Insurance claims · AI system for providers

An AI check on every claims batch, before it goes to Dhamani.

We start with a denial audit of your last three months, personal details removed, to show the rejection reasons and the OMR at stake. Then we set up Submit-Ready to check each new batch against insurer rules and your contracts before it is sent. Your coders work only on the flags.

After permit. This service opens once our Ministry of Health data permit is in place. Until then we only share the method and a fictional sample report. Join the early list and we will tell you first.

Join the early listAll services
You approve before anything is sentNDA before you share your own recordsPrice agreed in writing before we start
Batch_Oct_W3 · 412 claimsBefore Dhamani
412claims checked
Clean398
Flagged14OMR 2,860 at stake
  • Prior approval missing4
  • Diagnosis and procedure don't match5
  • Price above contract5
Your coder reviews 14 claims, not 412

Illustrative screen, fictional data.

The problem

Insurers check every claim on Dhamani against prior approvals, member eligibility, codes and contract prices. A rejected claim is revenue that arrives late or not at all, and most clinics only see the reasons weeks later.

  • Rejections that surface weeks later.
  • No time to group the rejection reasons.
  • The front desk submits claims; nobody checks them first.

How it works, start to finish

Hover or tap a step to see an example.

System
  1. 1

    Claims exported

    Your team

    Your team exports a claims file from your system.

    ExampleBatch_Oct_W3.xlsx · 412 claims exported from your hospital system
  2. 2

    Personal details removed

    Your team

    Names, civil IDs, member numbers, phone numbers and dates of birth are removed before the file reaches us.

    ExampleNames, civil IDs, member numbers, phones and dates of birth removed on your side before upload
  3. 3

    Every claim checked

    Submit-Ready

    The system checks prior approval, eligibility, codes and contract prices, and lists each issue with its reason and the OMR at stake.

    Example14 of 412 flagged · 4 missing prior approval · OMR 2,860 at stake
  4. 4

    Your coder decides

    Your team

    Your coder or treating doctor decides on every flag.

    ExampleClaim 0388: suggested code change with the reason shown. Your coder accepts or rejects it.
  5. 5

    Submitted through Dhamani

    Outside

    Claims go through Dhamani as they do today, with fewer avoidable errors.

    Example398 clean and 11 corrected claims go to Dhamani; 3 are held for a doctor's note.
What you get

Where rejected money comes from

What the system takes off your desk

  • Denial audit: rejection rate, top reasons and OMR at stake
  • Pre-submission check on prior approval, eligibility and duplicates
  • Diagnosis–procedure consistency and contract-price checks
  • Code suggestions for your coder, with the reason shown

What stays with you

  • Final coding and every decision by your coder or treating doctor
  • Submission through Dhamani
  • Your contracts with insurers
Rejection reasons in a sample auditSample · fictional data
  • Prior approval missing32%
  • Diagnosis and procedure don't match21%
  • Member not eligible on the date17%
  • Price above contract14%
  • Duplicate lines9%
  • Other7%
OMR at stake in the sample period
  • Still within the resubmission windowOMR 4,120
  • Past the windowOMR 3,230

Dhamani connects private hospitals, clinics and insurers.

36 · 1,290Private hospitals and private pharmacies in Oman at the end of 2025.
92 million+Claims settled through Dhamani, as reported by the Financial Services Authority in October 2026.
3 monthsOf history, names removed, is enough for a first audit.
Your coder decidesEvery suggestion goes to your coder or treating doctor.

Sources: NCSI Health Statistics 2026; Financial Services Authority figures reported by Muscat Daily, 7 Oct 2026. Dhamani is the FSA's national health-insurance platform.

How to start

  1. Sample audit

    A denial audit on synthetic data, in the format you would receive.

    Free

  2. Your denial audit

    Three months of your claims, personal details removed: reasons and OMR at stake, in 5 working days. No fee if we find less than five times the fee in claims still within the resubmission window.

    After permit

  3. 30-day pilot on your files

    We set the system up on your claims and it checks every batch before submission. We measure rejections before and after.

    After permit

  4. System + support

    The system checks every batch; we keep it tuned and send a monthly rejection report.

    After permit
Start with a free sample →See all prices →

Questions

Do you need patient names?

No. For the first audit your team exports the claims file with names, civil IDs, member numbers, phone numbers and dates of birth removed. We send a one-page guide. The file is used only for your audit and deleted 30 days after we deliver it.

Can you recover rejected money?

Sometimes, if a claim is still within the resubmission window. The audit shows which ones are; your team resubmits.

Do you code claims?

We suggest. Your coder or treating doctor decides.

Will this stop all rejections?

No. It catches the avoidable ones before submission and shows you where the rest come from.

Ask for a sample denial audit.

We will send the sample report and explain what we would need from your system.

Join the early listBook a 20-minute call
We reply within one working day.Email [email protected]Muscat, Sultanate of Oman