Eligibility result

The NPHIES answer for one eligibility check, with the IDs support asks for.

Print or save as PDF View case Back to list

This screen answersUS-04 US-26 OP-6

Acceptance criteria

US-04 NPHIES ID Traceability HIGHEST

As a support/functional user, I want the full NPHIES ID chain visible on each request, so that I can trace a request end-to-end when troubleshooting.

Internal Req ID, NPHIES Req ID, Response, Response ID all visible per request.
Queued requests show "Pending," not blank/error.
Copy-to-clipboard on each ID.

US-26 Soft Workflow Sequencing LOWEST

As a user, I want optional non-blocking guidance to the next logical module, so that the workflow is clearer without being forced.

After Eligibility → non-blocking suggestion to proceed to Pre-Auth for same patient.
Ignoring it blocks nothing.

OP-6 CSV export and print P1 OPERATIONAL REVIEW

As a desk user, I need to export a list to CSV and print a result, so I can hand it to finance or file it with the patient.

Every list has Export with CSV. The export says how many rows it holds and is logged.
Eligibility, authorization and claim results have Print or save as PDF.
A role that cannot read a list cannot export it.

Wireframe state

Not eligibleApprovedPendingErrorLoadingPrint view

Al Raneem Hospital, eligibility result

Printed 05 Oct 2026, 10:12 by Omar Al-Zahrani

Noura Al Harbi

ActiveQueuedInactiveError

1087654321

Request ID: EL-30551
Payer: Bupa Arabia, plan Bupa Select Gold
Purposes: Validation, Benefits
Service Date: 12 Oct 2026
Facility: Al Raneem Hospital

Coverage active. The policy is active on 12 Oct 2026. Benefits are listed on the Benefits tab.

Waiting for the payer. The request is queued at NPHIES. Poll NPHIES or wait. The result shows up here and in your Inbox.

Poll NPHIES

Coverage inactive. The policy ended on 30 Sep 2026. Ask the patient for a new member card, or try another payer.

NPHIES returned errors. NPHIES could not read the request: Subscriber ID is not valid for this payer. Fix the coverage and send it again.

Edit coverage

OverviewBenefitsErrors (1)Raw ResponseRelated

Lifecycle

Coverage active 05 Oct 2026, 09:13

Response from Bupa Arabia.

NPHIES processed 05 Oct 2026, 09:13

Outcome: complete.

Request submitted 05 Oct 2026, 09:12

Submitted by Layla Al-Harbi.

Queued at NPHIES 05 Oct 2026, 09:12

Waiting for the payer to answer.

Request submitted 05 Oct 2026, 09:12

Submitted by Layla Al-Harbi.

Coverage inactive 05 Oct 2026, 09:13

Policy ended 30 Sep 2026.

NPHIES processed 05 Oct 2026, 09:13

Outcome: complete.

Request submitted 05 Oct 2026, 09:12

Submitted by Layla Al-Harbi.

NPHIES returned errors 05 Oct 2026, 09:12

Subscriber ID is not valid for this payer.

Request submitted 05 Oct 2026, 09:12

Submitted by Layla Al-Harbi.

Patient

Name: Noura Al Harbi
ID Number: 1087654321
Date of Birth: 17 Apr 1991
Gender: Female
Marital Status: Married
Occupation: Education

Coverage

Payer: Bupa Arabia
Member Card No.: 4410 2287 6035
Policy Number: BP-77120934
Class: Group GRP-4471
Coverage Status: Active
Coverage Period: 01 Jan 2026 to 31 Dec 2026
Verified At: 05 Oct 2026, 09:13
Outcome: Complete
Co-payment: 20% up to 400.00 SAR per visit

NPHIES errors

Code	Display	Severity
BV-00102	Subscriber ID is not valid for this payer	error