5 amendments from the Insurance Authority expedite patient treatment via Nafis
The Saudi Arabian Health Insurance Authority has announced
Details of the new modifications to the Nafis platform
The amendments approved by the authority focus on enhancing the accuracy of entered data and expediting the medical approval process. These amendments include requiring service providers and insurance companies to use the Australian coding standard to ensure diagnostic accuracy, as well as activating real-time verification mechanisms that prevent the transmission of erroneous data. The new controls include:
- Checking the compatibility of the diagnostic code with the International Diagnostic Code List (ICD).
- The date of provision of medical service is applied in conjunction with the validity period of the International Classification of Diseases.
- Ensuring that the medical diagnosis is compatible with the patient's gender and age to reduce human errors.
- Ensuring that the selected code is permitted as a primary diagnosis within the approved lists.
The context of digital transformation in the health sector
These changes are part of a broader digital transformation strategy for the Kingdom's healthcare sector, with the "Nafees" platform playing a pivotal role in electronically connecting insurance companies and healthcare providers. This platform, a key outcome of Vision 2030, aims to provide accurate and standardized health data, thereby reducing financial waste and improving the quality of services. The transition to precise global coding standards is a necessary step to keep pace with the rapid advancements in digital healthcare services.
Expected impact on patients and the sector
These measures are expected to directly contribute to reducing patient waiting times for medical approvals, as the accuracy of the entered data will decrease the rate of claims rejection or delays due to administrative and technical errors. This step will also enhance trust among the parties involved in the insurance relationship (patient, service provider, and insurance company) and support the sector's financial sustainability by reducing disputes related to billing and inaccurate diagnoses.
The regulatory role of the insurance authority
It is worth noting that the Insurance Authority assumed full supervisory and regulatory responsibilities for the insurance sector, including health insurance, pursuant to Cabinet Resolution No. (85) issued in August 2023. This resolution aims to unify the regulatory framework for the sector under one umbrella, which enhances the Authority’s ability to impose strict governance standards, protect the rights of policyholders and beneficiaries, and ensure the stability and growth of the insurance market in the Kingdom.
