Claims intake, prior authorisation, provider directories, and fraud pattern dashboards - integrated with NPHIES and provider EMRs across the GCC. We help insurers reduce manual document assembly and give providers clearer submission rules. PDPL-aligned handling of member data throughout.
Health insurers and TPAs in the Gulf process high volumes of claims from clinics with inconsistent formats and attachments. Manual review teams become bottlenecks, and providers complain about opaque rejection reasons.
MiraalTech builds insurer-facing portals, automated claim validation, and provider integration kits that standardise submissions while keeping member data protected under PDPL.
When every clinic formats claims differently, auto-adjudication fails. We publish schemas, validation APIs, and sandbox environments providers can test against.
Manual prior auth queues frustrate members and providers. Digital workflows with clinical attachment rules cut turnaround for routine requests.
Insurers hold sensitive health data across millions of rows. We implement access tiers, encryption, and audit trails aligned to PDPL expectations.
Core policy systems were not built for modern APIs. Integration layers and event buses connect cores to provider portals without multi-year replatforming.
Discuss your NPHIES roadmap and provider integration goals with our team.
Products and services we deliver most often for this audience - each scoped to Gulf compliance and bilingual workflows.
Project Success
Outpatient network cut first-pass rejections and saved billing hours with automated claim packets.
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Project Success
Dental group linked treatment plans to insurer-ready codes - fewer manual corrections.
Explore the Project →Provider integration, claim automation, and member-data-safe analytics.
APIs, sandboxes, and documentation so clinics connect once and submit validated claims consistently.
Certification workflows verify providers before production access.
Rules engines flag missing attachments, code mismatches, and duplicate submissions before human review.
Review queues prioritise high-value exceptions and SLA breaches.
Providers track claim status and rejection codes; members access authorised documents under PDPL consent.
Arabic and English interfaces across web and mobile.
Dashboards for utilisation, fraud patterns, and network performance feed actuarial and network teams.
Exports align with internal BI tools and regulator reporting calendars.
Event-driven layers sync policy, membership, and claims cores without blocking modern channel development.
We document data contracts and monitor integration health in production.
Billing teams manually assembled claim packets from EMR exports, scans, and spreadsheets - a process prone to delays and rejections. They wanted automated claim packet generation from EMR data, validation against insurer rules, and a review queue before submission.
Imaging software, practice management, and insurer billing lived in separate systems, forcing staff to re-key treatment codes and photos. They asked for a unified patient timeline with Arabic treatment summaries and NPHIES-ready claim codes.
Leadership wanted one system for scheduling, clinical notes handoff, inventory, and insurer-ready billing - without a risky big-bang cutover. Staff needed Arabic and English screens, PDPL-compliant consent capture, and training that fit shift patterns.
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