21-04-2025
Newly launched Dhamani platform to ease insurance claims
MUSCAT, APRIL 21
The recently inaugurated Dhamani platform marks a major leap forward in the digital transformation of Oman's healthcare and insurance sectors. Designed as a national digital information exchange, the platform facilitates seamless, real-time communication between healthcare providers and insurance payers.
Speaking exclusively to the Observer, Dr Hatim al Lawati, Digital Economy Consultant at the Financial Services Authority (FSA), emphasised that Dhamani is not a standalone system but a comprehensive infrastructure for streamlining claims processing.
'Previously, there was a lot of fluctuation and delay, some claims took up to two years to process,' Dr Al Lawati said. 'Today, with Dhamani, claims can be submitted immediately after treatment, and insurance companies are required to respond within 45 days. The process is faster, more transparent, and significantly reduces administrative hassle.'
He also noted that the platform's operational footprint is minimal. 'It is efficient enough to be managed with as few as three workstations,' he added. 'It greatly improves speed and ease for both patients and hospitals.'
Through integration with healthcare providers' Health Information Systems (HIS), Dhamani enables instant claim submission by hospitals, polyclinics, clinics, medical centres, and soon, independent pharmacies. Once a patient receives treatment, the system can automatically transmit the claim to Dhamani, which then delivers all relevant data, medical reports, attachments, approvals, diagnoses, costs, and bills, directly to insurance companies.
This digital workflow enables payers to act quickly, either approving, rejecting, returning the claim for clarification, or requesting missing information, within a short timeframe.
'Healthcare providers have up to 45 days to submit a claim after the patient receives treatment,' Dr Al Lawati explained. 'If the claim is returned by the insurer, it can be resubmitted within 30 days. Once accepted, the payer is obligated to process payment within another 45 days. This structured timeline ensures swift and smooth claims handling.'
Beyond efficiency, Dhamani plays a critical role in combating fraud, waste, and abuse (FWA), common challenges in health insurance systems.
'Fraud involves submitting false claims for treatments that never occurred. Abuse refers to intentionally over-treating patients, for example, prescribing unnecessary medications or requesting unrelated tests. Waste relates to redundant or repeated services, like duplicate lab tests within or across hospitals,' Dr Al Lawati said.
To reduce FWA, the platform implements several robust measures. 'First, we are standardising CPT codes, also known as medical protocols, so all providers use consistent procedures for specific illnesses. This allows regulators and insurers to quickly spot irregularities and potential abuse.'
'Second, all transactions on Dhamani are fully digital and transparent, allowing regulators to set automated rules to detect suspicious patterns. For example, if a medicine prescribed only for women is issued to a male patient, the system can flag it immediately.'
'Third, the FSA is deploying business intelligence (BI) and artificial intelligence (AI) tools to analyse data, detect fraud, and manage risk. These technologies empower both payers and the regulator to monitor claims comprehensively and protect system integrity.'
In conclusion, Dr Al Lawati affirmed that Dhamani is not only enhancing the speed and transparency of insurance claims but is also serving as a critical infrastructure in safeguarding Oman's healthcare ecosystem from inefficiencies and malpractice.
