• Dhamani helps healthcare organizations save time, reduce errors, and follow regulations more easily. It ensures smooth communication between all stakeholders and improves overall efficiency.

• Yes, Dhamani is a regulatory requirement for healthcare facilities and insurers in Oman to ensure transparency, efficiency, and compliance in the healthcare sector.

• Dhamani uses advanced encryption, secure access controls, and compliance with international data protection standards to safeguard patient information and prevent unauthorized access.

• Checking patient eligibility in real time.
• Managing preauthorization and claims submissions.
• Sharing data securely between providers and payers.
• Generating reports and ensuring compliance with standards.
• Radiology Images and results
• Prescriptions for medicines
• Transfer of payments between healthcare facilities and insurance companies

• Dhamani uses advanced global healthcare standards like FHIR HL7 for data exchange.

• The platform uses a standardized coding system, including ICD for diagnosis, CPT for procedure codes HCPCS Codes for consumables, MOH drug Codes for Medications, OSL Codes for Consultation & Hospitalization, which are not listed in CPT Code List.

• Hospitals, clinics, diagnostic centers, and Standalone pharmacies that work with insurers and TPAs can benefit from Dhamani.

• Yes, Dhamani is accessible to healthcare providers of all sizes, including small clinics and individual practitioners, as long as they have contracts with payers or TPAs.

• Verifying contracts with payers and TPAs. • Completing the registration on the Dhamani portal. • Setting up their systems to connect with Dhamani and meeting compliance requirements.

• Citizens and residents get faster approvals for treatments, more accurate claim processing, and better healthcare services without delays. Citizens and the population get to know their medical coverage from their insurance companies

• Work with system integrators to connect their IT systems to Dhamani. • Use standardized codes and follow data exchange rules. • Train staff and ensure compliance with platform requirements.

• Yes, Dhamani supports multiple languages, including Arabic and English, to accommodate to diverse users in Oman.

• Dhamani is designed to comply fully with the Financial Services Authority (FSA) and other regulatory requirements, ensuring all stakeholders adhere to Oman’s healthcare policies.

• Dhamani helps payers and insurers reduce processing times, improve data accuracy, and minimize fraud while ensuring compliance with regulations.

• By using standardized codes, audit trails, and real-time monitoring, Dhamani helps detect inconsistencies and prevents fraudulent claims.

• It is a mandatory agreement issued by the Health Services Regulatory Authority in the Sultanate of Oman. It is used to regulate the contractual relationship between approved insurance companies and healthcare providers within the system. It aims to unify the basic terms and conditions to guarantee the rights of all parties, enhance transparency and fairness in healthcare service delivery, and facilitate claims and financial settlements.

• It refers to the standardization of the basic insurance coverage for all beneficiaries to ensure the provision of a minimum level of healthcare, as stipulated in the Unified Health Insurance Policy.

• No, because the insurance coverage is limited to emergency and unintentional medical cases only.

• Two years.

• Medical expenses must be paid to healthcare providers within 45 days of receiving the claim. All claims must be submitted by healthcare providers and are payable in Omani Rials after the healthcare service is rendered.

• Consultations are auto-approved through the system. Other services are approved within less than 30 minutes for outpatient clinics.

• Yes, but only if the health card has not been used. The remaining premium for the unused period of the policy will be refunded.

• No, healthcare providers are not allowed to link electronically to the Dhamani platform without signing the Unified Health Insurance Contract.

• No, TPAs are not permitted to transfer or pay any amounts directly to healthcare providers. Payment must be made directly by the insurance companies to healthcare providers electronically via the Dhamani platform.

• No, it is not allowed to reimburse medical expenses for services provided by unlicensed doctors or those practicing outside their authorized scope of work.

• Yes. All rejected claims can be resubmitted with necessary corrections within 30 days of receiving the response. Disputed claims may only be resubmitted a maximum of two times.

• Yes, either party may terminate the agreement by providing written notice to the other party at least 90 days prior to the termination date.

• No, all health insurance operations, service provision, and processing must be conducted exclusively through the Dhamani platform.

• 1% of the total direct annual premiums.

• 0.9% of the total direct annual premiums.

• Dhamani is a national platform for information exchange within the health insurance system. It is one of the programs under the Financial Services Authority.

• Your electronic systems used at the healthcare facility must have features that allow direct integration with Dhamani. Alternatively, you can work with a digital solutions provider to prepare the necessary environment for integration. There is a specific list of licensed companies authorized by the Authority to perform this task.

• Yes, all healthcare institutions that deal with health insurance and are part of the healthcare network of one or more insurance companies can connect to Dhamani.

• Currently, only institutions can access and use the platform directly. However, a mobile application is being developed to enable individual beneficiaries to use Dhamani, and it will be available in the future.

• Like all promising digital projects, Dhamani is developed in phases. Services are enhanced based on demand and technological progress. The idea of using card readers hasn’t been overlooked, but it will be implemented in later stages. The current focus is on data cleansing and standardizing access codes. Later, digital features such as automatic registration and verification through card readers may be added.

• Dhamani is a channel that links healthcare providers with insurance companies and Third-Party Administrators (TPAs). It facilitates the fast exchange of data and transactions but is not responsible for approvals. Approval decisions lie with the insurance companies, based on applicable laws, the benefits and exclusions agreed upon in the insurance policy, and the efficiency and response time of the insurance provider in managing the request.

• Patient care services must never stop, regardless of the reason. If Dhamani or any other system experiences downtime, services are continued using traditional or manual methods. Once the systems are back online, the data is uploaded to the Dhamani platform. This process does not affect the healthcare services provided to the insured person in any way.

• An integrator is a technical vendor or service provider responsible for connecting your entities internal system (such as your entity management software) to the Dhamani platform. They ensure smooth data exchange between your system and Dhamani, enabling automated eligibility checks.

• SaaS refers to a cloud-based software delivery model where the application is hosted by a third party and accessed via the internet. Entities using SaaS systems do not need to maintain hardware or software locally; instead, they access the system through a browser or client provided by the software vendor.

• System-to-System integration involves directly linking your entity software system with the Dhamani platform. This allows real-time, automated data exchange without manual uploads or portal entry, improving efficiency and accuracy.

• PRV (Private Health Establishment License): Issued by the Ministry of Health (MOH) to doctors working in private healthcare facilities. • MOH (General License): Refers to the standard MOH license for medical professionals. • MOH-VST (MOH Visiting Specialist): Issued for doctors who practice temporarily or on a visiting basis within MOH-regulated facilities.

o Authenticity and traceability of the registration request o Enhanced security o Professional representation of your organization o Generic emails (like Gmail or Yahoo) are not accepted for official registration.

• The Data Collection Sheet captures key details about your entity. To complete it: o Follow the provided template structure o Provide accurate entity, contact, system, and license details o Include all healthcare professionals, insurance contract details. o Ensure the data is up-to-date and matches official records • Note It is important to fill the Data Collection Sheet accordingly and precisely to avoid delays in approval or onboarding • Contact the Dhamani Onboarding team if a template or guidance document is needed.

• When registering on the Dhamani platform, you typically need to submit: o Completed Data Collection Sheet (contact Dhamani Onboarding team to get it) o Valid entity license (issued by MOH) o Commercial Registration (CR) of the entity o Civil ID of the Authorized Representative

• Yes, if your entity system is integrating with Dhamani (especially in system-to-system mode), the static IP address used must be whitelisted by the FSA team to ensure secure access.