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Shafafiya e-claims integration for Abu Dhabi facilities

Shafafiya is the Department of Health e-claims platform in Abu Dhabi. It works like a post office: you upload transaction files through web services and collect what is waiting. This is what it asks of a hospital system.

What Shafafiya is

Shafafiya is the Abu Dhabi Department of Health platform for health insurance transactions. Its web services technical definition, version 3.5, describes a post office: a sender uploads a transaction file, and the receiver collects it.

The post office communicates only through web services. There is no web page or Department of Health software for uploading or downloading files, so the facility's own system has to do it.

At a glance
Where
Abu Dhabi
Operated by
Department of Health
Carries
Claim submission, person register, remittance advice, prior request, prior authorisation
Format
XML transactions through web services only
Published
Web services technical definition, version 3.5
Shafafiya

Who needs to connect

Facilities in Abu Dhabi that submit claims to insurers.
Insurers and third-party administrators, who collect and answer on the same platform.
Groups with facilities in Dubai as well, who run a second, separate integration for DHPO and eClaimLink.
Shafafiya

What data is exchanged

ClaimsClaim submission transactions built from charges with coded diagnoses and services.
RemittanceRemittance advice applied to each claim line.
Prior requests and authorisationsPrior request and prior authorisation transactions.
Person registerThe person register transaction.
Shafafiya

What the exchange involves

The services

The technical definition lists services for each step.

  • UploadTransaction returns an identifier or an error report
  • GetNewTransactions and DownloadTransactionFile list and download waiting files
  • SetTransactionDownloaded marks a file as received

Transaction types

The platform exchanges five kinds of transaction.

  • Claim submission and remittance advice
  • Person register
  • Prior request and prior authorisation

Validation

Rules run when a file is uploaded.

  • Errors come back as a report the system has to read
  • Rejections go to the people who can fix the charge
  • Counts are reconciled against the platform
Shafafiya

How Ventrecs handles it

Claim lifecycleOne draft claim per encounter and coverage, then ready, submitted, answered and invoiced for the accepted amount.
Pre-authorisationApproval numbers and validity stored against the service.
Charges and codesCharges created by the departments as care happens, so the claim is built from what was delivered. Claims export as CSV for portal upload and as a FHIR R4 Claim.
Durable outboxMessages leave through an outbox with retry, a transaction log and a reconciliation queue, so a deferred, rejected or missing response is a visible state with an owner.
How the connection is delivered

Each connection is delivered as a project: scoped with your facility and Shafafiya, built as an interface adapter on the Ventrecs integration layer, tested in the operator's environment and signed off before go-live. Where the operator requires approval or certification, it is part of the project plan. The Shafafiya claim format is delivered as an adapter for the jurisdiction, on top of the insurance module.

Messages are carried by Ventrecs Connect. See how an integration is delivered, from scoping to monitoring. Ventrecs Connect · The integration lifecycle

Shafafiya

Typical rollout steps

The same eight stages as every Ventrecs deployment, applied to this connection. How we deliver

  1. 1
    DiscoverConfirm with the Department of Health which of your facility types must connect, and which messages or transactions apply.
  2. 2
    DesignAgree the message set, identifiers and code mappings, and name an owner for each interface.
  3. 3
    ConfigureSet up facilities, users, catalogues and the integration layer, with credentials held outside the clinical records.
  4. 4
    MigrateLoad the master data the exchange needs, such as facilities, clinicians and patient identifiers, and reconcile it.
  5. 5
    TestTest in the environment the Department of Health provides, with synthetic data, including rejected and duplicate messages.
  6. 6
    TrainTrain the teams who watch the interface and fix the rejections.
  7. 7
    Go-liveCut over in phases with on-site support, and with sign-off from the Department of Health where the operator requires it.
  8. 8
    HypercareClose monitoring in the first weeks, then hand-over to the agreed support process.
Shafafiya

Sources

Operator and standards documents these statements rest on. Standards change, so work from the current version.

Shafafiya

Questions we are asked

How does Shafafiya work technically?

As a post office. A sender uploads a transaction file through a web service, the platform validates it and returns errors, and the receiver downloads it. There is no web page for uploading files.

What transactions does it carry?

Claim submission, person register, remittance advice, prior request and prior authorisation.

Is there one UAE platform for claims?

No. Abu Dhabi uses Shafafiya and Dubai uses eClaimLink with the DHPO gateway.

Can Ventrecs submit claims in the Shafafiya format?

Yes, through a Shafafiya adapter on the integration layer, delivered on top of the insurance module. We scope it with you, build it and test it in the operator's environment before go-live.

Talk to us about your setup

Tell us about your facility and current systems. We will reply within one working day.