Insurance Department & Claims Department

1. Check Eligibility (verifying the insurance patients )

1.1. regular insurance

1.1.1. Live saving

1.1.1.1. Approvals team (Send it to insurance company directly within 24 hours)

1.1.2. Normal

1.1.2.1. Eligible

1.1.2.1.1. Approvals team

1.1.2.2. Not eligible

1.1.2.2.1. Cash

1.2. Pilgrims Insurance

1.2.1. Covid-19

1.2.1.1. Approvals team

1.2.2. Other

1.2.2.1. Statistics team

2. Approvals

2.1. Pilgrims Insurance

2.1.1. Covid-19

2.1.1.1. Send the approval request through Riaya-ksa.com within 24 hours

2.1.1.1.1. Creating the invoices on the system

2.2. Regular insurance

2.2.1. Send the approvals request through insurance companies portal

2.2.1.1. Creating the invoices on the system

2.2.1.1.1. Send the invoices and all supported document to claims department

3. Claims

3.1. Filling forms and preparing a statement of patients' names and amounts according to each insurance company

3.1.1. Submitting claims through insurance companies' portals within the period specified by the Health Insurance Council for submitting claims

3.1.1.1. Follow up the payment

3.1.1.1.1. Creating the receipts for the received payment according to the insurance company name