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Eligibility, claim assembly, and rejection routing — wired into the daily workflow so insurance is not a separate department.
NPHIES is the Saudi national platform for insurance eligibility and claims. Clinics that batch-submit claims at month-end face higher rejection rates because the visit context is lost. ClinicOS captures claim data the moment it happens — at registration, encounter, and invoicing.
When you register a patient, ClinicOS can verify insurance eligibility before the doctor sees them. The receptionist learns of coverage limits, copays, and pre-authorization requirements in seconds.
During the encounter, every diagnosis and service order builds the claim structure incrementally. By invoice time, the claim is ready to submit. No retroactive coding, no missing diagnosis codes.
Rejected claims land in a dedicated queue with rejection reason codes. Staff can correct and resubmit without leaving ClinicOS, and the audit log captures every change.
Direct real-time submission to NPHIES via web service requires a registered TPA or clearinghouse relationship per payer. ClinicOS prepares the claim data; the submission step varies per payer. Our roadmap includes deeper bilateral integrations with common Saudi payers in Q4 2026.
Common questions
No. ClinicOS is cloud-native. NPHIES connectivity is configured per payer during onboarding.
ClinicOS still assembles the claim data and exports it in the format your payer accepts. You can submit through their portal until direct integration is added.
Yes. Rejection reports show patterns by payer, doctor, and rejection code, so you can fix the upstream behavior, not just resubmit.