Medical Insurance Software for Payers across Dubai and the UAE

Six connected capability areas: (1) Enrolment engine with bulk processing, corporate HR connectors, and structured exception handling. (2) Claims adjudication workflow aligned with DHA eClaimLink and DOH Shafafiya. (3) Pre-authorisation queue with PD-05-2025 SLA clocks and automated provider communication. (4) MemberRegister submission pre-validated against DHA schema. (5) Corporate client portal for HR self-service, utilisation, and compliance reporting. (6) Leadership dashboards for loss ratio, pre-auth SLA, and PD-05-2025 exposure.

Around those six, most payers and brokers also want: ePrescription and Tatmeen integration patterns, Malaffi HIE read access where licensed, bilingual Arabic member communication, and a reporting layer feeding the payer or broker ERP.

Sapiens IDITSuite and Oracle Health Insurance are established core platforms with deep policy admin, claims, and billing. They run large payer operations well and are deployed across EMEA and the GCC. The gap for UAE medical operations is usually not the core - it is the UAE-specific layer above the core.

Custom medical software is designed to sit alongside the core and close the gaps that matter locally: DHA MemberRegister submission pre-validation, PD-05-2025 SLA tracking, Northern Emirates MOHRE Basic scheme handling, corporate HR integration patterns for UAE employers, bilingual Arabic member-facing interfaces, and Malaffi and Riayati integration where licensed.

The platform is designed to align with eClaimLink claim submission formats, MemberRegister demographic schema, ePrescription data flows, and the DHPO technical interface expectations. Format changes are absorbed through configuration rather than code release.

BY BANKS has not claimed prior Shafafiya integration delivery - the platform is designed to the published DHA specifications. Integration and certification with DHA remain the operating entity's responsibility.

DOH Shafafiya (the Abu Dhabi claims platform, distinct from DHA's), Malaffi HIE, Riayati, and Thiqa workflow patterns are supported as configurable integration targets. The federal Riayati integration, National Unified Medical Record, matters increasingly for payers operating across emirates.

Northern Emirates coverage under the MOHRE Basic scheme (AED 320/year, administered by Dubai Insurance PSC from 1 January 2025) is supported including the specific co-payment structure, network constraints, and MOHRE compliance reporting patterns.

PD-05-2025 from the Dubai Health Insurance Corporation sets electronic claim and authorisation timelines with delay-fee mechanisms. The pre-authorisation queue tracks SLA clocks per request, escalates on threshold breach, and automates provider communication so pending-authorisation cases do not drift.

Delay-fee exposure is visible at portfolio level continuously - finance sees the number hours, not months, after it starts accruing.

UAE corporate clients run a range of HR systems - Oracle, SAP SuccessFactors, Workday, Bayzat, Darwinbox, and local or legacy stacks. The platform ships pre-built connectors for common patterns (API, SFTP, structured file upload) and supports custom adapters for bespoke employer schemas.

Corporate HR self-service covers enrolment, dependant management, endorsement request, utilisation at employer level, member card distribution, and compliance report retrieval. Payer servicing load drops because HR teams self-serve the routine cases.

Here's where custom medical insurance software typically sits.

Core policy admin - we sit alongside Sapiens IDITSuite, Guidewire, Oracle Health Insurance, Premia, and TCS BaNCS Insurance for core policy, claims, and billing records.

TPA and provider platforms - we exchange with Cognizant TriZetto, VBA, and local TPA custom stacks, and with provider-side platforms Shade QC Messenger, Balsam Medico, Insta by Practo, and PharmacyPlus for clinic, hospital, and pharmacy integration.

Analytics and reporting - we feed Tableau, Power BI, and internal IFRS 17 calculation stacks for consolidated reporting.

Integration approach is scoped during discovery. We don't ask you to rip and replace anything that works.

Discovery runs four to six weeks. Working with your enrolment, claims adjudication, pre-authorisation, corporate servicing, and compliance teams, we map current DHA and DOH workflow, PD-05-2025 exposure, corporate HR integration practice, and reporting cadence. Output is a detailed report covering current-state map, platform architecture, integration scope against regulators and corporate clients, phased implementation plan, and fixed-price build proposal.

Build for a core medical platform runs twelve to sixteen weeks from discovery completion. Full DHA, DOH, and MOHAP integration with corporate HR connector rollout phases in over six to twelve months.

Pricing varies by insured-lives count, corporate client mix, and regulator integration scope. A bracket isn't published; discovery produces a fixed-price proposal with no obligation to proceed.