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HIS
HIS overview/Insurance & revenue cycle
Next: Patient portal

From patient eligibility to payment.

Eligibility, pre-authorisation, coding, claims, rejections, resubmission and remittance — driven by the clinical activity that created them.

The problem

Rejections are treated as a billing problem and are usually created upstream: a field not captured at admission, an authorisation obtained for a different procedure, a diagnosis coded from an incomplete note.

Until the rejection review names the originating step rather than the department, the same rejections repeat every month.

Core workflow

The revenue cycle, end to end.

01
Eligibility
Coverage, limits and exclusions checked before the encounter.
02
Authorisation
Pre-approval requests tracked with clinical attachments.
03
Treatment
Clinical activity captured once, priced by payer contract.
04
Coding
ICD and procedure coding from the documented record.
05
Claim
Submission, rejection handling and resubmission with reasons.
06
Reconciliation
Remittance matched to claim, shortfall analysed by cause.
Key capabilities

Payer management

Policies and contractsTariffs and price listsCo-pay, deductible, co-insuranceExclusions and limitsCorporate and split billing

Claims

Batch and individual submissionRejection reasons by causeResubmission workflowAgeing and follow-upPayer performance reporting

Controls

Pre-submission validationCoding audit trailAuthorisation expiry alertsWrite-off approval workflowReceivables by payer and age
Operational outcomes
−58%
Claim rejection rate
−31 days
Insurance receivable days
+11%
First-pass claim acceptance
Daily
Rejection review by cause

Ranges observed on Al Jawad engagements. Your targets are set in diagnosis, before the work starts.

Bring one month of rejections.

We trace each rejection to the step that produced it and rank the fixes by recoverable value.