TOSHFA

What Is TOSHFA?

TOSHFA is an insurance management platform designed for organizations to manage core insurance operations from a centralized system. The software automates processes such as policy administration, claims management, and provider network management, reducing manual effort across key workflows. It also offers real-time reporting that supports faster review of claims, policies, and financial transactions. TOSHFA is suitable for growing and large organizations that want better control over insurance operations and improved coordination between departments across their insurance setup.

What Is TOSHFA Best Known For?

TOSHFA is best known for its flexible workflow configuration, which allows organizations to adapt operational processes and business rules to their specific requirements without extensive reprogramming. This capability is especially useful for health insurers and third-party administrators managing varied workflows, helping simplify administration, maintain process consistency, and accommodate changing operational needs.

How Much Does TOSHFA Cost?

TOSHFA cost is estimated to range from $5,000 to $25,000/month as a base software subscription, based on industry benchmarks for comparable enterprise-grade core insurance and policy administration suites. This range is provided for general informational purposes only, and actual pricing may vary depending on the modules selected such as Hospital Network or Claim Process, the number of user licenses required, and the level of customization needed for specific operational requirements.

In addition to the base subscription costs, organizations should also consider the following additional expenses:

• Implementation: Usually estimated between $40,000 to $150,000 for focused configurations, and can go up to $150,000 to $500,000+ for large-scale, enterprise-wide deployments, depending on complexity
• Content Migration: Typically ranges from $25,000 and $120,000, based on the volume of policy history and the complexity of data validation required
• Admin And Instructor Training: Generally estimated at $10,000 to $45,000 to ensure proper system adoption and effective usage
• Hospital Network, EDI, And API Integrations: Usually ranges from $15,000 to $75,000 depending on the scope and depth of integration requirements

Disclaimer: Pricing references are based on publicly available third-party information and industry benchmarks. Actual costs may vary.

TOSHFA Integrations

TOSHFA integrates with various systems and platforms, including:

• Waseel
• Yakeen Web Services

How Does TOSHFA Work?

Here is how you can get started with the software:

• Log in to the platform and configure master data, including medical codes, provider details, insurance plans, and policy information
• Create prospect groups and upload member data to generate quotations using predefined products and network plans
• Review premium calculations and convert approved quotations into active policies with the relevant coverage details
• Manage provider networks by maintaining provider records, contracts, reimbursement information, and approved provider directories
• Enroll members and verify eligibility based on policy terms and configured business rules
• Process approval requests and review healthcare services according to policy coverage requirements
• Submit and manage claim batches, then review and process reimbursements based on member benefits and policy conditions
• Generate reports to monitor policies, claims, approvals, and overall operational performance

Who Is TOSHFA For?

TOSHFA software is designed for organizations that manage and administer health insurance operations. It is typically used by:

• Insurance companies
• Third party administrators (TPAs)
• Insurance brokers and agents
• Corporate insurance teams
• Healthcare provider networks and hospitals

TOSHFA Use Cases

Based on our analysis of TOSHFA's capabilities, we have identified key scenarios where this software is a good fit for insurance organizations:

Insurance Carriers Managing Fragmented Group Underwriting Operations

Large underwriting teams often experience delays in premium calculations when manually assessing complex corporate risk profiles. This platform enables risk assessors to automate multi-tiered plan options by directly importing member data matrices. This automated validation process significantly reduces quote turnaround times and speeds up proposal delivery.

Third Party Administrators Overwhelmed By Fragmented Reimbursement Demands

Administrative teams managing large volumes of inpatient, outpatient, and cashless medical bills often struggle while ensuring each claim aligns with the correct member policy. TOSHFA helps address this by using a table-driven architecture that automates rule-based validation processes. This allows teams to review complex diagnostic criteria more efficiently and maintain better oversight across large-scale claim settlement workflows.

Insurance Companies And TPAs Managing Provider Networks

Insurance companies managing large provider networks often face challenges in tracking provider classifications, contract terms, and fee schedules across multiple regions. The software here supports insurer and TPA billing teams through a centralized platform that consolidates provider contracts and verified directories in one system. This helps improve coverage verification, maintain consistent records, and streamline electronic transaction processing across the provider network.

Insurance Sales Teams Coordinating Commercial SME Enrollment Lifecycles

Commercial insurance teams looking to expand their reach among small and medium-sized businesses often encounter delays during policy onboarding, document preparation, and compliance reviews. TOSHFA helps centralize these processes through a dedicated online portal that brings enrollment activities and digital premium calculations into one place. This allows sales teams to print insurance cards, manage employee enrollments, and process bulk submissions more efficiently from a single interface.

Is TOSHFA Right For You?

If you are a health insurer or a third-party administrator looking for a specialized medical insurance platform to streamline complex administrative processes, TOSHFA can be a great option. This enterprise-grade system addresses common challenges such as delayed group quote generation and fragmented claim-settlement workflows. It offers strong data scalability along with robust security measures to protect sensitive patient information.

Designed with financial transparency in mind, the platform supports IFRS 17 compliance and aligns with strict regulatory frameworks set by the Council of Health Insurance. It is used by several established insurance institutions, including Boubyan Takaful, Cigna Saico, Al Wathba, Al Sagr, Anchor HMO, and AXA Mansard.

Still doubtful if TOSHFA is the right fit for you? Get in touch with us at (661) 384-7070, and we will help you make an informed decision.