provide them with the essential skills to implement the change and to develop a more detailed understanding of NPHIES and to ease the adaptation of the platform.

Note: All provided training sessions are considered mandatory for any entity to be certified to use NPHIES platform.

The training program is divided into Three specialized domains

1. Standard Coding Training:
Standard Coding Training Courses focus on developing a high-level understanding of standard code sets in order to use them within the working environment. These codes are very important to simplify the processes and decrease the costs associated with every health care transaction.
2. Business/Operational training:
Business and Operational Training Courses will focus more on specific areas of the implementation process, it is anticipated that the onboarding orientation sessions will encompass all generic project overviews regarding objectives, approach, and desired outcomes.
3. Technical Training:
Technical Training Courses will be conducted using the integration tool kit (Material, guidelines, sample data, and web services) provided by NPHIES insurance core vendor. The course will provide details about NPHIES solution, registration, configuring, and utilization to perform the transaction, mapping, and communication.
Training sessions are held weekly for those who have been invited from healthcare providers and health insurance companies.

Within the framework of the digital transformation of the health sector in the Kingdom of Saudi Arabia and in order to achieve one of the vision's goals 2030 The council of cooperative insurance (CCHI) has lunched NPHIES initiative which is the unified electronic services platform is National Platform for Health and Insurance Exchange Services. Accordingly, the CCHI approved the list of entities to join the first wave of qualification and preparation of the NPHEIS initiative The list of entities to join the first wave was chosen based on market assessment and maturity level assessment. Accordingly, the council of cooperative health insurance will provide all possible support during the onboarding period.

Health Care Providers
مجموعة الحبيب شركة المواساة للخدمات الطبية شركة المركز الطبي الدولي المحدودة
شركة مستشفى الدكتور سليمان عبدالقادر فقيه شركة الشرق الاوسط للرعاية الصحية شركة دله للخدمات الصحيه
شركة الحمادي للتنمية و الإستثمار الشركه الطبيه التخصصيه المحدوده شركة عيادات باقدو الطبية
مركز مغربي للبصريات
شركة مستشفيات ومراكز مغربي الطبية شركه مراكز العبير الطبيه
شركة مستشفى الدكتور عبدالرحمن بخش المحدوده مستشفى الموسى التخصصي شركة الاطباء المتحدون المحدودة
شركه خدمات المشاريع الطبيه المحدوده شركة المشاريع الطبية المتحدة المحدودة الحرس الوطني
شركه مستشفى غسان نجيب فرعون العام مستشفى محمد الدوسري مستشفى جدة الاهلي
شركة النهدي الطبية شركه الدواء للخدمات الطبيه المحدوده شركة الانماء للخدمات الطبية
شركه اندلسيه العربيه القابضه للخدمات الطبيه شركه مستشفى الامير فهد بن سلطان
شركة سند الرحمة للرعاية الطبية
مستشفى ابها الخاص شركه اسطون للخدمات الطبيه المحدوده الشركة الوطنية للرعاية الطبية
شركة ناظر للعيادات الطبية شركة تداوي للخدمات الطبيه شركة مستشفى باقدو والدكتور محمد عرفان العام
شركه ابراهيم محمد المانع واخوانه

Health Insurance Companies and TPAs
شركة بوبا العربية للتأمين التعاوني الشركة التعاونية للتأمين التعاوني شركة الراجحي للتأمين التعاوني
شركة عنايه السعوديه للتامين التعاوني شركة المتوسط والخليج للتأمين وإعادة التأمين التعاوني_ ميدغلف شركة الصقر للتأمين التعاوني
شركة الاتحاد التجاري للتأمين التعاوني شركة بروج للتأمين التعاوني الشركة العربية السعوديه للتامين التعاوني_ سايكو)
شركة الدرع العربي للتأمين التعاوني الشركة السعودية المتحدة للتأمين التعاوني_ولاء شركة التأمين العربية التعاونية
شركة سلامة للتأمين التعاوني شركة المجموعة المتحدة للتأمين التعاوني _ اسيج شركة إتحاد الخليج للتأمين التعاوني
شركة اكسا للتأمين التعاون شركة سوليدرتي السعودية للتكافل شركة أمانة للتأمين التعاوني
شركة ملاذ للتأمين وإعادة التأمين التعاوني الشركة الاهلية للتأمين التعاوني شركة متلايف والمجموعة الأمريكيه الدولية والبنك العربي الوطني للتامين التعاوني
شركة وفا للتأمين التعاوني شركة اليانز السعودي الفرنسي للتأمين التعاون الشركة المتحدة للتأمين التعاوني
الشركة الخليجية العامة للتامين التعاوني شركة الأنماء طوكيو مارين الشركة العالمية للتأمين التعاوني
Total Care Saudi Company - TPA Saudi NextCare Company – TPA Saudi GlobeMed Company - TPA
Madarat National Company for the settlement of insurance claim - TPA Saudi Arabian Mednet Company - TPA

If you any questions or concerns in this regard, please contact us on 920004299 or at the email Onboarding@cchi.gov.sa

Which coding sets should be used in NPHIES for diagnosis?

ICD 10 AM 10th edition as announced by CCHI.

which coding sets should be used for cause of death and morbidity services?

ICD 10 WHO codes to be used in HIS to code the cause of death or morbidity services.

which coding sets should be used in NPHIES for druges/packaged pharmaceuticals ?

SFDA (Saudi Food and Drg Authority) codes and GTIN codes as announced by CCHI

Which coding sets should be used in NPHIES for laboratory services and Blood and Bank products ?

LOINC (Logical Observation Identifiers Names and Codes) version 2.65 as announced by CCHI.

Which coding sets should be used in NPHIES for Radiology/imaging service?

Local codes list as announced by CCHI.

Which coding sets should be used for outpatint in NPHIES for dental services and procedures ?

local codes list/ Saudi Modified Ambulatory Classification as announced by CCHI.

Which coding sets should be used in NPHIES for Out-patient services (Consultation, Ambulatory, Ambulance etc) ?

Local codes list / Saudi modified ambulatory classification as announced by CCHI

Which DRG codes should be used in NPHIES?

AR-DRG version 9.0 Grouper as announced by CCHI/ however, not to be implemented at this stage.

What is UCUM?

This is NPHIES list for units of measures for reporting laboratory results as announced by CCHI.

How will we map our internal codes to standard codes

*NPHIES users have to map their codes to the published standards coders.

* The provider can utilize the closest standard code for mapping.

*some internal codes can have multiple matches (one to many mapping)

Are there going to be any charges for using standard codes sets Are there going to be any charges for using NPHIES system

Charges (if any ) and its mechanism will be announced by CCHI.

How are we going to access / download standard codes sets

The mechanism will be announced by CCHI.

Is there going to be any transition period between use of existing and standard codes sets?

Yes, there will be a Transition period/grace period, it is announced by CCHI, please visit: https://www.cchi.gov.sa/en/Uniplat/Pages/default.aspx

Who needs to be trained?

Persons handling clinical / billing information should be trained (Doctors, Nurses, Billing staff, Insurance co-ordinators, Case Managers, RCM team, etc)

Do I need to hire professional coders for mapping / coding

Its provider's decision to hire professional coders for mapping / coding for accurate mapping/coding.

why do we need to change the code sets, whats the reason and benefits?

1)Clinical data will be in a unified format
3)Will help in statistical studies/performance reviews
4)Will help in improving clinical documentation
5)Will be a door for strong and robust HIS system (Reimbursement/ decrease rejections/ smooth claims)
6)In the future, it will help us in adopting VBHC

How will packages be billed in the system? One package will contain several items under one package price

The provider needs to enter all the package components in standard coding, using the exact or closes code for each of the components separately
Package price will be assigned to the major code within the package, and the rest of the items will have a price as 0.

How will we finalize our price lists?

It depends on the contract between the Payer and Provider, to be finalized within the transition period.

To whom to contact for support in regard to medical/coding issue?

CCHI Call Center and official Channels

What is FHIR?

The Fast Healthcare Interoperability Resources (FHIR - Pronounced "fire") is an interoperability standard intended to enable the exchange of healthcare data between different health systems

What is FHIR version adopted by NPHIES?

FHIR V4.0.1

How is FHIR different from other interoperability standards?

The major difference between FHIR and other standards is simplicity and flexibility. Fast – the F in FHIR – expresses the intent to make this standard faster to learn, develop and implement

What is interoperability?

Interoperability refers to the ability of applications to exchange and make use of information

What are the type of transactions covered by FHIR ?

The main transactions are: Eligibility (Request/Response),Authorization(Request/Reponse),Claim(Request/Response) and Payment(Notification and Confirmation)..etc

What are the relevant needed Resources(Profiles)?

The list will be shared once finalized

How have the data set mandatory/optional fields been identified?

The mandatory & optional data set fields have been identified based on the FHIR base resources and customized as per the Saudi market need.

Any available documents/guide on the used profiles in NPHIES?

Documentation will be provided once finalized

Any planned awarness session/ workshopts prior the implemetation?

Yes, the session dates will be announced by CCHI

As an insurer that outsources claims to a TPA, do we have to engage with the onboarding platform?

Yes. There are several requirements such as the Member Register and eligibility checks that will require insurers to participate in the system

How will you communicate regulatory requirements to the market for onboarding?

All communications will be available on the Community Portal. In addition, direct communications will be made to each company's Single Point of Contact (SPoC). Regulatory requirements will take the form of Enabling Provisions Notices (EPNs), therefore you are kindly requested to keep your SPOC contact information updates on a regular basis

Coding fields required	Codes, classifications and terminologies to be used	Description
Diagnosis Codes, includes: Ophthalmology, Rehabilitation	ICD-10-AM Tenth Edition	الترميز الطبي الأسترالي للأمراض والتشخيص
Procedures / Health interventions (in-patient) includes: Ophthalmology, Rehabilitation and allied health services	CCHI Billing System (CCHI-BS)	قائمة الترميز للإجراءات والعمليات
Outpatient Cost/ Ambulatory Services, Consultation, Room and Board, Inpatient Rounding	CCHI Billing System (CCHI-BS)	قائمة ترميز الإجراءات للعيادات الخارجية والتكلفة
Medical devices	GMDN = classification of devices per intended use and specification	التصنيف والترميز للمعدات والأجهزة الطبية ومجموعاتها
Oral Health	Inpatient: CCHI Billing System (CCHI-BS) Outpatient: The Australian Schedule of Dental Services and Glossary (ADA)	قائمة الترميز للتنويم والعمليات لخدمات طب الأسنان الترميز للعيادات الخارجية: جدول خدمات طب الأسنان الأسترالي
Laboratory tests, observations and Blood Bank products	CCHI Billing System (CCHI-BS)	الترميز للاختبارات التحليلية وبنوك الدم
Imaging Procedures	CCHI Billing System (CCHI-BS)	الترميز والتصنيف للأشعة
Packaged pharmaceuticals	SFDA (GTIN)	ترميز تصنيف الأدوية
Ambulance and Transportation Services (SRCA)	CCHI Billing System (CCHI-BS)	ترميز النقل الإسعافي للمرضى وحالاتهم

Health Care Providers
مجموعة الحبيب	شركة المواساة للخدمات الطبية	شركة المركز الطبي الدولي المحدودة
شركة مستشفى الدكتور سليمان عبدالقادر فقيه	شركة الشرق الاوسط للرعاية الصحية	شركة دله للخدمات الصحيه
شركة الحمادي للتنمية و الإستثمار	الشركه الطبيه التخصصيه المحدوده	شركة عيادات باقدو الطبية
مركز مغربي للبصريات	شركة مستشفيات ومراكز مغربي الطبية	شركه مراكز العبير الطبيه
شركة مستشفى الدكتور عبدالرحمن بخش المحدوده	مستشفى الموسى التخصصي	شركة الاطباء المتحدون المحدودة
شركه خدمات المشاريع الطبيه المحدوده	شركة المشاريع الطبية المتحدة المحدودة	الحرس الوطني
شركه مستشفى غسان نجيب فرعون العام	مستشفى محمد الدوسري	مستشفى جدة الاهلي
شركة النهدي الطبية	شركه الدواء للخدمات الطبيه المحدوده	شركة الانماء للخدمات الطبية
شركه اندلسيه العربيه القابضه للخدمات الطبيه	شركه مستشفى الامير فهد بن سلطان	شركة سند الرحمة للرعاية الطبية
مستشفى ابها الخاص	شركه اسطون للخدمات الطبيه المحدوده	الشركة الوطنية للرعاية الطبية
شركة ناظر للعيادات الطبية	شركة تداوي للخدمات الطبيه	شركة مستشفى باقدو والدكتور محمد عرفان العام
شركه ابراهيم محمد المانع واخوانه

Health Insurance Companies and TPAs
شركة بوبا العربية للتأمين التعاوني	الشركة التعاونية للتأمين التعاوني	شركة الراجحي للتأمين التعاوني
شركة عنايه السعوديه للتامين التعاوني	شركة المتوسط والخليج للتأمين وإعادة التأمين التعاوني_ ميدغلف	شركة الصقر للتأمين التعاوني
شركة الاتحاد التجاري للتأمين التعاوني	شركة بروج للتأمين التعاوني	الشركة العربية السعوديه للتامين التعاوني_ سايكو)
شركة الدرع العربي للتأمين التعاوني	الشركة السعودية المتحدة للتأمين التعاوني_ولاء	شركة التأمين العربية التعاونية
شركة سلامة للتأمين التعاوني	شركة المجموعة المتحدة للتأمين التعاوني _ اسيج	شركة إتحاد الخليج للتأمين التعاوني
شركة اكسا للتأمين التعاون	شركة سوليدرتي السعودية للتكافل	شركة أمانة للتأمين التعاوني
شركة ملاذ للتأمين وإعادة التأمين التعاوني	الشركة الاهلية للتأمين التعاوني	شركة متلايف والمجموعة الأمريكيه الدولية والبنك العربي الوطني للتامين التعاوني
شركة وفا للتأمين التعاوني	شركة اليانز السعودي الفرنسي للتأمين التعاون	الشركة المتحدة للتأمين التعاوني
الشركة الخليجية العامة للتامين التعاوني	شركة الأنماء طوكيو مارين	الشركة العالمية للتأمين التعاوني
Total Care Saudi Company - TPA	Saudi NextCare Company – TPA	Saudi GlobeMed Company - TPA
Madarat National Company for the settlement of insurance claim - TPA	Saudi Arabian Mednet Company - TPA

NPHIES

Main Menu

What is NPHIES?

Vision

Value Proposition

NPHIES Component​

Insurance Services

Clinical Services​

​NPHIES​ Target Audience

Eligibility Management Services

User Management Services

​Claim(s) Management Services ​

CCHI Insurance Management Services

Payment Management Services

Release 1

Release 2

Release 3

Release 4

Notes:

Enabling Provisions Notice pursuant to the implementation of the NPHIES system General Circular Number 1 of 2020 (GC​ 01-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system Policy Directive Number 1 of 2020 (PD 01-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system Technical Update Number 1 of 2020 (TU 01-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system Technical Update Number 2 of 2020 (TU 02-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system General Circular Number 2 of 2020 (GC 02-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system Policy Directive​ Number 2 of 2020 (PD 02-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system Technical Update Number 3 of 2020 (TU 03-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system General Circular Number 3 of 2020 (GC 03-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system Policy Directive​ Number 3 of 2020 (PD 03-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system Policy Directive​ Number 4 of 2020 (PD 04-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system General Circular Number 4 of 2021 (GC​ 04-2021)

CCHI Billing System

​This billing procedure has been developed by CCHI to ease for health care providers coding health services as will billing their invoices insurance companies. It has been developed based on ACHI. This billing procedure are compatible with standards and classifications that are acceptable by SHC.

Clinical Standards

NPHIES Champions ​

Vendors Certification Program ​

​In order to become one of nphies certified vendors, kindly see below the requirements to get the certificate and have the ability to link nphies to the health care providers and the health care insurance:

Available Resources ​

Documentation​​

Training

Support

Implementation Guide ​

Exchange Profiles​​ ​

​Standard profiles will define for each transaction the schema elements, fields, cardinality type, datatype, and minimum data sets. There are four major profiles as below each having sub-profiles:

Business Rules and Validation Rules (BRVR)

​

Denial Codes ​

Use Cases ​

NPHIES Training sessions ​​ ​

The training program is divided into Three specialized domains

​1. Standard Coding Training:

Download

CCHI App

Social Media Channels

Contact

General Secretary

Working hours

From Sunday to Thursday from 8 Am to 4Pm

Customer Service

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NPHIES Component

Clinical Services

NPHIES Target Audience

Claim(s) Management Services

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

General Circular Number 1 of 2020 (GC 01-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Policy Directive Number 1 of 2020 (PD 01-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Technical Update Number 1 of 2020 (TU 01-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Technical Update Number 2 of 2020 (TU 02-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

General Circular Number 2 of 2020 (GC 02-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Policy Directive Number 2 of 2020 (PD 02-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Technical Update Number 3 of 2020 (TU 03-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

General Circular Number 3 of 2020 (GC 03-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Policy Directive Number 3 of 2020 (PD 03-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

Policy Directive Number 4 of 2020 (PD 04-2020)

Enabling Provisions Notice pursuant to the implementation of the NPHIES system

General Circular Number 4 of 2021 (GC 04-2021)

This billing procedure has been developed by CCHI to ease for health care providers coding health services as will billing their invoices insurance companies. It has been developed based on ACHI. This billing procedure are compatible with standards and classifications that are acceptable by SHC.

NPHIES Champions

Vendors Certification Program

In order to become one of nphies certified vendors, kindly see below the requirements to get the certificate and have the ability to link nphies to the health care providers and the health care insurance:

Available Resources

Documentation

Implementation Guide

Exchange Profiles

Standard profiles will define for each transaction the schema elements, fields, cardinality type, datatype, and minimum data sets. There are four major profiles as below each having sub-profiles:

Denial Codes

Use Cases

NPHIES Training sessions

1. Standard Coding Training:

NPHIES