Introduction

Note To Balloters:

This STU 0.3.0 specification has been readied for Ballot through public consultation and several connectathons using the artifacts and examples.

Ballot feedback is welcomed and encouraged from both HL7 Saudi Arabia members and members of other HL7 organizations and affiliates as we complete this guide for a Fall 2025 publication. While all ballot comments will be reviewed they may not all be considered for implementation in the current version of the guide as the primary goal of this guide is to reflect the Use Cases and artifacts which are already in production.

The Ballot review period will be from August 21 2025 through 11:59PM KSA on September 21 2025.

The Ballot scope is the entire contents of this Implementation Guide. Note that some portions of the Guide are informative, such as the Home page, Background, Roadmap and the Support sections.

People wishing to be part of the Ballot Pool (Consensus Group) should email that intention to walhaidery-c@chi.gov.sa by August 20 2025 providing their name, organization name, email, and the HL7 organization or affiliate of which they are a member.

All Balloters will be emailed the ballot vote and comment spreadsheet on August 20 2025.

Ballot votes and comment spreadsheets are to be completed and returned to the same email above by September 21 2025.

This guide can be reviewed offline. Go to the Support/Downloads section. Click on the link to download the full Implementation Guide as a zip file. Expand the zip file and use a web browser to launch the index.html file in the directory created by the zip extract process. External hyperlinks in the guide will not be available unless you have an active internet connection.

Financial Management is the Sponsoring Work Group for this Implementation Guide.

This implementation guide provides the business and technical requirements for healthcare providers and healthcare insurers participating in the exchange of eClaims information within Saudi Arabia. The guide documents a suite of messages to: support the determination of insurance (coverage) eligibility; perform and manage authorizations; submit and respond to claims for reimbursement; cancel requests; submit supporting clinical information; request deferred responses from insurers; and, provide and confirm claim payment details.

Technical Overview

The information exchanges are implemented using HL7 FHIR R4.0.1 standard.

The main sections of this IG are:

• Background - provides business context for the implementation guide, information that implementers should be familiar with before reading the remainder of the IG, and acknowledges key contributors to the guide.
• Specification - The information exchange patterns, implementation requirements and general conformance.
• Use Cases - The use case descriptions, information flows, technical requirements and guidance.
• Artifacts - The detailed definitions of the profiles, extension, terminology and both resource and full message examples.
• Roadmap - Provides some issues or features which are not being addressed in this version of the specification but may result in changes in a future version.
• Support - Allows downloading a copy of this implementation guide and other useful implementation information