Services

What the payer is asked to approve. Net Amount and shares are checked as you type.

This screen answersUS-01 US-02 US-09b US-38 OP-7 DS-8

Acceptance criteria

US-01 Automate Financial Fields HIGHEST

As a claims processor, I want the system to auto-calculate Net Amount from Quantity and Unit Price, so I don't manually reconcile totals.

Given Unit Price and Quantity entered, when the line is saved, then Net Amount = Quantity × Unit Price (auto-calculated, read-only).
Given a mismatch is detected, when the user attempts to submit, then the system displays a clear inline error identifying the discrepancy amount.
Test-restricted auto-calc fields enabled; editable only for confirmed exceptions.
Manual overrides flagged distinctly in the audit trail.

US-02 Net Amount Calculation Logic HIGHEST

As a claims processor, I want Patient Share + Payer Share validated against Net Amount, so that submissions aren't rejected for inconsistent totals.

Given Patient Share and Payer Share are entered, when both are populated, then the system validates their sum = Net Amount within 0.01 SAR and blocks save on mismatch.
Given a mismatch, when the user attempts to submit, then a clear inline error identifies the discrepancy amount.
Given only one share is entered, when saved, then the system calculates the other.

US-09b Care Team Cascading Dead-End HIGH - SHIP WITH US-09

As a claims submitter, I want the per-service Care Team picker to guide me back to add a member when none exist, so that I'm not stuck in an unrecoverable dead-end.

Care Team empty → each Service line's Care Team picker disabled with "Add Care Team in Step 6 first."
≥1 member → pickers populate normally.

US-38 Wizard Navigability LOW

As a user filling long wizards, I want to save a draft and resume, plus jump between completed steps, so that I don't lose work on long forms.

Persistent step indicator with jump-to-completed-step.
Save-as-draft + resume across Eligibility, Pre-Auth, Claims.
No partial submission to NPHIES from a draft.

OP-7 Permission matrix fixes P1 OPERATIONAL REVIEW

As an administrator, I need the permission matrix to match daily work, so people can do their job and no more.

A/R can read the status checker and reply on messages linked to a claim it chases.
Delete means a draft of your own, never a submitted record. Submitted records are cancelled.
An override above a threshold needs a second person in a later release. The override screen says so.

DS-8 Source badge, lookup and health on daily screens P1 ADDED BY SCOPE: DATA SOURCES

As a desk user, I need to find a patient, practitioner, service, payer or diagnosis from the hospital system while I work, and to know when it is not available, so I keep working.

Pickers offer Find in hospital system. Records from a source carry a source badge and a reference id, show source fields read only and offer Refresh from source.
When the source is down a banner says so. Last known data may be shown where allowed. Creating a request for that entity is blocked or allowed with manual entry, as the per entity fallback setting says.
Roles that can read Data sources see a source health indicator in the top bar and on Home.

Wireframe state

DefaultShares mismatchCare team emptyOverrideFrom source

Find in the hospital system

From Hospital information system

Search by

Search the service catalogue

Find in the hospital system

Service code	Description	Price (SAR)
49518-00	Total knee replacement, right	18,500.00	Add
96093-00	Inpatient room, semi-private, per night	900.00	Add
92514-00	Knee prosthesis implant	6,400.00	Added

Prices are filled from the source. Unit prices come from the hospital catalogue and are read-only. Refresh price reads the current price from the source.

Services

From Hospital information systemCatalogue updated 05 Oct 2026, 07:30

#	Service from the catalogue	Unit Price	Net Amount
1	Total knee replacement, right49518-00 Catalogue	Refresh price	18,500.00
2	Inpatient room, semi-private (3 nights)96093-00 Catalogue	Refresh price	2,700.00
3	Knee prosthesis implant92514-00 Catalogue	Refresh price	6,400.00

Shares match the net amount. Patient 20% + Payer 80% = 100%. Net Amount is quantity times unit price.

Services

Add service or item

#	Service code and description	Net Amount	Patient Share	Payer Share
1	Total knee replacement, right49518-00, M17.11 Override	18,500.00
2	Inpatient room, semi-private (3 nights)96093-00, M17.11 Override	2,700.00
3	Knee prosthesis implant92514-00, M17.11, E11.9 Override	6,400.00
	Grand total (SAR)	27,600.00	5,520.00	22,080.00

Shares do not match by 140.00 SAR. Line 3: shares add to 6,260.00 but net is 6,400.00. The difference is 140.00 SAR. Patient Share and Payer Share must add up to the Net Amount.

Services

Add service or item

#	Service code and description	Net Amount	Patient Share	Payer Share
1	Total knee replacement, right49518-00, M17.11 Override	18,500.00
2	Inpatient room, semi-private (3 nights)96093-00, M17.11 Override	2,700.00
3	Knee prosthesis implant92514-00, M17.11, E11.9 Override	6,400.00
	Grand total (SAR)	27,600.00	5,520.00	21,940.00

Add the care team first. Care Team Member pickers are disabled until the care team has at least one member.

Services

Add service or item

#	Service code and description	Net Amount	Patient Share	Payer Share
1	Total knee replacement, right49518-00, M17.11 Add the care team in step 6 first. Override	18,500.00
2	Inpatient room, semi-private (3 nights)96093-00, M17.11 Add the care team in step 6 first. Override	2,700.00
3	Knee prosthesis implant92514-00, M17.11, E11.9 Add the care team in step 6 first. Override	6,400.00
	Grand total (SAR)	27,600.00	5,520.00	22,080.00

Net amount overridden. Line 1 net amount is set by hand: 18,000.00 instead of 18,500.00. Shares still add up to the net amount.

Services

Add service or item

#	Service code and description	Net Amount	Patient Share	Payer Share
1	Total knee replacement, right49518-00, M17.11 Override	By hand
2	Inpatient room, semi-private (3 nights)96093-00, M17.11 Override	2,700.00
3	Knee prosthesis implant92514-00, M17.11, E11.9 Override	6,400.00
	Grand total (SAR)	27,100.00	5,420.00	21,680.00

Override reason

Reason

Overrides are written to the audit log as a financial override.

Above a threshold set by your facility a second person will confirm this override. Not active in the first release.

Net Amount is quantity times unit price and cannot be edited, unless you switch on Override for a confirmed exception. An override needs a reason and goes to the audit log as a financial override. Each service also takes a Factor, a single date or a date range, a Patient Invoice Number, Body Site and Modifiers. If you enter only one share, the other is filled in. Differences up to 0.01 SAR are accepted.

BackDraft saved 2 minutes agoSave draft Continue

BackDraft saved 2 minutes agoSave draftContinue