Policies & benefits
The core record. Clients, insurers, covered services, benefit schedules, sub-limits, copays, exclusions, payment terms and reimbursement rules — versioned and enforced.
Third-party administration, built for Sudan
Every claim, every member, every provider — one network.
Sudan Health Care Network administers health cover from the policy down to the individual line item: benefits and sub-limits, provider contracts and price lists, preauthorization, and claims adjudication. Arabic-first, fully bilingual, in a single system.
Arabic-first · Full right-to-left · Runs in any modern browser
Preauthorization
Reference PA-2026-04817
- Member
- A. M. Ibrahim
- Policy
- SHC-114-207
- Provider
- Royal Care Hospital — Khartoum
- Requested service
- MRI — Lumbar spine, without contrast
-
Request received
Raised from the provider portal
-
Eligibility verified
Member active · policy in force
-
Benefit & limit check
Radiology covered · sub-limit available
-
Price list matched
Contracted rate applied for this network
-
Decision returned
Approval sent back to the provider
Contracted price
240,000 SDG
Member share (20%)
− 48,000 SDG
Payable by scheme
192,000 SDG
Approved
Within annual radiology sub-limit
Built to carry a national book of business.
- 0
- Corporate & individual policies under administration
- 0
- Contracted hospitals, clinics and pharmacies
- 0
- Lives covered across the network
- 0
- Median preauthorization turnaround
Four sides of the same transaction
One platform, four points of view.
Insurers, employers, providers and members each see the part of the network that belongs to them — and nothing that does not.
Underwrite with the numbers in front of you
Configure a product once and administer it forever. Benefits, sub-limits, copays, exclusions, waiting periods, payment terms and reimbursement rules are all defined at the policy and enforced on every single claim.
- Policy, benefit and service configuration in one place
- Contract terms, payment schedules and reimbursement rules
- Additions and removals with pro-rata terms
- Full claim and batch history behind every settlement
Look after your people without the paperwork
Manage your organisation, its branches and its members from one registry. Add joiners, remove leavers, issue cards and see exactly what your scheme is spending.
- Company, branch and contact registry
- Member enrolment with documents attached
- Digital and printable member cards
- Transaction history per member
Get an answer before the patient leaves the desk
A dedicated provider portal for preauthorization, claim submission and batch settlement — with your contracted price list already loaded, so there is nothing to look up and nothing to argue about.
- Raise and track preauthorizations in real time
- Submit claims individually or as a batch
- Your contracted prices, applied automatically
- Request price changes and manage your doctors
Your cover, in your pocket
A digital member card, the full provider directory and the status of every approval — on a phone, in Arabic or English.
- Digital member card, always with you
- Search the network by city and speciality
- Follow preauthorization status live
- Chronic medication approvals and refills
The platform
Everything a TPA actually does.
Not a dashboard bolted onto a spreadsheet — the whole administrative chain, modelled properly and wired together.
Provider registry
Hospitals, clinics, labs and pharmacies with their branches, contacts, documents, contracts and the networks they belong to.
Preauthorization
Requests raised at the point of care, checked against eligibility, benefit and limit, priced from the contract and decided while the patient is still there.
Claims & batches
Individual claims and provider batches, adjudicated line by line against the policy and settled with a full audit trail.
Price lists
Item-level pricing per provider and per network, with provider-initiated change requests that route through approval.
Member cards
Issue, render and print member cards straight from the policy — as a PDF for the file or a digital card in the app.
Chronic management
Standing approvals for long-term conditions, with scheduled dispensing so chronic patients are not re-approved every month.
Network directory
A searchable directory of every contracted facility by city, speciality and network tier — for staff, providers and members alike.
How it works
From the reception desk to settlement.
The same five steps run behind every visit on the network — whether the request comes from a teaching hospital in Khartoum or a single-room clinic.
-
01
The member presents
A digital or printed card identifies the member and the policy behind them at any contracted facility.
-
02
The provider requests
Reception raises a preauthorization from the provider portal and picks the service from the medical operations catalogue.
-
03
The scheme is checked
Eligibility, benefit coverage, sub-limits, copays and exclusions are evaluated against the live policy.
-
04
The price is applied
The contracted rate for that provider and that network is matched from the price list — no negotiation at the counter.
-
05
The claim settles
The visit becomes a claim, joins the provider batch, is adjudicated line by line and settled against the payment terms.
Member app
The network, in a pocket.
Members carry their cover with them: a digital card that works at any contracted desk, the full provider directory, and live approval status — in Arabic or English.
Digital member card
Policy, member number and cover tier, ready at the desk.
Find a provider
Search the network by city, speciality or facility name.
Approval status
Follow every preauthorization from request to decision.
You stay in control
Request deletion of your account and data at any time.
Available for iOS and Android
Good morning
Amira
Member card
A. M. Ibrahim
SHC-114-207-08
Gold — Family
Valid to
12/2026
Approved
PA-2026-04817
Near you
Royal Care Hospital
Khartoum · Multi-speciality
Alamal Pharmacy
Bahri · Pharmacy
By design
Bilingual, governed, and boring in all the right places.
Health claims are other people's money and other people's medical records. The platform is built accordingly.
Arabic first, not Arabic later
Every record carries both an Arabic and an English name, and the entire interface mirrors to right-to-left — not a translation layer, a first-class direction.
Separate portals, separate eyes
Administrators, providers and members each authenticate into their own portal and see only the records their role permits.
A trail behind every decision
Approvals, price changes, additions and removals are recorded with who did what and when, so a settlement can always be explained.
Documents where they belong
Contracts, licences, member documents and provider paperwork are attached to the record they concern instead of an inbox.
Get started
Move your book onto the network.
Whether you are an insurer looking for an administrator, an employer arranging cover, or a facility that wants to join the network — talk to us.