The Council of Cooperative Health Insurance (CCHI) regulates health insurance providers in Kingdom of Saudi Arabia (KSA). Together with its stakeholders, it is implementing a standardised code set for interventions claimed by providers from health insurers. The project was part of a larger agenda to transform the KSA health system to price services based on quality outcomes.
Australian Institute of
Health and Welfare
Our approach
HPA worked with ACCUMED (a company based in the United Arab Emirates), and Matthews Coding Solutions (Australia) on phase 1 of the project, which was to code approximately 40,000 claims by providers using the Australian Classification of Health Interventions (ACHI).
Outcome
HPA’s contribution was to review the coded records and refine the ACHI classification to ensure that it adequately covers interventions in ambulatory settings and that the codes appropriately reflect resource use. The coverage of the refined system was then expanded to include inpatient care claims, and towards this HPA reviewed and expanded the inpatient codes to ensure sufficient specificity and granularity in the codes for claims, for example, reflecting unilateral vs bilateral procedures or multiple procedures undertaken in a single episode of care (such as a course intravenous antibiotics). In addition, HPA developed standards for applying the new code set in ambulatory and inpatient settings.
