Hakeem

Last updated: 2026-03-29

Overview

The Hakeem (JoFotara / TPO) Integration module connects your facility to the national health insurance network. It handles the electronic communication between your clinic or hospital and the patient's insurance company. You will use this module to check patient coverage, generate official E-Forms, request medical approvals, and submit final financial claims for payment.

When Do I Use This?

  • At Reception (Patient Check-In): To verify a patient's insurance eligibility and generate an E-Form before they see the doctor.
  • During Treatment (Prior Authorization): When a doctor prescribes a medication or service that requires special approval from the insurance company.
  • At Checkout / Billing: To submit the final invoice (the "Claim") to the insurance company so your facility gets paid.

Insurance Company Rules (E-Form Generation)

The system automatically knows how to handle different insurance companies based on national regulations. When you register a visit, the system applies one of three rules to get the E-Form:

Insurance Company (Payer) How the System Handles It
Medservice, Omnicare Checks Eligibility First. It sends patient details to the network to confirm coverage before generating the form.
Islamic, Mednet, Solidarity Requires Authorization Observation. The system submits a specific authorization request to get the E-Form number.
Newton, EuroArab, Arab Assurers, Globmed Auto-Generates the form. The network does not require pre-checks for these companies.

How To Use

1. Checking Eligibility & Getting an E-Form

  1. Open the patient's visit or encounter record.
  2. Ensure the patient's National ID Number and Insurance Details are filled out.
  3. Click Check Eligibility / Auth.
  4. The system will securely contact the health network. If approved, the E-Form Number will automatically appear on the screen.

2. Submitting a Financial Claim

Once the patient's visit is complete and all services/drugs are recorded:

  1. Go to the Billing or Claims section for the visit.
  2. Review the financial breakdown to ensure the Gross amount and Patient Share are correct.
  3. Click Submit Claim.
  4. The system will send the final bill to the network. If successful, you will receive confirmation and digital QR Codes for the invoice.

3. Handling Resubmissions or Corrections

If a claim is rejected or needs adjustment:

  1. Open the rejected claim.
  2. Make the required corrections (e.g., fix a diagnosis code or remove a denied service).
  3. Add a short explanation in the Comment box.
  4. Click Resubmit.

Field Descriptions

Field Name Description
E-Form Number The official national tracking number for the visit (e.g., JOR-F-999...). This is required for all billing.
Prior Auth ID The specific approval code provided by the insurance company for restricted services or medications.
Encounter Type Classifies the visit type. Options include: Outpatient, Emergency, or Inpatient.
Gross Amount The total price of the services or drugs before any insurance coverage is applied.
Patient Share The out-of-pocket amount the patient must pay at the front desk (deductible/copay).
Net Amount The remaining amount that the insurance company is responsible for paying to your facility.
Diagnosis Type Classifies the medical diagnosis. It must be marked as Principal (main reason for visit), Secondary, or Admitting.
Activity Type Identifies what was provided to the patient: JMA (Doctor Consultations), Drug (Pharmacy), or Service (Labs/X-Rays).
TPO Transaction ID A behind-the-scenes system tracking number used by IT if there is a technical problem with the claim.
Tip: When a claim is successfully submitted, the system receives QR Codes. You can print these directly onto the patient's receipt or the insurance invoice. There is usually one QR code for the Patient and one for the Insurance records.
Note on Errors: If a submission fails, the system will display an "API Error" with a specific rule code (e.g., "Missing Diagnosis"). Check the error message carefully—it tells you exactly which field is missing or incorrect before you try submitting again.
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