Overview
Dr. Abdulrahman Al Mishari Hospital, a long-established healthcare provider in Riyadh, Saudi Arabia, runs its clinical and administrative operations on SAP with Cerner ISH MED. Its revenue cycle had accumulated a series of manual workarounds, disconnected insurance touchpoints and billing rules that no longer reflected how payers in the Kingdom actually settle claims.
The hospital partnered with DigiMed Technologies to revamp the revenue cycle inside SAP — connecting it directly to the Waseel clearinghouse, automating the work that staff were doing by hand, and correcting the billing calculation at its source rather than at the point of dispute.

The Challenge:

• Manual insurance mapping at scale: IDF data ran to approximately 86,000 lines that were being mapped manually — slow, repetitive and an ongoing source of error.
• Eligibility checked outside the system: Benefits and eligibility were not visible to staff within SAP at the point of registration, so coverage decisions were made against information retrieved separately from the payer portal.
• Incorrect co-payment calculation: The billing logic applied the co-payment split before the insurance discount. The resulting patient and insurer shares did not match the payer-agreed method, creating billing disputes and rework.
• Policies created by hand: Insurance policies were keyed manually, with no duplication check, leading to repeated records for the same policy number.
• Fragmented approvals and submissions: Outpatient and pharmacy approvals were not visible in one place, and emergency and referral cases were not being submitted through the same channel as routine eligibility traffic.
• Package billing not reflected in the lab: Services bundled into a package were non-billable and therefore invisible in LIMS, so requested tests could not be completed until billing had been resolved.

The Solution:

• Automated IDF processing: A purpose-built program replaced the manual mapping exercise, processing and mapping the full dataset and validated against the complete dataset.
• Real-time benefits from Waseel: The Benefits Management tab was restored and integrated with the Waseel eligibility service, so current benefits — including generic and branded percentages and limits — are retrieved live and displayed to staff inside SAP.
• Automatic policy creation with duplicate control: Successful eligibility checks now auto-create the policy in SAP, with duplication checks preventing repeat records and user editing available for the few payer fields that arrive as free text.
• Corrected billing calculation: The co-payment logic was rebuilt to apply the drug discount first and then split the co-payment across IDF, generic and branded categories — matching the method the payers use. Related rules were corrected at the same time, including zero-limit handling and the treatment of substitute brands as generics.
• Unified approval screen: Pending outpatient and pharmacy approvals were surfaced in a single screen, and the outbound Waseel eligibility integration was repaired so submissions flow from the same place.
• MOH and referral submissions on the existing channel: Emergency cases for the Ministry of Health and referrals to other hospitals are now submitted to Waseel through the existing approval screen and API, with a referral flag set at service level — no parallel interface to build or maintain.
• Package billing and LIMS visibility: Packaged services are imported and zero-billed individually with only the package price appearing on the invoice, and the LIMS view was changed so bundled tests are visible to the laboratory without waiting for billing.
• Structured acceptance: Every scope item was signed off against defined acceptance criteria — a minimum of five UAT scenarios per function, and full-dataset validation for the IDF program.

Benefits Achieved:

• Manual effort eliminated: An 86,000-line mapping task that consumed staff time on every cycle is now executed by the system.
• Coverage decisions at the point of registration: Staff see live, payer-sourced benefits inside SAP rather than reconciling against a separate portal.
• Billing that matches the payer method: Co-payment amounts are calculated the way payers settle them, removing a standing cause of invoice disputes and resubmission.
• Cleaner insurance master data: Duplicate policy records are prevented at creation rather than cleaned up afterwards.
• One submission channel: Routine eligibility, emergency MOH cases and outbound referrals all travel through the same proven integration, reducing the surface area to support.
• Uninterrupted laboratory workflow: Bundled tests reach the laboratory immediately, so packaged care is no longer held up by billing status.

Conclusion:

With the revenue cycle revamp complete, Al Mishari now runs eligibility, policy creation, IDF processing, approvals and packaged billing as connected, automated steps inside SAP. The hospital has removed a long-standing manual burden from its staff, corrected billing at source, and put every payer interaction — routine, emergency and referral — on a single integration it already trusts.