Over the past months, major insurance companies in Saudi Arabia have escalated their auditing of clinical documentation—focusing closely on the accuracy of diagnoses, completeness of ICD-10-AM coding, and regulatory alignment with the Council of Health Insurance (CHI).
The result? A notable spike in claim rejections, delayed reimbursements, and mounting administrative stress for hospitals and healthcare providers.
This shift signals a systemic push towards tightened oversight, with insurance companies leveraging internal audit systems and AI tools to validate every line item in a submitted claim. Hospitals that are not prepared will feel the financial and operational strain.
The Core of the Problem: Documentation Gaps and Coding Errors
Rejections aren’t just about incorrect ICD-10-AM codes. Insurers are now:
- Requesting justification for each diagnosis code
- Auditing alignment between notes, codes, and treatment plans
- Rejecting vague or incomplete clinical documentation
- Denying claims that lack CHI-compliant medication or service details
Without a robust clinical documentation integrity (CDI) system, even the most well-meaning clinicians are at risk of miscoding or under-documenting care.
How Hospitals Should Respond
To safeguard revenue and improve operational integrity, hospitals must adopt a proactive strategy built on standardized documentation, accurate coding, and regulatory compliance.
- Strengthen Clinical Decision Support Equip physicians with tools that guide them through accurate differential diagnosis, and recommend evidence-bases and guideline-based tests and treatments. This helps improve both the quality of care and the clarity of documentation.
- Automate Claim Validation Before Submission Use pre-audit engines that simulate insurance checks before the claim leaves your system. These tools ensure every code is tied to adequate documentation and CHI standards.
- Train and Support Coding Teams Invest in ongoing education for your RCM and coding staff on the latest ICD-10-AM updates, CHI policies, and audit trends. Combine human expertise with smart tools like Glance CodeAudit or Glance Moramiz to reduce manual errors.
- Integrate Smart Documentation Tools Use tools like Glance Omni that support CHI-compliant clinical notes, recommend codes, and embed audit trails—reducing callbacks and rework from payers. Try Glance Omni now
Rejections Are Expensive. Prevention is Cheaper.
Each rejected claim costs hospitals not just time, but revenue and reputation. As regulations tighten, hospitals that embrace AI-powered documentation and coding support will outperform others in efficiency, compliance, and reimbursement speed.
The Bottom Line: You Can’t Afford to Guess
The era of poor documentation is over. Hospitals must ensure that every claim submitted is bulletproof—from the diagnosis to the code to the approval request.
- Use AI tools to support clinical decisions
- Pre-audit claims before submission
- Ensure CHI compliance at every step
Want to see how Glance Care helps hospitals reduce rejection rates and ensure claim integrity?
