Shafafiya
Reporting of medical tourism, self-pay and non-insurance claims
In accordance with DOH Circular CEO 52/11 Providers are required to report in electronic claims with ReceiverID=HAAD all transactions not previously submitted through shafafiya. In addition, the DoH Circular US/25/18 requires Providers to distinguish self-pay and medical tourism in their reporting claims.
From 17 October 2022, the DoH Circular number USO/235/2022 established an updated definition of Medical Tourism.
In relation to that, the following definitions and rules apply within the DoH Data Standard:
Definitions
Medical tourist: Any non-UAE resident, travelling from abroad into the UAE, receiving non-emergency medical treatment (clinical and/or wellness care) in the emirate of Abu Dhabi. Excludes patients whose care is funded by UAE government or AD-based.
Self-pay patient: Any UAE national or non-national not classified as Medical tourist paying directly for a medical service received in a healthcare facility licenced by the Abu Dhabi Department of Health.
Other non-insurance patient: Any UAE national or non-national not classified as Medical tourist neither claiming insurance nor paying directly for a medical service received in a healthcare facility licenced by the Abu Dhabi Department of Health.
Reporting
Patient demographics reported in PersonRegister and encounters in ClaimSubmission transactions in accordance with general requirements of the Data Standard and particularly:
Person Register
-
Header
- ReceiverID=HAAD
- Other elements as per the Data Standard
-
Person
- UnifiedNumber – required if EmiratesIDNumber contains one of the default values as per the definition
- BirthDate
- Gender
- Nationality
- PassportNumber
- EmiratesIDNumber
- MemberID=EncounterFacilityID#EncounterPatientID - as per the definition
- CountryOfResidence=a value from the ‘Country’ column of the list of nationalities
- EmirateOfresidence=a value from the ‘Code’ column of the list of Emirates – only reported if CountryOfResidence=’United Arab Emirates’
Other relevant elements as per the Data Standard
ClaimSubmission
-
Header
- ReceiverID=HAAD
- Other elements as per the Data Standard
-
Claim
- PayerID=MedicalTourismSelfPay or MedicalTourismOther or SelfPay or ProFormaPayer - depending on the patient status as per the definition of ClaimPayerID
- MemberID=EncounterFacilityID#EncounterPatientID - as per the definition
- Gross – as per the definition
- PatientShare=Amount Patient owes to the provider
- Net=0
-
Encounter
- PatientID=Medical record number, as per the definition
- Other relevant elements as per the Data Standard
-
Diagnosis
- all relevant diagnoses as per the Data Standard
-
Activity
- all relevant activities as per the Data Standard
- Other relevant elements as per the Data Standard