المملكة: 5 amendments to the insurance system reduce patient waiting times in hospitals

Announced The Insurance Authority announced the implementation of five fundamental amendments to the medical coding system used through the “Nafis SHIB” platform with the aim of accelerating medical approval procedures for health insurance policy holders, and enhancing the accuracy and reliability of insurance transactions between insurance companies and health care service providers.

The Authority explained that this step comes within the framework of its efforts to protect the interests of the insured and the beneficiaries of insurance coverage, by developing electronic linking mechanisms between insurance companies, hospitals and medical centers, ensuring the smooth exchange of data and reducing errors related to diagnosis. And billing.

The new amendments focus on strengthening the parties’ commitment to using accurate and reliable diagnostic codes in accordance with the Australian coding standard, which increases the efficiency of procedures and contributes to reducing waiting times for medical approvals.

The authority indicated that the updates provide a mechanism for immediate verification of the validity of diagnostic data before passing it between service providers and insurance companies, as it prevents the transfer of inaccurate data, and verifies that the diagnosis code is compatible with the list of international codes associated with diseases related to billing.

It ensures that the date of service provision matches the validity period. The International Classification of Diseases, checking that the patient’s sex and age match the diagnosis code used, and ensuring that the chosen code is allowed as a main diagnosis within the approved classification list, along with a package of additional features that enhance the accuracy and quality of the data.

The authority confirmed that it had previously worked to evaluate the readiness of The “Nafis” platformto begin implementing these amendments, in line with the highest international standards in health insurance management, by employing modern technologies to enhance transparency, raise the efficiency of operations, and improve the experience of beneficiaries, as well as supporting efforts to improve public health and increase the effectiveness of the health insurance system.

It is noteworthy that The work of supervisionand control of the insurance sector, in accordance with the system for monitoring cooperative insurance companies and the cooperative health insurance system, was transferred to the Insurance Authority pursuant to Cabinet Resolution No. “85” issued on August 15, 2023 AD, in a step aimed at unifying the regulatory reference and strengthening governance in the sector.