Plenty of vendors promise “NPHIES integration in two weeks”. The truth is that the software part can be done quickly, but reaching the live NPHIES environment involves regulatory steps the facility itself has to complete. Let’s be upfront about that.
NPHIES in two lines
NPHIES is Saudi Arabia’s national platform for exchanging health information between providers and insurers, built on one standard — HL7 FHIR R4: one message format and one endpoint instead of a different system for every insurer.
What the facility must do (not the developer)
- Facility licence: a licensed healthcare facility with its official data ready.
- NPHIES onboarding: registration with the supervising authority (the Council of Health Insurance) as a provider.
- Digital certificates: the NPHIES gateway uses mutual TLS, which requires certificates issued to the facility.
- Conformance testing: the system must pass test scenarios in the sandbox before production access is granted.
- Reference data: codes for insurers, practitioners and approved services.
These steps take time and nobody can shortcut them for you — but they can run in parallel with preparing the system.
What the system must do
- Build FHIR R4 messages against the official NPHIES profiles.
- Validate identity data before sending: national ID is 10 digits starting with 1, iqama is 10 digits starting with 2.
- Manage each patient’s insurance policies and payers.
- Store every request and response as a complete, reviewable record.
- Switch between simulator, sandbox and production without changing code.
The core transactions
| Transaction | Purpose |
|---|---|
| Eligibility | Is the patient covered? What is the limit and the co-pay? |
| Pre-authorization | Insurer approval before procedures that require it |
| Claim | Submitting delivered services for payment |
| Payment reconciliation | Matching paid and rejected items against accounting |
Try it before onboarding is done
So you don’t have to wait for the paperwork, our Odoo system includes a simulator mode that answers in the same shape as NPHIES. You can register a patient, add their policy, run an eligibility check and inspect the full FHIR message that was sent and the response.
Example from the demo: a check on an active policy → eligible, SAR 500,000 limit, 20% co-pay. On an expired policy → not eligible, with the expiry date.
Once onboarding is complete, switching to the live environment is a single setting — same code, same messages.
To be transparent: the current demo covers patient and practitioner records and eligibility checks; pre-authorization and claims are in the next development phase.
Try it yourself
The demo is live on our demo page — request login details. For more on the full solution, see the NPHIES hub.