NPHIES Taameen
Manages insurance and financial transactions across the patient journey.
Your Fastest Path to Reliable NPHIES Compliance and Stronger Cash Flow
Achieve clean eligibility, timely approvals, and denial-free claims powered by a unified NPHIES-compliant HMS that strengthens financial stability for your hospital or clinic.
What is NPHIES?
NPHIES (National Platform for Health and Insurance Exchange Services) is the national framework introduced under Saudi Arabia’s Vision 2030 healthcare transformation to unify how providers and insurers manage eligibility, pre-authorization, encounter documentation, and claims. It establishes a single, standards-based method for exchanging clinical and financial information, ensuring every patient encounter follows a structured and validated workflow.
NPHIES Sehey
Standardizes clinical and encounter information for accurate documentation.
NPHIES-Ready Workflows for Every Healthcare Setting with Medinous
Built to Support
- High-volume eligibility checks
- Complex pre-authorization workflows
- Co-ordinated multi-department encounters
- Large-scale claims management.
Optimizes procedure-driven care through
- Compliant pre-authorizations
- Structured clinical documentation
- Precise coding
- Predictable reimbursement cycles
Enables efficient outpatient workflows by
- Minimizing eligibility errors
- Improving documentation accuracy
- Speeding up approvals
- Increasing first-pass claim acceptance
The NPHIES Workflow in Medinous
A Unified Journey from Eligibility to Revenue Reconciliation
1
Patient Eligibility Verification
Confirm insurance coverage in real-time before treatment.
2
Prior Authorization (PA) Management
Approve necessary procedures, tests, or treatments efficiently.
3
Claims Submission & Adjudication
Submit, track, and reconcile claims with insurers.
4
Secure Patient Data Exchange
Share medical records, lab results, and imaging safely across providers.
5
E-Prescriptions
Send prescriptions digitally to pharmacies, reducing errors and delays.
6
Interoperability with Healthcare Systems
Connect EMRs, HIS, and other hospital software seamlessly.
KEY PRODUCT CAPABILITIES
Advanced NPHIES Capabilities for Modern Healthcare Providers
Real-time Eligibility
Check insurance coverage instantly with automated NPHIES-compliant verification that support seamless encounters and reduce wait times.
Automated Pre-Authorization
Accelerate care delivery with structured, payer-ready requests that receive faster approvals and minimize insurer follow-ups.
NPHIES-Compliant Claims
Improve revenue performance with clean, validated claims built for high first-pass acceptance and predictable reimbursement cycles.
Digital Remittance Tracking
Gain full visibility into insurer responses and payment updates in real time—strengthening financial planning and month-end accuracy.
Audit Logs & Reporting
Promote organizational transparency with complete user traceability and easy-to-generate reports aligned with NPHIES documentation standards.
Meet Regulatory Requirements
Stay confidently compliant with standardized workflows, unified documentation, and automated reporting that reduce variation across departments.
BENEFITS FOR HOSPITALS & CLINICS
Performance Gains for Hospitals & Clinics with NPHIES-Ready HMS
Faster, cleaner, more predictable revenue cycles
- Quicker reimbursements from insurers
- Higher first-pass claim acceptance
- Lower write-offs from coding or documentation gaps
- Clear visibility into insurer responses and remittances
Simplified, unified workflows for every team
- No double entry across portals or disconnected systems
- Standardised eligibility, pre-auth, and claims steps
- Consistent processes from registration to billing
- Better coordination between front desk, clinical, and RCM teams
Always audit-ready, always aligned with NPHIES
- Consistent, structured documentation across departments
- Complete audit trails for clinical, financial, and user actions
- Easier preparation for internal and external audits
- Automated, compliance-ready reporting
Resources
Ebook
Understanding NPHIES: A complete process flow guide for clinics & hospitals
A simple, clear handbook on how NPHIES works inside a modern Hospital & Clinic Management System (HMS)
Download now
Ebook
10 steps to choose the right hospital management system
Practical guide to selecting an unified, future-ready HMS for smarter hospital operations.
Download nowFrequently Asked Questions
Not significantly. Your team follows the same steps—eligibility, pre-auth, encounters, claims—but the system captures the required NPHIES details automatically, making the process easier and more consistent.
By checking information in real time. If something is missing or incorrect, the system alerts the user before submission, so most claims go out complete and error-free.
No major changes. Clinicians record notes, diagnoses, and procedures as they always have. The system ensures the required NPHIES fields are captured without adding extra work.
Usually, yes. When eligibility, approvals, and claims are submitted correctly the first time, insurers can process them faster, leading to more predictable payment cycles.
Yes. A NPHIES-ready solution understands payer-specific rules and applies the right checks for each insurer, so staff don’t need to track these differences manually.
What makes Medinous your best decision ever
- Robust product perfected over a couple of decades with extensive R&D and innovation
- Presence in 10+ countries
- Excellent customer support
- Long standing customers with decades of relationship
- Fully compliant with highly configurable Billing and Insurance Modules
