Healthcare ERP for Saudi Arabia

Healthcare billing involves insurance claim processing through the NPHIES (National Platform for Health Insurance Exchange Services) system, which provides a standardized electronic claims platform. Claims follow specific coding standards and submission formats defined by NPHIES. The Council of Health Insurance (Dhaman) sets minimum benefit standards for cooperative health insurance policies, and claim adjudication follows the approved fee schedules. Patient co-payment structures and network restrictions vary by insurance plan.

Vision 2030 health sector transformation includes the establishment of health clusters as independent entities, privatization of government hospitals, and expansion of the private healthcare sector. Saudization requirements under Nitaqat apply to healthcare with specific quotas for Saudi pharmacists, nurses, and administrative staff. The Saudi Commission for Health Specialties (SCFHS) licenses all healthcare professionals.

Yukti provides Saudi healthcare organizations with NPHIES integration for electronic claims processing, including pre-authorization workflows, claim submission, and remittance tracking. The insurance module manages multiple payer contracts with different benefit structures, co-payment calculations, and network restrictions. The pharmacy module complies with SFDA pharmaceutical regulations including medication tracking, controlled substance management, and drug recall procedures. SCFHS license tracking monitors renewal deadlines for all healthcare professionals. Nitaqat compliance tracks Saudization percentages for healthcare workforce categories. ZATCA FATOORA integration handles e-invoicing for patient billing and insurance settlements. The financial module processes Zakat and corporate income tax based on entity ownership. Payroll handles GOSI contributions and the end-of-service benefit calculations under Saudi labor law.