Dhamani ePlatform regulations reinvent health insurance governance

Muscat: The Capital Market Authority (CMA) issued a decision approving the regulation for health insurance electronic link (Dhamani E-platform) to regulate and govern the linking process between the parties of health insurance relation based on an adequate legal framework.  

The provisions of this regulation oblige entities offering health insurance services to register on Dhamani ePlatform. All the health insurance transactions and exchange of information will be done via the platform from the effective date of the health insurance policy to its expiry. Additionally, institutions of the insurance sector and private health institutions have started registration and linking with Dhamani to exchange claims and policyholders’ data; which later will enable the transfer of all their processes to the platform.

Moreover, the regulation includes provisions on the registration mechanism and uses of the platform. It specifies the obligations of entities registered in the platform to ensure that they benefit from its services. These entities are insurance companies, health Insurance claims administrators and health insurance claims revenue cycle managers and public and private health institutions.

Also, it includes provisions ensuring proper regulation of this vital project and the necessary procedures followed by the CMA in cases of violating legislation regulating health insurance or misusage of the platform. The Regulation contains a chapter specifying the fees for services offered by Dhamani which makes it an integrated regulatory platform that includes all regulatory, administrative, technical and financial aspects of health insurance processes. It saves effort and money by automating all processes of the health insurance sector and eliminating paper transactions.

It is worth mentioning that the Dhamani Platform represents a breakthrough in the regulation of the health insurance market in the Sultanate of Oman since it links insurance companies and private health institutions.  

It is considered to be a unified channel for insurance transactions between health insurance providers and insurance companies and it provides health files of policyholders.  It will contribute to providing proper medical coding related to medical and technical codes and measuring the extent of compliance of health institutions, insurance companies and other related parties with the directives and procedures. 

This ensures the quality of health care provided to citizens and residents in addition to limiting misuse of benefits included in the policy.  This link will work to ensure obtaining approval promptly and dealing with claims electronically.  There will be other features when the e-link between Dhamani and Shifa by the Ministry of Health is completed.