A centre affiliated to the CHIC, which acts as a mediator between insurance companies, service providers and claims management companies to end financial disputes without resorting to judicial authorities.
In establishing the centre, the Council relies on the decision of His Excellency the Minister of Health and Chairman of the CHIC No. (18/5/R) dated 19/7/2018 AD to adopt a new mechanism for settling and paying the dues of health service providers.
It aims to facilitate the reconciliation process between the parties and motivate them by bringing their views closer to reach an agreement which is acceptable to the parties through fully automated and digitized procedures.
The statutory document for the establishment of the center
In establishing the center, the Council relies on the decision of His Excellency the Minister of Health, Chairman of the Council of Cooperative Health Insurance No. (5/18/R) dated 7/19/2018 AD, to adopt a new mechanism for settling and paying the dues of health service providers, which included in Paragraph No. (6) that “ In the event that the two parties do not agree on the final settlement or no settlement occurs or it falters, it will be transferred to the Reconciliation Center of the CHIC ” According to the decision of His Excellency the Minister of Justice No. (5595) dated 11/29/1440 AH, he approved on the rules of work in the offices of Reconciliation and their procedures.
When the Council undertakes the financial settlements, that allows to it to see the real challenges facing the parties to the insurance relationship and then adopt the regulatory amendments to overcome obstacles and avoid negatives in the insurance market.
Enabling the Center to issue a code of the most prominent principles of reconciliation and the decisions made through the sessions by counting the points of conflict between the parties, and documenting those decisions.
Achieving sustainable development of the health insurance market by taking proactive measures to ensure the smooth running of health insurance operations, and proposing appropriate solutions and systems to develop the health insurance market.
Terminating the health insurance financial disputes between insurance and claims management companies and service providers through the reconciliation Center encourages the rest of the service providers to end their financial disputes with insurance and claims management companies without resorting to the judicial authorities that some service providers may refrain from in their desire to continue the relationship with the insurance companies.
Resorting to the center relieves the burden on the judicial authorities, reduces the period of procedures, allows maintaining the cordiality of the contractual relationship between the parties of the dispute, and gives the possibility of continuing their financial transactions after settlement.
Reaching a solution by the parties to the conflict.
Ensuring financial rights between the parties to the insurance relationship.
Recording and keeping all reconciliation and dialogue sessions, which can be referred to when needed.
The center specializes in settling the following health insurance disputes
The Center is not competent to consider any dispute or part of a dispute related to a criminal matter or related to public order
The Center is not competent to consider any reconciliation request that has been more than one year since the due date of the compensation in question
Financial disputes that arise between insurance companies and health service providers.
Financial disputes that arise between claims management companies and health service providers.
Any other financial disputes that are related to health insurance business shall be added pursuant to a decision by the director of the Reconciliation Center at the CCHI.
