Shafafiya Explained: Claims and Approvals for Abu Dhabi Clinics
Short answer: Shafafiya is the Department of Health Abu Dhabi system for exchanging insurance transactions, plus the standards those transactions must follow. Every prior request, authorisation, claim and remittance between an Abu Dhabi clinic and its payers moves through the Shafafiya Post Office in a set XML format, so getting Shafafiya right is a billing system and process job, not just a login.
Last verified: October 2026 against the DOH Shafafiya portal (Dictionary, Standards, Prices and Notices), the DOH Business Rules and the DOH Connecting to Shafafiya Webservices Guide (2025).
Key Takeaways
- Shafafiya has two parts: published data standards and the Post Office that moves transactions between providers and payers.
- Access is requested through the DOH user management page and needs a facility authorisation letter and DOH approval.
- Prior request, authorisation, claim, remittance and resubmission are linked steps, and one validation error makes a whole transaction invalid.
- You cannot resubmit a claim until its Remittance Advice arrives, and the member ID must match the insurance card exactly.
- The rules sit in several places on the DOH site, so check the Notices page and the current Claims and Adjudication Rules before you change a billing rule.
What Shafafiya Does
DOH describes Shafafiya in two parts. The portal holds the key standards that govern how healthcare information is exchanged in Abu Dhabi: data elements, code sets, schemas and business rules. The Shafafiya Post Office is the data exchange system that actually moves the files between healthcare entities. DOH states that any electronic transactions between healthcare entities need to be structured and exchanged according to these standards, and it requires all Abu Dhabi healthcare entities to monitor its Notices page so their systems stay up to date.
The Dictionary publishes the schemas and XML samples your billing software must produce, including Claim Submission, Remittance Advice, Prior Request and Prior Authorization, and the code sets behind them: ICD 10, CPT and HCPCS, drugs, LOINC, SNOMED CT and DOH’s other codes. When we review an Abu Dhabi clinic’s billing, the first question is whether the practice system is producing these files correctly, because most problems start there.
Shafafiya is not Malaffi. Shafafiya carries insurance and other structured transactions, while Malaffi is Abu Dhabi’s health information exchange for clinical records. Our guide to health information exchange in the UAE covers Malaffi. Dubai uses a different system, so do not reuse Dubai instructions for an Abu Dhabi claim.
How a Clinic Gets Access
The clearest official steps are in DOH’s 2025 Connecting to Shafafiya Webservices Guide. It was written for the clinical costing data submission, but the registration steps for a Shafafiya user are set out in it:
- Register a new user on the DOH user management page.
- Choose “Shafafiya E-claim” as the facility type and select your facility.
- Select the service line you need.
- Attach a letter confirming you are authorised by the facility to access the function, and add a short justification.
- Request the e-service and wait for DOH approval.
- Email the Shafafiya team (shafafiyasupport@doh.gov.ae, copying IT@doh.gov.ae) from the email address registered on your facility licence.
The guide does not publish a fee or an approval time, so treat both as not published and confirm with DOH. Before going live, use the Public Test Environment to test your files. DOH says it is designed for functional testing, not performance or stress testing of your system.
In practice most clinics connect through their practice management or billing system rather than building their own link, so ask your vendor to show you a successful test submission before you sign.
How the Transaction Cycle Works
| Stage | What Happens | What to Control |
|---|---|---|
| Prior Request | The clinic sends the planned service with coded details when the payer requires approval | Patient, payer, diagnosis, activity, quantity and date match the clinical record |
| Prior Authorization | The payer replies; a refusal must carry a denial code | Record the authorisation and approved activities exactly |
| Claim Submission | The clinic bills the service after care | Bill what was documented and authorised; member ID exactly as on the card |
| Remittance Advice | The payer or TPA that received the claim returns the result | Reconcile every activity, payment and denial code |
| Resubmission | The clinic corrects an error or disputes a decision | Wait for remittance and use the Resubmission element |
The DOH Business Rules add a few points that catch new billing teams out:
- If validation finds an error, the transaction is invalid in full. It can be sent again once every error is corrected.
- If a TPA receives the claim, that TPA, not the insurer, sends the Remittance Advice, and payers must submit it on the day of remittance.
- A claim cannot be resubmitted until its Remittance Advice has been received.
- A correction resends the entire claim, while an internal complaint includes only the activity you are contesting.
- The version of the Business Rules DOH links today sets 45 calendar days from the Remittance Advice for a disputed claim or correction. Check your payer contract and the latest DOH circulars too, because they can set their own time limits.
If approvals are your weak point, our guide to prior authorization in the UAE goes through the workflow in more detail.
Which Rules Govern a Claim
Shafafiya is not one rulebook. The rules sit in four places on the DOH site:
- Dictionary: data elements, schemas, code sets and samples.
- Standards: Business Rules, validation rules, policies and release management.
- Prices: the mandatory tariff and the Claims and Adjudication Rules.
- Notices and circulars: changes and new requirements.
The newest general claims document on the Prices page during our review was the DOH Claims and Adjudication Rules V2025.1, which applies to claims with an encounter start date from 1 November 2025, together with a series of numbered addenda. The Prices page also now carries draft rules for the outpatient and emergency care reimbursement reform (ADOC shadow billing). Check the live Prices page before you apply a coding or pricing rule, because a newer version or addendum may have replaced the one your team learned.
Common Rejection Risks to Control
DOH does not publish a ranking of rejection reasons, so we will not invent one. These are the failure points the rules themselves point to:
- A member ID that does not match the card exactly.
- A missing mandatory field or a schema error, which invalidates the whole transaction.
- A billed service, quantity, date or code that does not match the authorisation.
- A second original claim sent instead of waiting for remittance and resubmitting properly.
- A correction that includes only one line when the whole claim must be resent.
- Outdated code files, tariff rules or schemas in the billing system.
A simple daily habit helps: keep technical rejections and adjudication denials in separate queues. Technical errors need a clean corrected file. Denials need the clinical, coding or contract reason understood before anything is resent.
Frequently Asked Questions.
Is Shafafiya the same as Malaffi?
No. Shafafiya is the DOH standards and exchange system for insurance transactions such as claims and authorisations. Malaffi is Abu Dhabi’s health information exchange for clinical records.
How do I register for Shafafiya?
Register a user on the DOH user management page, choose the Shafafiya E-claim facility type, attach a facility authorisation letter and request the e-service. DOH approves it, and the approval email must come from the address on your facility licence.
Can a clinic resubmit a claim straight away?
No. Under the DOH Business Rules you must first receive the Remittance Advice for that claim. The resubmission must carry the Resubmission element and follow the rules for a correction or an internal complaint.
Is there a fee to connect to Shafafiya?
DOH’s registration guide does not publish a fee or an approval time. Ask DOH for the current position, and ask your billing vendor what their own connection and support charges are.
Where This Comes From.
- DOH: Shafafiya overview and Post Office
- DOH Shafafiya: Dictionary (schemas, samples and code sets)
- DOH Shafafiya: Prior Request and Prior Authorization
- DOH Shafafiya: Public Test Environment
- DOH Shafafiya: Standards
- DOH Shafafiya Business Rules
- DOH Shafafiya: Prices and Claims and Adjudication Rules
- DOH: Connecting to Shafafiya Webservices Guide (2025)
How OzaniX Partners Can Help.
Our Insurance and Revenue Cycle team helps Abu Dhabi clinics set up Shafafiya the right way: checking that your billing system produces clean files, building prior authorisation and resubmission routines, and reconciling remittances so denials are worked rather than written off. If you are still getting on to insurer panels, our Insurance Empanelment service can run that alongside.
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