NPHIES national platform
We support claims preparation for NPHIES discussions, while live submission and facility connection status need confirmation before your team relies on operational use.
Set by Council of Health Insurance
What this is
NPHIES is the Saudi national health information exchange platform for health insurance and related transactions. It is a national platform with its own onboarding, transactions and testing, not a data format.
What is built
- Care Claims and approvals provides the insurance record workflow.
- The claims record holds the information used to discuss required transactions.
- Live NPHIES submission is not claimed.
What a technical reviewer can inspect
Review the claim information available in Care against the transaction you intend to send. General insurance functionality does not prove a working connection to a national platform, and no NPHIES connector is described on this page.
Questions for a Saudi interface assessment
- Which transactions are needed, for example eligibility, prior authorisation and claim submission?
- Which diagnosis, procedure and billing codes must each payer receive, and how are they maintained?
- What registration and facility identifiers does the platform require, and who holds them?
- Which test environment and test cases will be used, and who accepts the results?
- Who in the facility monitors responses and rejections, and what happens next?
Boundaries
Obtain facility-specific integration, testing and activation evidence before relying on operational submission. General standards support does not equal NPHIES readiness. No live NPHIES submission, Saudi deployment or automatic receiving acceptance is claimed.
What we claim, precisely
The system holds the evidence; the facility's accountable person attests. Nothing here asserts that a facility is compliant.
Common questions
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We do not claim live NPHIES submission. Agree the required transactions and obtain facility-specific integration, testing and activation evidence before relying on operational submission.
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List the transactions you need, the payers and code sets involved, your facility registration details and the test evidence you expect. The assessment confirms what Care can support and what would need to be built or agreed.
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No. General exchange formats do not establish NPHIES readiness, which depends on the platform’s own profiles, onboarding and testing for each facility.
Not answered here? Contact the team
NXH Flow