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KSA Healthcare Financial Services Implementation Guide (PSS in Confluence)

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Basics

KSA Healthcare Financial Services Implementation Guide (PSS in Confluence)

1635
Ballot - STU to Normative


FHIR Implementation Guide

Implementation Guide

Details

The Kingdom of Saudi Arabia has two complimentary healthcare systems: a private system which covers expatriates and Saudi citizens working in private industry, and a public system which covers all other Saudi citizens. This project will address the private market to support the eligibility checking, prior authorization, claims and other supporting information exchanges to standardize the these information exchanges for the approximately 28 payors and 5000+ private provider organizations serving the 12+ million beneficiaries in the private market. In the future the public system covering another 20+ million beneficiaries is expected to adopt these standards.

The project goals and general approach was presented at the May 2015 WGM in Paris under the project name: Saudi Health Insurance Bus (SHIB).

Testing/reference implementation(s) are being used to both test the standards and to allow implementers to test their solutions.


Currently eClaims information is exchanged on paper and proprietary electronic formats and does not use standardized terminology. These standards are needed to modernize and provide an efficient interoperable framework for eClaims exchanges.

A clearinghouse, currently named the Uniplat, is being established as the central connection point for all providers and payors, and will servce to validate and store and forward eClaims information exchanges.

This Implementation Guide is being developed under the Financial Management Work Group to allow for balloting within a larger community for this initial Saudi FHIR implementation Guide.

Given the overall project timelines, this implementation guide is being developed in parallel with the actual implementation. In lieu of a second Connectathon the concepts of this implementation guide are being conducted in a pilot implementation in Saudi Arabia in the late fall, prior to submission of the guide for ballot.



September 2020 WGM: FHIR Connectathon November 2020: Project Pilot (in lieu of 2nd connectathon) January 2021 Ballot: STU Ballot April/May 2021: STU Publication May WGM reach out to project to clarify resumption of participation or project closure


https://confluence.hl7.org/display/FM/KSA+Healthcare+Financial+Services+Implementation+Guide

Council for Cooperative Health Insurance (KSA)

Project has moved from HL7 Inc. governance to HL7 Saudi Arabia. Balloted in August-Sept 2025, Published in Nov 2025.

Clinical and Public Health Laboratories, Payors,Emergency Services; Medical Imaging Service; Healthcare Institutions (hospitals, long term care, home care, mental health),Pharmaceutical; EHR, PHR; Health Care IT; HIS

All private healthcare insurers in KSA: (eg BUPA, Al Rajhi) All private healthcare providers in KSA:

The Saudi Council for Cooperative Health Insurance (CCHI) project operated by Sehati for Health Information Services.

Uniplat Financial Services, SHIB


Yes

N/A

No


Organization & Realm

Realm Specific - Enter "U.S." or name of HL7 Affiliate below

Saudi Arabia
People

Paul Knapp



Financial Management Work Group


Status & Dates

Active

Active Project (Resources assigned to pjt)

06/02/2020

05/01/2023

2023 May WGM/Ballot

05/01/2023

2023 May WGM/Ballot

Project has moved from HL7 Inc. governance to HL7 Saudi Arabia. 1.0.0 Balloted in August-Sept 2025, Published in Nov 2025.
Approvals

10/26/2020


Not Needed


All Received




System Info



View Ballot Items (with NIBs)




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