Revenue cycle advisory
Revenue Cycle Management in Abu Dhabi
Shafafiya submissions are checked against DoH coding and pricing rules, and payers apply their own edits on top. We review eligibility, authorisation, coding and documentation, set up denial management and resubmission routines, and prepare teams for DoH claims audits. Reporting then shows which payer and which reason drives most rejections.
The rules of the ground
Who regulates and pays in Abu Dhabi
Abu Dhabi was the first emirate to make health insurance compulsory. UAE nationals are generally covered by Thiqa, a government programme administered by Daman, while expatriates are covered through employer-sponsored plans, with a Basic product for lower-income workers and enhanced plans above it. Daman is the largest payer, alongside private insurers and administrators. Claims flow through Shafafiya under DoH rules, so coding accuracy, clinical documentation and pricing compliance directly decide how much a provider is actually paid.
Regulator for the whole emirate: licenses facilities and professionals, sets insurance and pricing rules, and audits quality and claims.
The Abu Dhabi government services platform through which many DoH licensing transactions for facilities and healthcare professionals are carried out.
Abu Dhabi's health information exchange. DoH expects licensed facilities to connect and share patient records through it.
The DoH e-claims and data exchange platform used for eligibility, prior authorisation, claims and remittance between providers and payers in Abu Dhabi.
Scope
What we deliver in Abu Dhabi
End-to-end RCM audit
A sample-based review of encounters from registration to remittance, identifying where claims fail, what the root causes are and how much value sits in unworked rejections and underpayments.
Front-end eligibility and prior authorisation
Registration scripts, eligibility checks and prior authorisation workflows redesigned so coverage, benefits and approvals are confirmed before treatment, not discovered after the claim is rejected.
Clinical documentation and coding review
Coding accuracy reviewed against ICD-10-CM and CPT in the UAE, or ICD-10-AM and the Saudi Billing System in KSA, with documentation feedback for doctors and targeted coder training.
E-claims submission and scrubbing rules
Claim validation rules configured and tested for eClaimLink and DHPO, Shafafiya or NPHIES, so formatting, code pairing and mandatory field errors are caught before the claim leaves your system.
Denial management and resubmission
A categorised denial log, root-cause analysis by payer and reason, resubmission templates and a daily work queue, so every rejection is either recovered or consciously written off within the payer's deadline.
Contract loading and remittance reconciliation
Payer price lists and contract terms loaded accurately into your HIS, and remittance advices reconciled line by line, so underpayments are identified and disputed rather than silently absorbed.
Process
How the work runs
Baseline
We extract claims, rejection and remittance data by payer and establish your current rejection patterns, ageing profile and cash conversion before recommending anything.
Root-cause analysis
Every major rejection category is traced back to its true source: registration, authorisation, clinical documentation, coding, system configuration or contract loading.
Fix the process
Workflows, system rules, templates and training are corrected at the source, starting with the causes that account for the largest share of lost revenue.
Recover the backlog
In parallel, recoverable rejections and underpayments still inside payer resubmission windows are worked in priority order, so the project starts paying back early.
Monitor and hand over
A weekly RCM dashboard and review routine are handed to your team, with optional ongoing oversight of an in-house or outsourced billing function.
Frequently asked questions
What should I expect from a healthcare consultancy in Abu Dhabi?
Do I need to connect to Malaffi?
How important is Thiqa for a private clinic?
Does the same setup apply in Al Ain?
What does revenue cycle management include for a GCC clinic or hospital?
Do you handle NPHIES and Saudi Billing System coding in KSA?
Complimentary 30-minute call
Talk it through with Dr. Neeraj.
Tell us where your facility is today and where you want it to be. You leave the call with a clear next step.