Efficient handling of insurance claims is essential for pharmacies in the UAE. By using authorized healthcare information exchange platforms such as Pharmacy E-Claim, Riayati, Tatmeen, Shafafiya, and Malaffi, pharmacies can ensure compliance with healthcare regulations while simplifying the billing process. PharmacyPlus, a leading pharmacy software company in Dubai, Sharjah, Abu Dhabi, Saudi Arabia, and Qatar, integrates these systems to simplify claim management, reduce paperwork, and guarantee accurate billing.
Common reasons claims get rejected via Shafafiya or eClaim portals
- Incorrect or Missing ICD-10 / ATC Codes: Claims missing standard diagnosis or medication codes are often auto-rejected by the Shafafiya portal and eClaim systems.
- Expired or Invalid Insurance Policy: Claims submitted for patients with expired or inactive insurance policies get rejected instantly.
- Mismatch in Emirates ID or Insurance Information: Any mismatch in patient details, such as Emirates ID, insurance card number, or name, leads to rejection.
- Duplicate Claims for the Same Visit or Service: Resubmitting a claim for the same encounter or prescription without proper modification activities a “duplicate claim” rejection.
- Missing Documentation or Supporting Files: EClaims without required documents like scanned prescriptions, doctor notes, or pre-approvals may be denied, especially for restricted or high-value drugs.
- Invalid Provider or Facility Licensing Details: Claims are rejected if the pharmacy’s license, provider ID, or facility information is outdated or incorrect in the Shafafiya system.
- Unapproved Medication Quantities or Frequencies: Claims for quantities or dosages that exceed coverage limits are flagged and rejected. Retail pharmacy software like PharmacyPlus helps ensure prescribed amounts coordinate with insurer guidelines before claim submission.
- Late Claim Submission: Each insurer has a time limit for submitting claims. Delayed submissions may be auto-denied by the Shafafiya portal or eClaim system.
How do rejected claims affect stock levels?
Rejected claims can directly impact pharmaceutical stock management by creating variations between the actual inventory and what is billed to insurance. When a claim is rejected, the expected refund is delayed or canceled, leaving pharmacies with unsold stock that was originally thought to be accounted for in the revenue cycle.
This also affects inventory management in pharmacies, which may need to manually adjust stock levels or reprocess claims. Without proper synchronization between claims and stock levels, there’s a risk of overstocking or understocking, leading to inefficiencies and potential financial loss. Using integrated pharmacy software like PharmacyPlus helps mitigate these issues by keeping inventory and claim data synchronized instantly.
How PharmacyPlus helps pharmacies track and trace medicines
PharmacyPlus, with the advanced Tatmeen integration system, provides an easy solution for track and trace capabilities, confirming the accurate recording of each dispensed medication. This integration allows pharmacies to automatically update the status of medicines from purchase through to prescription processing, providing live visibility into stock movements. By linking pharmaceutical stock to regulatory systems such as Tatmeen, PharmacyPlus ensures that every medicine is traceable for safety, quality control, and compliance purposes.
PharmacyPlus is a leading Pharmacy ERP software in UAE, Africa and the Middle East, where pharmacies can easily monitor batch numbers, expiration dates, and even serial numbers for each medicine. This level of detailed tracking not only supports efficient inventory management but also helps in meeting regulatory requirements. Pharmacies can quickly access the traceability of medicines, ensuring that any recall or regulatory audit is handled immediately and accurately.
Abu Dhabi’s Malaffi system
Abu Dhabi’s Malaffi system is a complete health information exchange platform designed to improve the quality and efficiency of healthcare services across the emirates. It securely connects various healthcare providers, enabling easy access to patient records, medical histories, prescriptions, and diagnostic information. The Malaffi system enhances integration between hospitals, clinics, and pharmacies, ensuring that healthcare professionals have accurate and up-to-date information at their fingertips, ultimately leading to better patient care and simplified medical processes.
How does POS integration help with faster claim submissions?
POS integration helps speed up claim submissions by directly linking pharmacy POS hardware with the pharmacy’s billing and eClaim systems. When a transaction occurs, the POS system automatically records the prescription details, payment information, and insurance data. This live data transfer eliminates the need for manual data entry, reducing errors and speeding up the process of submitting claims. By simplifying the process, pharmacies can quickly generate accurate eClaims that are ready for submission to insurance providers, improving financial flow and reducing delays.
Additionally, integrating pharmacy retail hardware with the POS system ensures that all relevant information, such as patient details, medication, and insurance coverage, is captured at the point of sale. This effortless connection ensures that claims are submitted faster and with fewer mistakes, which ultimately enhances overall operational efficiency. By automating these processes, pharmacies can improve their billing accuracy, reduce office tasks, and ensure that payments are processed more quickly.
