29 firms vie for contract to build Unified Health Insurance platform

CONRAD PRABHU –
MUSCAT, MAY 15 –
As many as 29 local and international firms are competing for a contract to develop an electronic platform underpinning the Mandatory Health Insurance System (Dhamani) due to be rolled out before the end of this year.
In the fray for the contract award are a number of leading insurance services providers, third party administrators (TPAs), IT firms, technology solutions providers, and even telecom companies.
The successful bidder will secure a contract from the Capital Market Authority (CMA) — the regulator for insurance services in the Sultanate — to build and maintain what is billed as the ‘nerve centre’ of the Unified Health Insurance System.
Healthcare coverage will be mandatory for Omani and expatriate employees of private sector organisations as well as visitors and tourists when it is implemented in phases starting from later this year.
“The Health Insurance Information Exchange Platform (Dhamani Platform) is an integral part of the Compulsory Health Insurance System that will integrate stakeholders across the payer-provider-regulator-and-other stakeholder-setting into a supporting platform,” the CMA noted in a brief description about the project. This encompasses healthcare providers, insurers, allied service providers such as diagnostic labs, pharmacies and so on, third party administrators, relevant government agencies as well as the regulators.
The portal will facilitate the processing and settlement of insurance claims, payments, approval requests, verification and validation of insurance coverage, and so on. It will also serve as a real-time repository for information on individual patients and their employers, their medical and claims history, type and cost of care provided by hospitals, pharmacies, diagnostic labs and so on. This information — suitably anonymised in the interest of protecting the individual’s identity — will allow for insurers to customise and price their policies based on the claims history of employees of their client organisation.
Final submissions are due in by June 20, 2019.