Oman’s Shift Toward Digital Health
The healthcare sector in Oman is entering a decisive phase of transformation, shaped by demographic change, rising healthcare expenditure, and the government’s ambition to deliver more efficient, patient-centric services under Oman Vision 2040. A central pillar of this transformation is the modernization of the country’s health insurance infrastructure, where inefficiencies in claims management, eligibility verification, and reimbursement cycles have historically constrained both providers and insurers.
This builds on Oman’s earlier investments in digital health, including the Al-Shifa Health Information System, first deployed in the 1990s and now operating across government hospitals and health centers, along with the progressive adoption of EMR systems across facilities.
To address these systemic challenges, the Financial Services Authority (FSA) has launched Dhamani, a national health insurance integration platform that digitizes and standardizes interactions between hospitals, insurers, third-party administrators, and regulators. Since its pilot launch in April 2025, Dhamani has processed more than three million transactions, serving over 650,000 policyholders and enabling approximately 40,000 digital interactions per day.
With real-time eligibility checks, automated claims processing, standardized coding (CPT®), and improved regulatory oversight, Dhamani is designed to transform the financial ecosystem within healthcare and deliver measurable benefits across the value chain: improved cash flow for providers, more transparency for regulators, and a better experience for patients.
Dhamani: Background & National Strategy
The modernization of Oman’s health insurance ecosystem has been shaped by two converging forces: a steady rise in mandatory health insurance coverage, particularly for private-sector employees, and the government’s push to embed digital governance as a pillar of Oman Vision 2040.
Before Dhamani, claims settlement was often slow—providers reported reimbursement cycles stretching into weeks or months—and the lack of a unified workflow created inconsistencies across insurers and TPAs. These gaps directly impacted hospital liquidity, increased administrative costs, and left patients facing delays in approvals for even routine treatments.
The FSA ensured compliance by mandating standardized electronic workflows across insurers and requiring providers to migrate onto the platform. Regulators now have real-time visibility into claims data, allowing them to detect anomalies, reduce fraudulent billing, and enforce faster turnaround times for pre-authorizations. In effect, Dhamani has transitioned insurance management from a fragmented, paper-driven process to a single national digital backbone.
Beyond financial integration, Dhamani also lays the foundation for clinical-data linkages. Its roadmap includes interoperability with Shifa, Oman’s national electronic health record system, creating a unified environment where both financial and clinical information can flow seamlessly—an essential step toward a patient-centered, fully digital healthcare ecosystem.
How Dhamani Works: Integration, Coverage & Standards
Dhamani is structured as a centralized digital infrastructure with three priorities: interoperability, standardization, and compliance.
Stakeholder Ecosystem
The platform integrates hospitals, clinics, insurers, TPAs, and regulators into a single workflow. Every transaction—eligibility check, claim submission, reimbursement—is recorded digitally, creating consistency and accountability. Future phases will connect Dhamani with Shifa, extending integration from financial to clinical data.
Core Functionalities
- Eligibility Checks: Real-time verification of insurance coverage reduces bottlenecks at patient registration.
- Claims Management: Automated claims submission minimizes paperwork and human error, accelerating approvals.
- Payment Reconciliation: Providers gain visibility into their revenue cycle, supporting better financial planning.
- Fraud Prevention: Standardized audit trails and regulator oversight reduce fraudulent claims and strengthen trust.
Coding Standards
The adoption of the CPT® (Current Procedural Terminology) code set ensures uniform reporting of medical procedures. This alignment with global best practices enhances accuracy in billing, supports fair reimbursement, and creates a reliable dataset for policymaking.
Significance for Providers and Patients
For hospitals and clinics, Dhamani reduces claim rejections and accelerates reimbursements. For regulators, it strengthens oversight and improves health system accountability. For patients, it translates to faster approvals, transparent processes, and less administrative friction in accessing care.
Key Benefits Delivered by Dhamani
The introduction of Dhamani represents a strategic reform, not just a technical upgrade. Its benefits can be summarized across four dimensions:
Operational Efficiency
By replacing fragmented, manual workflows with automated digital processes, Dhamani reduces duplication, minimizes errors, and improves turnaround times. Healthcare staff can focus more on clinical duties rather than administrative tasks
Financial Resilience
Automated claims and reconciliation strengthen revenue cycle management, improving cash flow predictability for providers and reducing payment delays. This ensures greater financial stability, particularly for private hospitals that rely heavily on insurance reimbursements.
Compliance & Fraud Reduction
Dhamani creates a single source of truth for insurance transactions. Real-time oversight and standardized audit trails enhance compliance, reduce fraudulent activity, and increase system-wide accountability.
Patient-Centric Impact
Patients benefit from faster eligibility checks and pre-authorizations, fewer delays in treatment, and greater transparency in billing. By removing friction from the financing process, Dhamani helps build trust and confidence in both providers and insurers.
Challenges & Considerations
Despite its early success, Dhamani’s rollout presents several challenges:
- Onboarding Smaller Providers: While major hospitals have been integrated, many smaller clinics and pharmacies face financial and technical barriers to adoption.
- Interoperability Issues: Legacy HIS and HMS platforms often lack integration capabilities, creating the need for modern, cloud-ready solutions.
- Phase II Complexity: The upcoming expansion to include medical document exchange (X-rays, lab results, prescriptions) will demand more sophisticated workflows and tighter data standards.
- Data Security & Workforce Readiness: Protecting sensitive data and training staff on new digital workflows are essential to realizing Dhamani’s full potential.
Providers that act early to address these challenges will not only achieve compliance but also secure a competitive advantage in an increasingly digital healthcare market.
Preparing for Dhamani: Practical Readiness Guide
Based on FSA directives and national rollout updates, here are the key steps providers should act on now:
1. Confirm onboarding status and point of contact
Verify that your facility is registered in the current Dhamani rollout and designate a dedicated coordinator (finance + IT + coding) to manage readiness. The pilot engaged 9 insurers, 3 TPAs, and 33 hospitals before scaling nationwide, and momentum is accelerating.
2. Standardize coding practices
Build a procedure master mapped to CPT® codes and validate diagnoses against ICD-10/ICD-10-CM. This ensures consistency in claims and reduces rejections. Dhamani officially requires CPT® coding, bringing Oman in line with global best practice.
3. Make claims Dhamani-ready
Ensure your hospital management system or clinic management system can capture and transmit required data fields: member ID, policy number, payer code, provider facility ID, CPT® procedures, ICD-10 diagnoses, pre-authorization references, charges, and attachments.
4. Streamline pre-authorization workflows
Map services requiring pre-approval, embed turnaround time alerts, and integrate pre-authorization status into scheduling and discharge workflows to prevent patient delays.
5. Prepare for Phase II document exchange
Phase II will expand to include digital attachments such as prescriptions, lab reports, and imaging (DICOM). Providers should set up secure pipelines for document uploads now to avoid future disruption.
6. Strengthen security and privacy controls
Adopt encryption, TLS, role-based access, MFA for critical actions, and immutable audit logs. Regulators will expect evidence of data protection measures aligned with FSA guidelines.
7. Train and certify staff
Upskill revenue-cycle teams and coders on CPT® and ICD-10. Track coder accuracy, monitor first-pass clean claim rates, and ensure pre-authorization teams are confident in digital workflows.
8. Integrate with Oman’s broader digital health stack
Plan for future interoperability with Shifa, the national EHR system, so that both clinical and financial data flow seamlessly in one ecosystem.
9. Monitor KPIs with a monthly scorecard
Track key performance indicators such as clean-claim rate, pre-authorization turnaround, denial rate by reason, days in accounts receivable, and attachment completeness. These metrics will highlight gaps and ensure continuous improvement.
10. Build an audit-ready compliance pack
Maintain a repository with coding policies, training logs, security protocols, access reviews, and internal claim audits. This prepares you for regulator inspections and minimizes risk of penalties.
Looking Ahead: What’s Next for Dhamani & Oman’s Digital Health
Dhamani is best understood as the foundation of Oman’s digital health ecosystem, not its endpoint. While Phase I focused on insurance integration, future phases will broaden scope and functionality:
- Clinical Linkages: Integration with Shifa, Oman’s national electronic health record system, will enable seamless sharing of patient information across institutions.
- Advanced Analytics: Aggregated data can be leveraged for policy planning, cost management, and population health insights.
- AI-Driven Capabilities: Predictive models and AI-enabled claims auditing will reduce fraud, optimize resource use, and improve outcomes.
For providers, this future underscores the importance of integration readiness. Hospitals and clinics with modern, interoperable HIS/HMS platforms will not only meet compliance but also be positioned to thrive in a digitally integrated healthcare economy.
The Role of Medinous in Oman’s Digital Health Journey
At Medinous, we are committed to helping hospitals and clinics prepare for the future. Our hospital and clinic management systems are designed with flexibility, interoperability, and regulatory alignment at their core. Our platforms ensure compatibility with emerging regulatory standards across Oman and the GCC.
This means providers adopting Medinous solutions can be confident that they are investing in systems built to:
- Support integration readiness for new technologies and latest compliances
- Deliver cloud-ready and interoperable HIS/HMS capabilities for smoother compliance.
- Provide robust financial, clinical, and operational modules to manage workflows in line with regional standards.
- Adapt quickly to new regulatory requirements, from insurance integration to data privacy mandates.
For hospitals and clinics, partnering with us, we help build the resilience and agility needed to thrive in an evolving regulatory environment.
Ready to future-proof your healthcare operations?
Contact us today to learn how Medinous can support your digital health journey.
