NPHIES integrationComing soon
Insurance from the client's file: eligibility, approvals and claims
Wdhoh is built to connect to NPHIES, the national health information exchange, and the integration is coming soon. Then your team checks a client's cover, requests prior authorisation, submits and follows the claim and matches the payment — without leaving the system.
Coming soon. The NPHIES integration is built into Wdhoh and opens to centres as soon as its NPHIES accreditation is complete. Register your interest and we will tell you first.
What your team does through NPHIES
Coverage and eligibility
Find a client's cover from their national ID, and see status and share from the insurer's own answer — not from a fixed setting.
Prior authorisation
Request approval by session count and track what is used, session by session. When booking, the system warns you if appointments go beyond what was approved.
No session without cover
At check-in the system verifies cover and approval. If they are not valid, the session isn't recorded — and nobody can override it.
Claims built from sessions
The claim is assembled from sessions actually delivered, mandatory fields are checked before sending, and sessions beyond the approval are held back.
Rejection reasons in Arabic
When a line is rejected, the reason appears in NPHIES's own wording next to its code, so the team knows what to fix.
Payments and ageing
Match insurer payments to claims, with a receivables-ageing view per insurer.
The insurance journey, step by step
Every step happens from the client's file and schedule, not a separate portal.
- Find the coverFrom the national ID, across your contracted insurers
- Eligibility & shareThe client's share from the insurer's own answer
- Prior authorisationBy session count, with a warning when booking beyond it
- The sessionNo session without active cover — no exceptions
- The claimBuilt from sessions, checked before sending
- PaymentRemittance matching and receivables ageing
Inside the system
Claims and prior authorisations with their statuses and insurer decisions, each on one screen.
Built on NPHIES technical requirements
Messages in the HL7 FHIR standard NPHIES uses, with every transaction kept with its request and response.
- A log of every message: what was sent, what came back, and when
- No answer is lost: stored first, then read, even if reading fails
- Certificate-based secure connection in production
- Full isolation: each centre transacts under its own identity only
09:12:05 priorauth-request → 200 approved · 8 sessions
14:30:11 claim-request → 200 queued
14:35:02 poll-request → 200 claim-response · partial
14:35:02 line 3 rejected BE-1-4 Preauthorization required
Before you switch it on
From your centre
- Your facility registered with NPHIES, and its licence number
- The insurers you contract with and your prices with them
- The facility's digital certificate for production
From the Wdhoh team
- Setting up the connection in your centre's account
- Mapping your services to Saudi Billing System codes
- Training reception and specialists
Scope: health-insurance transactions through NPHIES — eligibility, approvals, claims and payment. The integration is an add-on to the subscription, and the insurance section appears only for centres subscribed to it.
Questions about NPHIES
Which transactions does Wdhoh support?
Eligibility, prior authorisation, claims with follow-up and cancellation, communications with the insurer about them, collecting responses, and payment matching.
Can a session go ahead if a client's cover has ended?
Not on insurance. If cover or approval is not valid, attendance is not recorded against insurance; reception can switch the client to cash if they wish.
Who decides the client's share?
The insurer, in its eligibility answer. The system takes the share from that answer, not from a percentage typed by hand.
Is the integration included in the subscription?
NPHIES is an add-on. Contact us for a quote that fits your centre.
Ready to bring insurance inside the system?
Book a walkthrough on cases like your own centre's; our team calls you within 24 hours to set up your trial account.