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Confirms cover in seconds, on the day, from the patient record.
NPHIES
NPHIES eligibility and claims for dental clinics
NPHIES turns insurance from a phone call into a request and a response. The value is only realised if that request happens where the treatment is recorded, rather than in a separate portal somebody logs into afterwards.
Last verified 2 October 2026 · NPHIES (official) · Council of Health Insurance
Eligibility checkRuns automatically when the appointment is booked — coverage, limit and co-pay come back before the patient sits down.Live
Automatic pre-approvalSubmits the treatment plan and returns the insurer decision without anyone rekeying it into a portal.Live
Claims sent1,284
Auto-approved1,141
Pending83
Claims
CLM-8841Balsam Al-NajjarMedGulfAuto-approved
CLM-8840Reem BodiahBupaPending
CLM-8839Arwa IdreesTawuniyaPartially
Eligibility before the chair, not after
The single most expensive assumption in an insured clinic is that cover is still valid. Checking through NPHIES at the moment of booking or arrival takes seconds and removes the conversation that otherwise happens after treatment.
- Eligibility checked from the patient record, not a separate portal
- Response stored against the visit with its timestamp
- Cover, limits and exclusions visible to the front desk
- Re-checked on the day rather than relied on from the first consultation
Pre-authorisation where it is required
Crowns, endodontics and surgical work usually need approval before they start. Requesting it from inside the treatment plan means the clinical detail is already there and the approval comes back attached to the case.
- Pre-authorisation requested from the treatment plan
- Approved, partially approved and rejected states tracked with dates
- Approved amount visible next to the quoted amount
- The patient portion recalculated from what was actually approved
Claims that keep their state
A submitted claim is not a finished claim. What stops money leaking is treating it as something with a state and an owner until it is paid.
- Claims submitted from the invoice, with the procedure codes already on it
- Status followed through submitted, approved, rejected, resubmitted, paid
- Rejection reasons recorded so the pattern is visible
- Ageing report showing what has been unpaid longest, and who is chasing it
Who works with NPHIES
It touches the front desk, the dentist and whoever chases money, which is why it belongs in the same system as all three.
Dentists
Requests pre-authorisation from the plan rather than filling a form a second time.
Finance
Sees what is outstanding, how old it is and why it was rejected.
By hand, and with Dentolize
A separate portal is still better than a phone call, but it is a second place to work.
Doing it by hand
- Eligibility checked by phone, or assumed
- Pre-approval requested separately
- Claims tracked on a spreadsheet
- Rejections handled one at a time
- Patient portion estimated
With Dentolize
- Checked through NPHIES from the record
- Requested from the treatment plan
- Each claim with its own state and dates
- Reasons recorded, so the pattern is visible
- Recalculated from the approved amount
Questions
NPHIES — frequently asked
What is NPHIES?
The national platform for health insurance exchange in Saudi Arabia, used for eligibility checks, pre-authorisation and claims between providers and insurers.
Does Dentolize connect to NPHIES?
Yes, for eligibility, pre-authorisation and claim submission, from inside the patient record and treatment plan rather than a separate portal.
When should eligibility be checked?
On the day of treatment. Cover changes between appointments and the patient is usually not aware, so a check made at the first consultation can be out of date.
What happens when a claim is rejected?
The reason is recorded against the claim, its state changes, and it can be corrected and resubmitted with the history kept.
Can we see how much is outstanding with insurers?
Yes, by insurer and by age, which is the report that usually finds money nobody was chasing.
See NPHIES on your own clinic
Thirty minutes on how your clinic actually runs, not a generic slideshow. We will call you within 24 hours.