Real-time Saudi NPHIES insurance integration — eligibility, pre-auth, claims and remittance in one compliance dashboard.
Verify patient insurance coverage against the NPHIES portal in real time at registration — confirming active policy, co-pay percentage and benefit limits before the encounter begins.
Submit pre-auth requests with clinical justification directly to the payer via NPHIES; track approval status in real time and receive decisions without manual payer portal logins.
FHIR R4 claim bundles generated from encounter and billing data without manual coding; submitted electronically to payers with validation before despatch to reduce rejection rates.
Electronic remittance advice (ERA) matched automatically against submitted claims; payment posting to the general ledger without manual reconciliation or data re-entry.
Rejected claims displayed with NPHIES error codes; a structured correction and resubmission workflow guides the billing team to fix and re-send within the payer's appeal window.
Pre-built reports for CCHI audit submissions, payer reconciliation and internal revenue cycle KPI tracking — claim acceptance rate, average settlement days and denial rate by payer.
For Saudi healthcare providers, NPHIES compliance is not optional — it is the foundation of every insurance revenue cycle. The metaSOFT NPHIES Dashboard integrates directly with the NPHIES portal using certified FHIR R4 APIs, so eligibility checks, pre-auth requests and claim submissions happen inside the HMS workflow without toggling between systems.
Billing staff see a single dashboard — pending eligibilities, open pre-auths, submitted claims and outstanding remittances — and act from the same screen. The integration with the billing module means charge data flows into claims automatically, and ERA payments post to the patient ledger and general ledger without manual entry.
