Build Dubai Health Claim (DHA eClaimLink XML)

Skill: Convert a clinical encounter into a DHA eClaim XML

Region: United Arab Emirates (الإمارات العربية المتحدة) Category: Health care — DHA eClaimLink Does: Takes a patient encounter and billing data and assembles the DHA eClaim XML — the electronic health-insurance claim that Dubai providers submit through the Dubai Health Authority eClaimLink platform (with remittance returned electronically). Spec: Dubai Health Authority eClaimLink XML schema (Dubai Drug Code, CPT/CCHI coding)

eClaimLink is the DHA's mandated channel for health-insurance e-claims in Dubai; Abu Dhabi uses Shafafiya (DoH). Claims use standard clinical/financial coding — CPT/HCPCS for procedures, ICD-10 for diagnoses, and the Dubai Drug Code (DDC) for medications — and are exchanged as XML (claim submission + remittance advice). The schema is set by the DHA eClaimLink data dictionary. Element names below follow the eClaim structure.

When this applies

• A licensed provider (clinic/hospital/pharmacy) submits an eClaim for an insured encounter to the payer via eClaimLink, then reconciles the electronic remittance advice.
• Pre-authorisation and eligibility may be required for certain services before the claim.

Structure (eClaim → XML)

Claim.Submission
  Header            SenderID, ReceiverID (payer), TransactionDate, RecordCount, DispositionFlag
  Claim (repeating):
     ID, MemberID, PayerID, ProviderID, EmiratesID
     Encounter        FacilityID, type, PatientID, start/end, discharge
     Diagnosis        ICD-10 codes (Principal / Secondary)
     Activity (repeating):  code type (CPT/HCPCS/DDC), code, quantity, net amount,
                            clinician, prior-authorization ID
     Resubmission / Contract / Observation as applicable

Data rules

• Coding: diagnoses are ICD-10; activities (procedures/services) use CPT/HCPCS (or the CCHI standard); drugs use the Dubai Drug Code (DDC); each activity carries a net amount and the performing clinician licence.
• Member & provider identity: the insured MemberID, PayerID, ProviderID/FacilityID, Emirates ID, and clinician licence must be valid in the DHA/payer directories.
• Claim total = Σ activity net amounts; quantities and amounts in AED.
• Prior authorisation: services requiring pre-approval carry the authorization ID; eligibility should be verified before submission.
• Resubmission carries the resubmission type and the original claim reference for corrections/appeals.
• The file must conform to the eClaimLink schema and validation rules (mandatory fields, code validity) before upload; the remittance advice XML is parsed to post payments/denials.

Worked example (outline)

Claim.Submission Header: SenderID=PROVIDER, ReceiverID=PAYER, TransactionDate=2025-05-31
Claim: ID=CLM001, MemberID=..., PayerID=..., ProviderID=..., EmiratesID=784-...
  Encounter: FacilityID=..., type=outpatient, start/end 2025-05-31
  Diagnosis: ICD-10 J02.9 (Principal)
  Activity 1: type=CPT 99213 (office visit), qty 1, net 150.00 AED, clinician=DHA-licence
  Activity 2: type=DDC <drug code> (amoxicillin), qty 1, net 25.00 AED
  Claim total = 175.00 AED

Emitted as the eClaim XML and submitted via eClaimLink; the remittance advice is reconciled on return.

Validation checklist

• Current eClaimLink schema / data dictionary used; Sender/Receiver/Provider/Payer IDs valid
• Member Emirates ID, MemberID, and clinician licence valid in the directories
• Diagnoses ICD-10; activities CPT/HCPCS/CCHI; drugs Dubai Drug Code (DDC)
• Claim total = Σ activity net amounts; quantities and AED amounts correct
• Prior-authorization IDs present for services that require it; eligibility verified
• Resubmissions carry the type and original claim reference
• Passes eClaimLink validation before upload; remittance advice parsed for posting (Abu Dhabi uses Shafafiya)

Last updated: 2026-05-31 — confirm the current eClaimLink schema, code sets (ICD-10/CPT/CCHI/Dubai Drug Code), and submission/remittance rules against current Dubai Health Authority (eclaimlink.ae / dha.gov.ae) guidance before use; Abu Dhabi providers use DoH Shafafiya.