Claim: CL-20233
Noura Al Harbi, Dental / Oral, SAR 380.00. Everything NPHIES and the payer said about this claim.
ApprovedNoura Al Harbi, Dental / Oral. Bupa Arabia.
Approved. Bupa Arabia approved SAR 342.00 and the patient pays SAR 38.00.
Patient
- Name
- Noura Al Harbi
- ID Number
- 1087654321
Claim details
- Claim ID
- CL-20233
- Claim type
- Dental / Oral
- Payer
- Bupa Arabia
- Sent
- 14 Sep 2026, 13:02
- Payer answered
- 14 Sep 2026, 13:05
- Outcome
- Approved
- Disposition
- Claim settled as per contract.
Financial totals
- Submitted
- SAR 380.00
- Approved
- SAR 342.00
- Benefit
- SAR 342.00
- Patient Share
- SAR 38.00
- Payer Share
- SAR 342.00
- Tax
- SAR 0.00
Process notes
Adjudicated with no changes.
NPHIES ID chain
Use the NPHIES response ID when you link or resubmit.
History
Claim sent 14 Sep 2026, 13:02
Sent to NPHIES by Reem Al-Otaibi.
Payer responded 14 Sep 2026, 13:05
Bupa Arabia approved the claim.
Line items (3)
| Service | Submitted | Approved | Patient Share | Denial Reason | Outcome |
|---|---|---|---|---|---|
| 97005-00Cardiology consultation, specialist | 140.00 | 126.00 | 14.00 | - | Approved |
| 11700-00Electrocardiogram, 12 lead | 48.00 | 43.20 | 4.80 | - | Approved |
| 55113-00Echocardiography, transthoracic | 192.00 | 172.80 | 19.20 | - | Approved |
Errors
No errors on this claim.
Raw payload
The exact bundle NPHIES returned. Read only.Copy JSON
Poll summary
- Task Status
- Completed
- Task ID
- 7a1f0233-2c05
- Extracted Responses
- 1
- Meta Tag
- N/A
Payer communication requests
No questions from Bupa Arabia on this claim.
Related
No linked requests on this claim.
Poll history
| Date / Time | Type | Result |
|---|---|---|
| 14 Sep 2026, 13:05 | Poll | Complete |