The standards, exchanges and claim rails we build against
Clinical records, terminology and claims all leave the building. What they leave through is set by the emirate or the kingdom the facility is licensed in, not by us.
What has to leave the building
Three different things travel, and they travel on different rails. Clinical records go to the health information exchange the facility is licensed under. Terminology has to be coded in a scheme the receiving system recognises. Claims go to the payer rail, with eligibility checked before the encounter and remittance reconciled after it.
Which exchange and which rail apply is decided by the regulator, so a group in Dubai and Abu Dhabi submits to two of them. The facility is the tenancy, which is what lets one deployment do that.
What we build against
Each entry has a page saying what the standard asks for and what the platform records against it. The list is read from the library, so it is never out of date with it.
How it is handled
- Coded at the point of entry
- Findings, procedures and observations are coded as they are recorded rather than mapped afterwards, so a submission does not depend on a batch job having run.
- Eligibility before the encounter
- A claim rail is checked when the appointment is made, not when the invoice is raised, which is where most rejections are actually created.
- Submission state is visible
- Accepted, rejected and resubmitted are states on the record rather than lines in a log, so a rejection reaches the person who can fix it.
- Which revision applies is configuration
- Diagnosis and procedure coding revisions differ between regulators. The revision is set per facility rather than per deployment.
Bring us your exchange and your payer
Tell us which regulator and which rail your facilities submit to. We will show you what the platform records against each.