From the treatment plan to pre-authorisation, claim and payment — in the same system.
Basmtak Clinics connects to NPHIES, the Council of Health Insurance's exchange, directly — not through a middleman. The request is generated from the coded plan lines, the response clock counts on screen, and every answer is read with its reason.
The direct NPHIES connection is being built and tested against the Council of Health Insurance's conformance programme. We will not print a status on this site that has not been granted; when the integration certificate is issued we will quote it in its own words — and until then, every cash workflow of the clinic runs in full.
No per-claim fee. Insurance is included from the Grow plan up, with no charge per request.
If the insurer stays silent past 60 minutes, the receipt is recorded as evidence
Seven steps, and nothing typed twice.
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Set-up, once
The facility licence and the provider number at the Council, the practitioners' licences, the payer contracts with their class tiers and price lists, and every price-list row mapped to an SBS code with its effective date.
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Eligibility at check-in
Reception scans the ID and sends an eligibility request for benefits — and sees the class, the co-pay, the remaining dental limit and the exclusions in Arabic, cached on the visit.
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The chart becomes the plan
The dentist marks the chart; every line carries the SBS code, the tooth, the surface, the quantity, the price by payer class, the patient's share and the payer's share, and exactly one principal ICD-10-AM diagnosis.
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Pre-authorisation
Any line above the approval threshold, or flagged by the contract, goes out as a pre-authorisation from those same lines, with the chief complaint, the missing-tooth record and downscaled X-rays. The clock starts at receipt.
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Treatment and claim
Completed lines become the claim and carry the pre-authorisation reference. Pre-authorisation and claim come from the same lines, so they cannot disagree. Batches go to each payer nightly and resend safely.
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Reconciliation and payment
The payment notice arrives by polling, is matched to the claims, receivables, write-offs and patient balances are posted, and a journal goes to Basmtak Books.
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The denial inbox
Rejections grouped by payer and reason — benefit, clinical or operational. One-click resubmission after correction, a pre-check that catches a missing justification before sending, and a monthly denial rate per practitioner.
The Council's rules on screen, not in someone's memory.
The Council of Health Insurance's approval standard gives the insurer sixty minutes to answer a pre-authorisation, requires a reason on refusal, and deems silence as approval when receipt is provable. The system shows the clock on the request, polls for the answer every few minutes while anything is pending, opens a task for the doctor when the insurer asks for an X-ray or a report, and on expiry records a deemed-approval entry with the acknowledgement as evidence.
60 minutes
The insurer's time to answer a pre-authorisation under the Council's standard.
Above the threshold
Outpatient treatment above the set amount per session needs approval; the system knows which line crosses it.
Why claims are refused
Refusals in the Kingdom are dominated by missing medical justification and coding errors — exactly what the pre-check catches.
Attachments
Intra-oral X-rays for crowns and root canals, photographs for some dermatology claims: the attachment picker is part of the request.
Which is why the plan screen shows cash versus insured per line from the first click.
Dental
The unified policy covers basic dental — fillings, extractions, root canals and one cleaning a year — with a limit and a co-pay, and excludes orthodontics, implants, crowns, bridges and dentures unless the employer buys them. The estimate the patient signs shows the deductible and the excess.
Dermatology
Insurers exclude aesthetics and often acne, hair loss, scars and warts, and cover psoriasis, eczema and infections. So the dermatology path is cash-first, with the insurance path for medical dermatology only.
State-borne VAT
Healthcare for a Saudi citizen is computed with VAT the State bears and marked so on the invoice; cosmetic procedures stay at the standard rate. The tax category sits on each line, not on the invoice as a whole.
Every bundle sent and every answer received, verbatim.
- An outbox per request with a unique identifier and a state: draft, sent, queued, pended, approved, partial, rejected, claimed, paid, reconciled.
- SBS, ICD-10-AM and FDI codes in versioned tables with effective dates; a line references the code row, never a string.
- The connection runs from a static in-Kingdom address with mutual certificates, and clinical data never leaves the Kingdom.
- A daily journal to Basmtak Books with receivables and ageing per insurer.
On which plan?
Eligibility, pre-authorisation, claims and reconciliation from the Grow plan, with no per-claim fee. The Start plan is fully cash for a clinic with no payer contracts yet, and moves to Grow when the first insurer is added.
See pricingQuestions about insurance
Do I need a middleman or a clearing house?
No. The system connects to NPHIES directly from inside the Kingdom. For a clinic that insists on a middleman it already has a contract with, an adapter puts it behind the same outbox.
What happens if the insurer does not answer?
The clock counts from receipt. When sixty minutes pass with no answer, the system records a deemed-approval entry with the acknowledgement as evidence, and the patient's share in the plan updates at once.
Does the claim always match the pre-authorisation?
Yes, because both are generated from the same plan lines and the claim carries the pre-authorisation reference. That is the most common interoperability error, and the design prevents it.
Is there a per-claim fee?
No. Insurance is included from the Grow plan up, with no charge per claim or request.
Is Basmtak Clinics an NPHIES system vendor?
The direct connection is being built and tested against the Council of Health Insurance's conformance programme, and this site will carry no status until the certificate is issued — then in its own words. The clinic's full cash workflow does not wait for it.
Open your clinic account today.
A minute to create it. 14 days with every feature. Your data stays in the Kingdom.
Every feature, every practitioner, no card, 14 days.