Intake
Drop the day’s claim submissions on the left — DHA eClaimLink and DoH Shafafiya Claim.Submission XML files, hundreds at a time, or a ZIP of them. The payer’s reference extracts (member register, authorisations, tariff, provider contracts, paid history, clinician licences) go on the right, from the payer’s own feed: a CSV that arrives with claim files is refused, not loaded.
Drop claim XML files or a ZIP here
Any number of .xml files · .zip bundles · saved coding-engine finding contracts (.json) · parsed in-browser. Reference .csv extracts dropped here are refused.
Choose claim files
Reference extracts
The payer’s own .csv extracts, or a ZIP of them · loaded as the authoritative feed
Choose extracts
Adjudication engine and evidence gate
History ledger
Demo: generate a synthetic intake dayFabricated data, shaped like a real UAE day
Builds a full day of provider submissions across Dubai, Abu Dhabi and the Northern Emirates — pharmacies, medical centres, hospitals, dental, diagnostics — as genuine Claim.Submission XML plus the payer’s reference extracts, then runs them through exactly the same intake path as an upload. Clean traffic dominates; a controlled minority carries seeded leakage and FWA patterns so every rule can be seen working.
Reference extractsWhat the engine can check against
Without a register or authorisation extract the eligibility and authorisation families are reported as not run rather than silently passed. Column names are documented in docs/xml-intake.md.
Decision
What the engine did with today’s intake: what it released, what it stopped, what it is holding for a person, and the handful of things that most deserve one this morning.
Work queue
Every claim that did not go straight through, ranked by the dirham it holds weighted by how sure the engine is, then by regulator deadline. Open a claim for the full evidence and the draft remittance.
Providers
Thousands of facilities submit every day; nobody can read them one by one. This view ranks them by what they are costing, tiers them for network action, and compares each against peers of the same facility type.
Clinicians
A licence across every facility it appears at: presence, coding, ordering, prescribing and money against peers of the same specialty, the pharmacies and laboratories it feeds, the members who follow it, and the week its profile moved. The top 100 by score, with the cohort size beside every peer figure.
Members
Behaviour, not just cost: provider shopping, controlled-drug sourcing, identity inconsistencies and impossible journeys across emirates.
Patterns & FWA
Fraud, waste and abuse behave differently commercially — one needs enforcement, one needs utilisation control, one needs provider behaviour management. This view separates them, shows which rules are earning their place, and surfaces the relationships a claim-by-claim review cannot see — prescriber and pharmacy, clinician and laboratory, member rings, facilities that depend on a handful of members, sponsors whose staff all attend one clinic.
Over time
Today, this week, this month, this quarter, this year — against the period before. Rates and their direction rather than totals, the backlog as it ages against regulator deadlines, providers moving between tiers, rules rising, cases and recoveries, and whether the actions the network team took changed anything. Then overcoding and overbilling as a sequence: the network’s coding profile week by week with the week it moved, who is drifting, codes rising network-wide, substitution after denials, patterns that persist, and facilities in their first ninety days.
Investigations
One place for the SIU: what the day’s evidence says should become a case, what is open and what each is worth, the next action on each, what has been recovered, and the controls protecting the money while the investigations run.
Audit
The process by stage — eligibility, authorisation, the claims decision — and the variance against what the platform paid: the recoupment list, the audit sample, and the leaks a pre-payment control should close.
Remittance & exports
The output side: draft Remittance.Advice XML per provider with activity-level denial codes, rejection letters for provider relations, and flat extracts for the finance and SIU teams.
Rule register
Every edit the engine applies, its denial code, what it needs, what it did today, and what adjudicators said about it. Switch a rule off or move a threshold and the whole day re-adjudicates.