Extensions
One revenue journey, with a clear next action at every stage.
Revenue Cycle Management
Configure legal organizations, administration agreements, provider contracts, products, issued policies and member classes in dependency order. Keep source evidence, effective dates and approval with each configuration version.
Resolve member eligibility, provider network, benefit rules, exclusions, limits and tariff applicability for the requested service. An unknown fact creates a named review item; it must not silently become an assumed price or patient liability.
Prepare required authorization and supporting evidence. Keep requested and approved services, quantities and validity separate. Review the provisional estimate, unresolved facts and expiry before accepting financial preparation.
Attest performed activity, reconcile charges and assemble the claim with coding and attachments. Validate the payload and submission identity; production transmission requires approved credentials, endpoints, exchange package and activation evidence.
Distinguish transport validation, payer business errors and adjudicated denials. Route corrections, evidence requests, contract disputes and clinical appeals to the right owner with the original business references and applicable deadlines.
Link remittance advice to claims, distinguish adjudication from cash settlement and reconcile partial payments, deductions and unmatched cash. Review ageing, exceptions and decision traces without converting unresolved balances into patient charges.
Verify member, policy and service context; retain verification time, response and unresolved coverage facts.
Track requested and approved services, quantities, evidence and validity, including partial approvals and expired requests.
Version signed provider and administration agreements with dates, amendments, allowed amounts and evidence authority.
Resolve provider membership, site, tier and effective dates; route unknown or out-of-network conditions to review.
Apply the issued policy and class rules, exclusions, deductibles, copay and limit evidence; preserve uncertainty when utilization is incomplete.
Resolve local service codes and contracted prices with currency, effective dates, assignments and negotiated exceptions.
Link performed service, quantity, practitioner and documentation; review missing charges, duplicates, corrections and reversals.
Validate payload and attachments, submission authority, identity and deadlines; retain statuses and correction references.
Classify reason and remedy, assign the owner and due date and retain clinical, contract or correction evidence.
Connect advice lines to claims, deductions and adjustments; review partial payments, reversals and unmatched advice.
Compare payer, bank and ledger references, currencies and control totals; review unallocated cash and approved adjustments.
Agree source lineage, definitions, refresh and access; reconcile queue and financial measures before using them for decisions.
Your configuration
Use the registered details of your organization. Do not enter patient records here.
Upload in the matching account setup step, review the preview, apply the values and Save and continue. The tenant version may define different columns; download its template inside setup.
| Column | Required | Format | Example |
|---|---|---|---|
Registered organization namelegal_name | Yes | text | Example Healthcare Organization |
Commercial registration numberregistration_number | Yes | text | EXAMPLE-CR-001 |
Countrycountry | Yes | SA / AE / BH / KW / QA / OM / EG / OTHER | SA |
Tax registration numbervat_number | Optional | text | — |
Add every facility included in your subscription. These become real, separate facilities in your app.
Upload in the matching account setup step, review the preview, apply the values and Save and continue. The tenant version may define different columns; download its template inside setup.
Load / review first: Your organization
| Column | Required | Format | Example |
|---|---|---|---|
Facility namename | Yes | text | Example Facility |
Facility typetype | Yes | hospital / clinic / polyclinic / laboratory / other | clinic |
Facility licenselicense_number | Yes | text | EXAMPLE-LICENSE-001 |
Addressaddress | Yes | text | Example training address |
Phonephone | Yes | text | +966500000000 |
Time zonetimezone | Yes | Asia/Riyadh / Asia/Dubai / Asia/Qatar / Africa/Cairo / UTC | Asia/Riyadh |
Create departments, consultation rooms, wards and beds. You can add more inside your app.
Upload in the matching account setup step, review the preview, apply the values and Save and continue. The tenant version may define different columns; download its template inside setup.
Load / review first: Facilities
| Column | Required | Format | Example |
|---|---|---|---|
Facility number (starting at 1)facility | Yes | integer 1–1000 | 1 |
Department namename | Yes | text | Example Department |
Create departments, consultation rooms, wards and beds. You can add more inside your app.
Upload in the matching account setup step, review the preview, apply the values and Save and continue. The tenant version may define different columns; download its template inside setup.
Load / review first: Facilities
| Column | Required | Format | Example |
|---|---|---|---|
Facility numberfacility | Yes | integer 1–1000 | 1 |
Location namename | Yes | text | Example Room |
Typekind | Yes | room / ward / bed | room |
Inside location (optional)parent | Optional | text | — |
Your verified account becomes the facility administrator. Invite staff in the account portal; staff seats are enforced.
Upload in the matching account setup step, review the preview, apply the values and Save and continue. The tenant version may define different columns; download its template inside setup.
| Column | Required | Format | Example |
|---|---|---|---|
Namename | Yes | text | Example Staff |
Work emailemail | Yes | staff@example.invalid | |
Clinical rolerole | Yes | facility_admin / doctor / nurse / pharmacist / reception / billing / member | doctor |
Healthcare service directory
Upload in Your products · configuration data. Apply, then Save and continue checks cross-file references. Launch imports supported records in one transaction and reconciles counts. Function settings are validated against the supported registry, applied natively and read back; prices, catalogue mappings and hardware require approval before activation.
Load / review first: Departments · Rooms, wards and beds
| Column | Required | Format | Example |
|---|---|---|---|
Local service codeservice_code | Yes | text | EXAMPLE-SVC-001 |
English namename_en | Yes | text | Example service |
Arabic namename_ar | Yes | text | خدمة تدريبية |
Facility numberfacility | Yes | integer 1–1000 | 1 |
Departmentdepartment | Yes | text | Example Department |
Locationlocation | Yes | text | Example Room |
Service functioninternal_type | Yes | general / scheduling / lab / pharmacy / store | scheduling |
Draft charge definitions with release-bound SBS codes
Upload in Your products · configuration data. Apply, then Save and continue checks cross-file references. Launch imports supported records in one transaction and reconciles counts. Function settings are validated against the supported registry, applied natively and read back; prices, catalogue mappings and hardware require approval before activation.
Load / review first: Services & department catalogue
| Column | Required | Format | Example |
|---|---|---|---|
Facility numberfacility | Yes | integer 1–1000 | 1 |
Local service codeservice_code | Yes | text | EXAMPLE-SVC-001 |
Gross price in minor currency unitsgross_price_minor | Yes | integer 0–2147483647 | 15000 |
Currencycurrency | Yes | SAR | SAR |
SBS codesbs_code | Optional | text | — |
SBS releasesbs_release | Optional | text | — |
Mapping approval referencemapping_evidence | Optional | text | — |
Registry function settings applied to native scheduling closures with readback
Upload in Your products · configuration data. Apply, then Save and continue checks cross-file references. Launch imports supported records in one transaction and reconciles counts. Function settings are validated against the supported registry, applied natively and read back; prices, catalogue mappings and hardware require approval before activation.
Load / review first: Rooms, wards and beds
| Column | Required | Format | Example |
|---|---|---|---|
Facility numberfacility | Yes | integer 1–1000 | 1 |
Selected feature IDfeature | Yes | scheduling | scheduling |
Function settingfunction_key | Yes | scheduling.closures | scheduling.closures |
Closure namename | Yes | text | Example closure |
First closed datevalid_from | Yes | YYYY-MM-DD | 2026-12-01 |
Last closed datevalid_to | Yes | YYYY-MM-DD | 2026-12-01 |
Closed fromstart_time | Yes | HH:MM | 08:00 |
Closed untilend_time | Yes | HH:MM | 17:00 |
Room (blank closes the whole facility)location | Optional | text | Example Room |
Create the legal payer, insurer, administrator/TPA and provider counterparties that every downstream contract, policy, tariff and integration route names.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
| Column | Required | Format | Example |
|---|---|---|---|
internal codeinternal_code | Yes | Source-backed value | TO-CONFIRM |
legal name arlegal_name_ar | Yes | Source-backed value | TO-CONFIRM |
legal name enlegal_name_en | Yes | Source-backed value | TO-CONFIRM |
country codecountry_code | Yes | Source-backed value | SA |
statusstatus | Yes | Readiness condition: status=active | draft |
evidence stateevidence_state | Yes | Readiness condition: evidence_state in activation-grade evidence | absent |
commercial registrationcommercial_registration | Optional | Source-backed value | TO-CONFIRM |
tax numbertax_number | Optional | Source-backed value | TO-CONFIRM |
license numberlicense_number | Optional | Source-backed value | TO-CONFIRM |
parent organizationparent_organization | Optional | Source-backed value | TO-CONFIRM |
contact directorycontact_directory | Optional | Source-backed value | TO-CONFIRM |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-001 |
Mark which organization is the risk-bearing payer/insurer so policy, claim and settlement decisions do not infer that a TPA is the payer.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: organizations
| Column | Required | Format | Example |
|---|---|---|---|
organizationorganization | Yes | Source-backed value | TO-CONFIRM |
rolerole | Yes | Readiness condition: role=insurer | insurer |
effective fromeffective_from | Yes | Source-backed value | 2026-10-09 |
statusstatus | Yes | Readiness condition: status=active | draft |
evidence stateevidence_state | Yes | Readiness condition: evidence_state in activation-grade evidence | absent |
effective toeffective_to | Optional | Source-backed value | 2026-10-09 |
network scopenetwork_scope | Optional | Source-backed value | TO-CONFIRM |
notesnotes | Optional | Source-backed value | TO-CONFIRM |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-001 |
Record the signed hospital-provider commercial contract that gives authority for allowed pricing, billing windows and settlement terms.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: organizations · insurer roles
| Column | Required | Format | Example |
|---|---|---|---|
payer or insurer orgpayer_or_insurer_org | Yes | Source-backed value | TO-CONFIRM |
provider facilityprovider_facility | Yes | Source-backed value | TO-CONFIRM |
contract numbercontract_number | Yes | Source-backed value | EXAMPLE-CONTRACT-001 |
effective fromeffective_from | Yes | Source-backed value | 2026-10-09 |
currencycurrency | Yes | Source-backed value | SAR |
statusstatus | Yes | Readiness condition: status=active | draft |
evidence stateevidence_state | Yes | Readiness condition: evidence_state in activation-grade evidence | absent |
effective toeffective_to | Optional | Source-backed value | 2026-10-09 |
network tiernetwork_tier | Optional | Source-backed value | TO-CONFIRM |
claim submission deadlineclaim_submission_deadline | Optional | Source-backed value | TO-CONFIRM |
payment termspayment_terms | Optional | Source-backed value | TO-CONFIRM |
appeal termsappeal_terms | Optional | Source-backed value | TO-CONFIRM |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-001 |
Define the insurer's commercial product/plan family before issued policies and classes inherit or override benefit rules.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: insurer roles
| Column | Required | Format | Example |
|---|---|---|---|
insurer orginsurer_org | Yes | Source-backed value | TO-CONFIRM |
product codeproduct_code | Yes | Source-backed value | TO-CONFIRM |
product nameproduct_name | Yes | Source-backed value | TO-CONFIRM |
jurisdictionjurisdiction | Yes | Source-backed value | SA |
effective fromeffective_from | Yes | Source-backed value | 2026-10-09 |
statusstatus | Yes | Readiness condition: status=active | draft |
evidence stateevidence_state | Yes | Readiness condition: evidence_state in activation-grade evidence | absent |
effective toeffective_to | Optional | Source-backed value | 2026-10-09 |
network typenetwork_type | Optional | Source-backed value | TO-CONFIRM |
product categoryproduct_category | Optional | Source-backed value | TO-CONFIRM |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-001 |
Represent the actual policyholder/employer contract period, caps and endorsements that member coverages must point to.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: insurance products
| Column | Required | Format | Example |
|---|---|---|---|
productproduct | Yes | Source-backed value | TO-CONFIRM |
policy numberpolicy_number | Yes | Source-backed value | EXAMPLE-POLICY |
policyholderpolicyholder | Yes | Source-backed value | TO-CONFIRM |
effective fromeffective_from | Yes | Source-backed value | 2026-10-09 |
effective toeffective_to | Yes | Source-backed value | 2026-10-09 |
statusstatus | Yes | Readiness condition: status=active | draft |
evidence stateevidence_state | Yes | Readiness condition: evidence_state in activation-grade evidence | absent |
global policy limitglobal_policy_limit | Optional | Source-backed value | TO-CONFIRM |
endorsement referenceendorsement_reference | Optional | Source-backed value | EXAMPLE-REF-001 |
renewal referencerenewal_reference | Optional | Source-backed value | EXAMPLE-REF-002 |
family limitfamily_limit | Optional | Source-backed value | TO-CONFIRM |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-003 |
Create policy/class tiers such as VIP, A, B or Basic so benefits, limits and tariffs resolve at the correct insured class.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: insurance products · issued policies
| Column | Required | Format | Example |
|---|---|---|---|
product or policyproduct_or_policy | Yes | Source-backed value | TO-CONFIRM |
class codeclass_code | Yes | Source-backed value | EXAMPLE-CLASS |
class nameclass_name | Yes | Source-backed value | TO-CONFIRM |
effective fromeffective_from | Yes | Source-backed value | 2026-10-09 |
statusstatus | Yes | Readiness condition: status=active | draft |
evidence stateevidence_state | Yes | Readiness condition: evidence_state in activation-grade evidence | absent |
rankrank | Optional | Source-backed value | TO-CONFIRM |
room graderoom_grade | Optional | Source-backed value | TO-CONFIRM |
network tiernetwork_tier | Optional | Source-backed value | TO-CONFIRM |
annual limitannual_limit | Optional | Source-backed value | TO-CONFIRM |
requires referralrequires_referral | Optional | Source-backed value | TO-CONFIRM |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-001 |
Load covered/uncovered services, copays, deductibles, coinsurance, authorization triggers, limits, exclusions and overrides.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: benefit classes
| Column | Required | Format | Example |
|---|---|---|---|
benefit class or policy scopebenefit_class_or_policy_scope | Yes | Source-backed value | TO-CONFIRM |
service code or groupservice_code_or_group | Yes | Source-backed value | TO-CONFIRM |
coverage decisioncoverage_decision | Yes | Source-backed value | TO-CONFIRM |
cost share rulecost_share_rule | Yes | Source-backed value | TO-CONFIRM |
effective fromeffective_from | Yes | Source-backed value | 2026-10-09 |
statusstatus | Yes | Readiness condition: status=active | draft |
evidence stateevidence_state | Yes | Readiness condition: evidence_state in activation-grade evidence | absent |
authorization requiredauthorization_required | Optional | Source-backed value | TO-CONFIRM |
limit scopelimit_scope | Optional | Source-backed value | TO-CONFIRM |
limit amountlimit_amount | Optional | Source-backed value | TO-CONFIRM |
frequency limitfrequency_limit | Optional | Source-backed value | TO-CONFIRM |
diagnosis restrictionsdiagnosis_restrictions | Optional | Source-backed value | TO-CONFIRM |
network restrictionsnetwork_restrictions | Optional | Source-backed value | TO-CONFIRM |
exclusion reasonexclusion_reason | Optional | Source-backed value | TO-CONFIRM |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-001 |
Define payer allowed-price lists separately from the hospital gross charge master so live invoices cannot confuse gross and allowed price.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: provider contracts
| Column | Required | Format | Example |
|---|---|---|---|
tariff codetariff_code | Yes | Source-backed value | TO-CONFIRM |
tariff nametariff_name | Yes | Source-backed value | TO-CONFIRM |
currencycurrency | Yes | Source-backed value | SAR |
effective fromeffective_from | Yes | Source-backed value | 2026-10-09 |
line itemsline_items | Yes | Source-backed value | TO-CONFIRM |
statusstatus | Yes | Readiness condition: status=active | draft |
evidence stateevidence_state | Yes | Readiness condition: evidence_state in activation-grade evidence | absent |
effective toeffective_to | Optional | Source-backed value | 2026-10-09 |
unit basisunit_basis | Optional | Source-backed value | TO-CONFIRM |
package rulespackage_rules | Optional | Source-backed value | TO-CONFIRM |
drug markup rulesdrug_markup_rules | Optional | Source-backed value | TO-CONFIRM |
rounding rulesrounding_rules | Optional | Source-backed value | TO-CONFIRM |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-001 |
Bind a contract/class/site/date context to exactly one applicable tariff precedence path.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: provider contracts · benefit classes · tariffs
| Column | Required | Format | Example |
|---|---|---|---|
provider contractprovider_contract | Yes | Source-backed value | EXAMPLE-CONTRACT-001 |
tarifftariff | Yes | Source-backed value | TO-CONFIRM |
effective fromeffective_from | Yes | Source-backed value | 2026-10-09 |
prioritypriority | Yes | Source-backed value | 1 |
statusstatus | Yes | Readiness condition: status=active | draft |
evidence stateevidence_state | Yes | Readiness condition: evidence_state in activation-grade evidence | absent |
effective toeffective_to | Optional | Source-backed value | 2026-10-09 |
facility sitefacility_site | Optional | Source-backed value | TO-CONFIRM |
departmentdepartment | Optional | Source-backed value | TO-CONFIRM |
benefit classbenefit_class | Optional | Source-backed value | EXAMPLE-CLASS |
network tiernetwork_tier | Optional | Source-backed value | TO-CONFIRM |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-001 |
Record network participation, exclusions and effective periods before coverage is used.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: provider contracts
| Column | Required | Format | Example |
|---|---|---|---|
Network codenetwork_code | Yes | text | EXAMPLE-NETWORK |
Provider legal identifierprovider_identifier | Yes | text | EXAMPLE-PROVIDER |
Network tiernetwork_tier | Yes | text | TO-CONFIRM |
Effective fromeffective_from | Yes | YYYY-MM-DD | 2026-10-10 |
Effective toeffective_to | Yes | YYYY-MM-DD | 2027-10-09 |
Approved contractcontract_reference | Yes | text | EXAMPLE-CONTRACT-001 |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-002 |
Prepare coverage mappings using synthetic references here; actual member identities belong in the approved secure migration route.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: issued policies · benefit classes · Provider networks & participation
| Column | Required | Format | Example |
|---|---|---|---|
Source member referencesource_member_reference | Yes | text; no patient identifiers in public examples | EXAMPLE-MEMBER |
Issued policy referencepolicy_reference | Yes | text | EXAMPLE-POLICY |
Benefit classbenefit_class_reference | Yes | text | EXAMPLE-CLASS |
Network codenetwork_code | Yes | text | EXAMPLE-NETWORK |
Effective fromeffective_from | Yes | YYYY-MM-DD | 2026-10-10 |
Effective toeffective_to | Yes | YYYY-MM-DD | 2027-10-09 |
Secure identity mapping referenceidentity_mapping_reference | Yes | text; secure workspace reference | EXAMPLE-REF-001 |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-002 |
Review rule precedence, exceptions and test evidence before immutable publication by authorized owners.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: benefit rules · tariff assignments · Acceptance tests
| Column | Required | Format | Example |
|---|---|---|---|
Rule referencerule_reference | Yes | text | EXAMPLE-RULE |
Rule releaserule_release | Yes | text | TO-CONFIRM |
Rule precedenceprecedence | Yes | integer | 1 |
Eligibility conditioneligibility_condition | Yes | text | TO-CONFIRM |
Exclusion / reasonexclusion | Yes | text | TO-CONFIRM |
Limit / deductible / copaylimit_or_copay | Yes | text; specify amount, unit and currency | TO-CONFIRM |
Test casetest_case_reference | Yes | text | EXAMPLE-UAT |
Prepared bymaker_reference | Yes | text | EXAMPLE-REF-001 |
Independent approvalchecker_reference | Yes | text | EXAMPLE-REF-002 |
Activation evidenceevidence_reference | Yes | text | EXAMPLE-REF-003 |
Publication statuspublication_status | Yes | draft / reviewed / approved / blocked | draft |
Reconcile normal, denied, partially paid, reversed and unmatched activity with explicit finance ownership.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: Service prices & SBS mapping · provider contracts · Acceptance tests
| Column | Required | Format | Example |
|---|---|---|---|
Control codecontrol_code | Yes | text | EXAMPLE-FIN-01 |
Transaction typetransaction_type | Yes | charge / invoice / claim / remittance / reversal / refund / write_off | claim |
Currencycurrency | Yes | ISO 4217 | SAR |
Expected source totalsource_total | Yes | decimal | 1000.00 |
Observed target totaltarget_total | Yes | decimal | 1000.00 |
Approved tolerancetolerance | Yes | decimal; do not assume a tolerance | 0.00 |
Exception queue / ownerexception_route | Yes | text | Finance review |
Reconciliation evidenceevidence_reference | Yes | text | EXAMPLE-REF-001 |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-002 |
Freeze products, versions, facilities, delivery mode and acceptance scope.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
| Column | Required | Format | Example |
|---|---|---|---|
Catalogue product IDproduct_id | Yes | text | outpatient |
Agreed releaserelease | Yes | text | TO-CONFIRM |
Operating modemode | Yes | native / connected | native |
Facility scopefacility_scope | Yes | text | all |
Included in this projectincluded | Yes | true / false | true |
Accountable roleowner_role | Yes | text | Project owner |
Acceptance evidenceacceptance_test | Yes | text | Approved end-to-end test |
Approval referenceapproval_reference | Yes | text | EXAMPLE-REF-001 |
Map roles to permitted actions and verify access across facility boundaries.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: Facilities · Planned team
| Column | Required | Format | Example |
|---|---|---|---|
Rolerole | Yes | text | doctor |
Facility scopefacility_scope | Yes | text | EXAMPLE-FACILITY-001 |
Resourceresource | Yes | text | Patient record |
Actionaction | Yes | text | read |
Allowedallowed | Yes | true / false | true |
Approverapprover_role | Yes | text | Security owner |
Test evidenceevidence_reference | Yes | text | EXAMPLE-REF-001 |
Record locally approved pathways, responsibilities and exception handling.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: Departments · Access & approvals
| Column | Required | Format | Example |
|---|---|---|---|
Workflow IDworkflow_id | Yes | text | EXAMPLE-WF-001 |
Product IDproduct_id | Yes | text | outpatient |
Entry evententry_event | Yes | text | Patient arrival |
Responsible roleresponsible_role | Yes | text | Nurse |
Required informationrequired_information | Yes | text | Verified identity and visit context |
Next eventnext_event | Yes | text | Clinical consultation |
Handover ownerhandover_owner | Yes | text | Doctor |
Exception pathexception_path | Yes | text | Identity mismatch to review |
Workflow approvalapproval_reference | Yes | text | EXAMPLE-REF-001 |
Record complete positive, negative, boundary, access and failure tests per product.
Upload in Account setup → Implementation files & acceptance evidence. The data is saved in your account implementation records. Review with the named owner, record approval and attach the evidence. This register records decisions; it does not activate production configuration.
Load / review first: Project scope · Clinical workflow configuration
| Column | Required | Format | Example |
|---|---|---|---|
Test IDtest_id | Yes | text | UAT-001 |
Product IDproduct_id | Yes | text | outpatient |
Scenarioscenario | Yes | text | Visit from arrival to financial follow-up |
Preconditionspreconditions | Yes | text | Approved setup and synthetic data |
Exact actionsactions | Yes | text | TO-CONFIRM |
Expected resultexpected_result | Yes | text | TO-CONFIRM |
Actual resultactual_result | Yes | text | NOT-RUN |
Statusstatus | Yes | not_run / pass / fail / blocked | not_run |
Evidence referenceevidence_reference | Yes | text | EXAMPLE-REF-001 |
Approverapprover_role | Yes | text | Product owner |
Illustrative operating cases
A provider processes a documented insured visit using approved configuration and an accepted production exchange.
Coverage, authorized activity, submission, adjudication and settlement are traceable as distinct decisions.
An estimate has incomplete benefit evidence, and later claim lines receive mixed payer decisions.
Uncertainty, rejection, denial and unpaid balance remain distinct, with owners and evidence for each.
Worked operating scenarios
Name the missing source and owner. Keep the estimate provisional with its assumptions and expiry; no default amount replaces the unresolved value.
Use the accepted identity rules for transport retry and payer correction. Classify adjudicated denial separately and choose its evidenced remedy and responsible reviewer.
Keep claim, advice and bank references distinct. Investigate the variance and approve allocation or adjustment without overwriting the settlement history.
Delivery boundary
Required NPHIES and ZATCA workflows are included in every plan. Live transmission is activated after your organisation’s NPHIES and ZATCA credentials and external acceptance. Catalogue reference data is not certified production configuration; payer credentials, terminology rights and external finance connections are each accepted before use.
A complete connected revenue workflow with granular modules for eligibility, authorization, payer configuration, charges, claims, denials and reconciliation. Establish the rules: Configure legal organizations, administration agreements, provider contracts, products, issued policies and member classes in dependency order. Keep source evidence, effective dates and approval with each configuration version. Verify coverage: Resolve member eligibility, provider network, benefit rules, exclusions, limits and tariff applicability for the requested service. An unknown fact creates a named review item; it must not silently become an assumed price or patient liability. Authorize & prepare: Prepare required authorization and supporting evidence. Keep requested and approved services, quantities and validity separate. Review the provisional estimate, unresolved facts and expiry before accepting financial preparation. Capture & submit: Attest performed activity, reconcile charges and assemble the claim with coding and attachments. Validate the payload and submission identity; production transmission requires approved credentials, endpoints, exchange package and activation evidence. Resolve responses: Distinguish transport validation, payer business errors and adjudicated denials. Route corrections, evidence requests, contract disputes and clinical appeals to the right owner with the original business references and applicable deadlines. Settle & explain: Link remittance advice to claims, distinguish adjudication from cash settlement and reconcile partial payments, deductions and unmatched cash. Review ageing, exceptions and decision traces without converting unresolved balances into patient charges.
Explore the detailsConfigure the selected release using the account templates, then validate references and preview before import. Required planning and setup files include organizations (rcm_organizations.csv); provider contracts (rcm_provider_contracts.csv); issued policies (rcm_issued_policies.csv); benefit classes (rcm_benefit_classes.csv); benefit rules (rcm_benefit_rules.csv); tariffs (rcm_tariffs.csv); Provider networks & participation (rcm_networks.csv); Member coverage mapping (rcm_member_coverage.csv); Rules, exceptions & publication (rcm_rule_publications.csv); Revenue & reconciliation controls (rcm_financial_controls.csv); Function settings · scheduling closures (product_settings.csv); Acceptance tests (uat_cases.csv). Each file’s field guide identifies whether it imports setup records or documents a migration/decision.
Explore the detailsBenefit or deductible balance unknown Name the missing source and owner. Keep the estimate provisional with its assumptions and expiry; no default amount replaces the unresolved value. Rejected transmission versus denied claim Use the accepted identity rules for transport retry and payer correction. Classify adjudicated denial separately and choose its evidenced remedy and responsible reviewer. Partial or unmatched payment Keep claim, advice and bank references distinct. Investigate the variance and approve allocation or adjustment without overwriting the settlement history.
Explore the detailsRequired NPHIES and ZATCA workflows are included in every plan. Live transmission is activated after your organisation’s NPHIES and ZATCA credentials and external acceptance. Catalogue reference data is not certified production configuration; payer credentials, terminology rights and external finance connections are each accepted before use.
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