We integrate NPHIES into clinical software — HL7 FHIR R4, National ID and Iqama matching, claims and prior authorization, and the conformance package for production.
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Operated by the Ministry of Health and built on HL7 FHIR R4, NPHIES is the national hub for electronic claims, prior authorization, and clinical data exchange. Connectivity follows the MoH's published NPHIES FHIR Implementation Guides.
Providers submit FHIR-based claim resources and insurers return adjudication decisions through the same platform. Claims integration is essential for billing, with the Council of Cooperative Health Insurance (CCHI) overseeing payer participation.
NPHIES handles electronic prior authorization for procedures, medications, and services requiring insurer approval — replacing manual, paper-based workflows. Health information systems must implement these workflows to function in the Saudi insurance environment.
NPHIES exchanges clinical records between connected facilities, building toward a unified national health record — encounter summaries, ICD-10-CM diagnoses, medications, and LOINC lab results. The MoH defines specific FHIR profiles for each data category that connected systems must conform to.
NPHIES uses Saudi national identifiers as the primary patient identifier — National ID for citizens, Iqama number for residents. Systems must capture and transmit the correct identifier, since matching failures cause data to be rejected or attributed to the wrong record.
NPHIES incorporates a national drug database and formulary with standardized medication codes for claims, prescriptions, and records. Systems must map local medication data to these codes, maintained by the Saudi Food and Drug Authority.
NPHIES is built on HL7 FHIR R4 with Saudi-specific profiles and workflows defined in the MoH Implementation Guides. Before production access, systems undergo conformance testing validating the required profiles and transaction types across claims, prior authorization, and clinical data.
A structured path from Ministry of Health registration to live production — each step with the technical deliverables that determine whether a system passes NPHIES conformance.
NPHIES is the foundation of Saudi Arabia's digital health ecosystem — a universal requirement for any system deployed in the Kingdom. Click through to see what is at stake.
Book a NPHIES Integration ConsultationEach NPHIES integration area maps to specific design decisions and onboarding deliverables — not configuration choices, but commitments made before a system can pass Ministry of Health conformance.
Claims and adjudication for the private insurance sector flow through NPHIES as FHIR claim resources.
Electronic approval workflows for procedures, medications, and services requiring insurer sign-off.
Clinical records exchanged between connected facilities toward a unified national health record.
Records must attach to the correct patient using the appropriate Saudi national identifier.
Local medication databases must map to the national drug codes used across NPHIES.
Registration, sandbox testing, and conformance certification precede production connectivity.
FHIR servers, terminology services, claims and prior authorization engines, and KSA-resident cloud — selected to match the MoH NPHIES FHIR Implementation Guides and Saudi conformance requirements.
H
HL7 FHIR R4
H
HAPI FHIR
N
NPHIES Implementation Guide
H
HL7 v2
C
CDA / C-CDA
I
ICD-10-CM
L
LOINC
C
CPT Procedures
S
SFDA Drug Codes
N
National ID / Iqama Matching
M
Master Patient Index
C
Claims Adjudication Engine
P
Prior Authorization Workflow
O
OAuth 2.0
A
AWS Bahrain / KSA Region
A
Azure Saudi Arabia
G
Google Cloud Dammam
I
In-Country Hosting
M
Monitoring & Alerting
FHIR-conformant submission, claims and prior authorization, National ID and Iqama matching, and the Ministry of Health conformance package — we build NPHIES integration into the architecture and carry it through sandbox testing, certification, and go-live. Book a consultation and we'll scope it for your Saudi deployment.
Book a NPHIES Integration Consultation
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Yes. The Saudi Ministry of Health mandates NPHIES connectivity for all licensed healthcare facilities — government and private. The rollout is phased, with large hospitals and insurers connecting first, and new facilities applying for an operating license must have a connectivity plan in place.
NPHIES is the central electronic claims infrastructure for Saudi Arabia's mandatory health insurance system, regulated by the Council of Cooperative Health Insurance. All claims between providers and insurers flow through NPHIES, making integration essential for any provider seeking reimbursement or any insurer in the Saudi market.
NPHIES uses internationally recognized coding standards adapted for Saudi Arabia: ICD-10-CM for diagnoses, LOINC for lab tests, Saudi FDA drug database codes for medications, and CPT plus Saudi-specific codes for procedures. Systems connecting to NPHIES must map their internal codes to these national standards.
