Interview - Health insurance
Building the IT backbone

Health insurance is playing an increasingly important role in the provision of healthcare across the Middle East with a number of countries in the region making health insurance mandatory. To facilitate this initiative Saudi Arabia-based Waseel is pioneering the digital connection of insurance companies with healthcare service providers. Middle East Health speaks to Riyadh Bajodah, chief operating officer, Waseel.

Middle East Health: Can you please provide a bit of background for Middle East Health readers who may be unfamiliar with Waseel? What it is it that Waseel does?


Riyadh Bajodah: Well, first I would like to thank you for this opportunity to tell you about Waseel and the vision of Waseel. Waseel in principle can be seen as the prime healthcare insurance data exchange portal (gateway). Waseel was built to be the market solution that will serve and enable both players in the healthcare industry, Payers and Providers (insurance companies, TPA, direct payers, hospitals, clinics and regulators) to operate smoothly, save time and reduce cost through the online exchange of health insurance information. Waseel offers three main services, “eligibility” that will enable providers to make sure that the patient has a valid [health insurance] card and is entitled to specified health services. The second service is “approvals submission”. This service highlights the efficiency of the system. Providers send all approvals requests directly to the payers system online without the need for paperwork. They can also send these requests from their own hospital information system to the payer’s backend system without the need to access the Internet and track the status of each approval as well. The third service is “claims submission”. This service saves time and cost by extracting electronically all the claims data from the provider system. It analyses, validates and sorts the claims information before sending them to the payer backend system without the need for paperwork or data entry.

MEH: Is Waseel still serving only Saudi Arabia or has it now expanded its operations to other countries in the region?
RB:
In the past two years, we have concentrated on expanding our network of healthcare providers in Saudi Arabian market to be able to better serve our group of payers. Waseel currently serves the Saudi market with more than 210 providers around the kingdom and three major payers. However, Waseel is engaged in a pilot programme with one of the major payers in the UAE.

MEH: Two years ago Saudi Arabia was just beginning the roll out of mandatory health insurance for all. What is the current state of the roll out? How successful has it been, so far?
RB:
I believe that the scheme is now applied to all companies with less than 500 employees [part of the phased roll out to companies, starting with large companies and then moving onto the smaller ones]. It’s a great development and I think its moving in the right direction. However, the market needs to be monitored closely to insure proper implementation and protect insured members’ rights from being manipulated by some companies (payers or policy holders).

MEH:
Waseel looked set to grow substantially when MEH visited two years ago. How has this rollout impacted your business?
RB:
The effect of the rollout on Waseel growth is still not as expected since we don’t yet have all the payers in our portal. On the other hand, we are experiencing substantial growth due to our focus on claims integration and on the added services that we have announced.

MEH:
What are these new services?
RB:
They are services like Online Unified Approval Claim Forms (UCAF) and an Electronic Claim Management Tool (WaseelE).

MEH:
Has Waseel succeeded in getting the main insurance companies on board to work with this digital technology? How many? Which ones?
RB:
NCCI (National Company for Cooperative Insurance), Med Gulf and CARS are our insurance partners. They represent around 50% of the healthcare insurance market in Saudi. On top of that we are in talks with three more companies in Saudi and the Gulf.

MEH:
Can you tell me about some of your biggest projects that have taken place in the past two years? Which companies are these with?
RB:
Our biggest project was linking Med Gulf to our portal. The project and the nature of the business was a challenge to the Waseel team. With the Med Gulf team we have managed to launch the first two services on time and without any sever issues or downtime. We expect to launch the claims soon along with CARS (our third payer) at the same time. Another project we have launched is the eligibility printout which will enable providers not yet using the claims service to smooth the process of registration by printing the eligibility response on the UCAF [agreed claims and approval form in Saudi Arabia] and use it as a claim-supporting document. This does away with the traditional photocopy of the insurance card. Several more projects such as pharmacy approvals, dental coded services and others are in the pipeline.

MEH:
What are the main challenges Waseel faces and how is it planning to overcome these?
RB:
In my opinion, the readiness of both payers and providers, the availability of the required data elements, the ability to manage and enhance the internal system and processes and the real utilisation of the internal systems are all challenges that Waseel is facing. We have developed our own integration tool that will give more options to the users to manage, save, edit and submit their claims and approvals easily. Also, ongoing training programmes that we offer will insure the proper utilisation and understanding of our tools and services.

MEH:
What does the future hold for Waseel?
RB:
We want to become the electronic super highway linking all the players in the healthcare insurance industry.

                                  
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