Claim: CL-20301

Sara Al Qahtani, Dental / Oral, SAR 410.00. Everything NPHIES and the payer said about this claim.

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This screen answersUS-04 US-03 US-20 OP-2 OP-3 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-03 Linking ID Standardization HIGHEST

As the system, I want cross-request links to always use the NPHIES Response ID (never the internal or bundle ID), so that linked requests resolve correctly and pass NPHIES validation.

Cross-request links store the NPHIES Response ID, never internal/bundle ID.
Related-claim references tie to the original response's Response ID.

US-20 Related Requests Traceability MEDIUM

As a provider user, I want related requests shown on the Pre-Auth Result page, so that I can see linked requests without manual lookup.

Pre-Auth Result shows a Related Requests section (via US-03 linkage) with type/status/link.
None exist → "No related requests" shown, not hidden.
Click → opens the record directly.

OP-2 Case owner, assign and take over P1 OPERATIONAL REVIEW

As a desk user, I need a case to have an owner I can change, so work does not get stuck when someone is absent.

A case shows its owner, or "No owner".
A colleague of the same role and facility can Assign to someone or Take over. Each is logged.
Deactivating a user shows their open drafts and cases and asks who takes them over.

OP-3 Internal case notes P1 OPERATIONAL REVIEW

As a desk user, I need to leave a note on a case that stays inside RaneemHCP, so the next person knows what was tried.

A note shows its author and time. It is never sent to NPHIES and says so.
Notes appear on the case timeline and on the authorization, claim, advanced authorization and message pages.
A note cannot be edited or deleted after it is saved. A correction is a new note.

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.

DeniedSara Al Qahtani, Dental / Oral. Tawuniya.

Denied by the payer. Member is not covered on the service date. Tawuniya returned code BE-1-4: coverage not active. Correct the member details and resubmit the claim.

OwnerRAReem Al-OtaibiDenied today, 02 Sep 2026, 08:45Take over Assign Add a note

Internal notes

Notes stay inside RaneemHCP. They are never sent to NPHIES or the payer.

Add a note

Add noteA note cannot be edited. Add a new one to correct it.

SummaryLine items (3)ErrorsRaw payloadLive pollCommunication (0)RelatedPoll history

Patient

Name: Sara Al Qahtani
ID Number: 1060763619

Claim details

Claim ID: CL-20301
Claim type: Dental / Oral
Payer: Tawuniya
Sent: 01 Sep 2026, 09:40
Payer answered: 02 Sep 2026, 08:45
Outcome: Denied
Disposition: Member is not covered on the date of service.

Financial totals

Submitted: SAR 410.00
Approved: SAR 0.00
Benefit: SAR 0.00
Patient Share: SAR 41.01
Payer Share: SAR 368.99
Tax: SAR 0.00

Process notes

BE-1-4: coverage not active on the service date.

NPHIES ID chain

Internal request IDCL-20301

NPHIES request IDRQ-9981-0301-3913

NPHIES responseComplete, outcome Denied

NPHIES response IDRS-6120-0301-2107

Use the NPHIES response ID when you link or resubmit.

History

Claim sent 01 Sep 2026, 09:40

Sent to NPHIES by Reem Al-Otaibi.

Payer denied the claim 02 Sep 2026, 08:45

Member is not covered on the service date.

Line items (3)

Service	Submitted	Patient Share	Denial Reason	Outcome
97005-00Cardiology consultation, specialist	151.05	15.11	BE-1-4 coverage not active	Denied
11700-00Electrocardiogram, 12 lead	51.79	5.18	BE-1-4 coverage not active	Denied
55113-00Echocardiography, transthoracic	207.16	20.72	BE-1-4 coverage not active	Denied

Errors

Code	Message	Field path
BE-1-4	Member is not covered on the service date.	Claim.insurance.coverage

Raw payload

The exact bundle NPHIES returned. Read only.Copy JSON

Poll summary

Poll NPHIES

Task Status: Completed
Task ID: 7a1f0301-2c05
Extracted Responses: 1
Meta Tag: N/A

Payer communication requests

No questions from Tawuniya on this claim.

No linked requests on this claim.

Poll history

Date / Time	Type	Result
02 Sep 2026, 08:45	Poll	Complete