Claim: CL-20418
Noura Al Harbi, Professional, SAR 950.00. Everything NPHIES and the payer said about this claim.
DeniedNoura Al Harbi, Professional. Bupa Arabia.
Denied by the payer. Member is not covered on the service date. Bupa Arabia returned code BE-1-4: coverage not active. Correct the member details and resubmit the claim.
OwnerRAReem Al-OtaibiDenied today, 05 Oct 2026, 09:31Take overAssignAdd a note
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Internal notes
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Patient
- Name
- Noura Al Harbi
- ID Number
- 1087654321
Claim details
- Claim ID
- CL-20418
- Claim type
- Professional
- Payer
- Bupa Arabia
- Prior authorization reference
- PA-10977
- Sent
- 01 Oct 2026, 10:42
- Payer answered
- 05 Oct 2026, 09:31
- Outcome
- Denied
- Disposition
- Member is not covered on the date of service.
Financial totals
- Submitted
- SAR 950.00
- Approved
- SAR 0.00
- Benefit
- SAR 0.00
- Patient Share
- SAR 95.00
- Payer Share
- SAR 855.00
- Tax
- SAR 0.00
Process notes
BE-1-4: coverage not active on the service date.
NPHIES ID chain
Use the NPHIES response ID when you link or resubmit.
History
Claim sent 01 Oct 2026, 10:42
Sent to NPHIES by Reem Al-Otaibi.
Payer denied the claim 05 Oct 2026, 09:31
Member is not covered on the service date.
Line items (3)
| Service | Submitted | Approved | Patient Share | Denial Reason | Outcome |
|---|---|---|---|---|---|
| 97005-00Cardiology consultation, specialist | 350.00 | 0.00 | 35.00 | BE-1-4 coverage not active | Denied |
| 11700-00Electrocardiogram, 12 lead | 120.00 | 0.00 | 12.00 | BE-1-4 coverage not active | Denied |
| 55113-00Echocardiography, transthoracic | 480.00 | 0.00 | 48.00 | 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
- 7a1f0418-2c05
- Extracted Responses
- 1
- Meta Tag
- N/A
Payer communication requests
| Request | Payer | |
|---|---|---|
| CR-4471-0021 | Bupa Arabia | Send communication |
Related
| Request | Type | Status | NPHIES response ID |
|---|---|---|---|
| PA-10977 | Prior authorization | Approved | 9e61b4d7-0a32-4c5f-8e29-d1f7a63b04c8 |
| EL-30551 | Eligibility check | Pending | Not answered yet |
| CL-20420 | Resubmission | Draft | Not sent |
Poll history
| Date / Time | Type | Result |
|---|---|---|
| 05 Oct 2026, 09:31 | Poll | Complete |
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Claim CL-20418
- Facility
- Al Raneem Hospital, Riyadh
- Patient
- Noura Al Harbi, ID 1087654321
- Payer
- Bupa Arabia
- Claim type
- Professional
- Prior authorization reference
- PA-10977
- Sent
- 01 Oct 2026, 10:42
- Outcome
- Denied, BE-1-4: member is not covered on the service date
- Submitted
- SAR 950.00
- Approved
- SAR 0.00
- NPHIES request ID
- RQ-9981-2207-5531
- NPHIES response ID
- RS-6120-4418-7705
Printed on 05 Oct 2026 from RaneemHCP. Internal notes are not included.
Line items
| Service | Submitted | Approved | Patient Share | Denial Reason | Outcome |
|---|---|---|---|---|---|
| 97005-00Cardiology consultation, specialist | 350.00 | 0.00 | 35.00 | BE-1-4 coverage not active | Denied |
| 11700-00Electrocardiogram, 12 lead | 120.00 | 0.00 | 12.00 | BE-1-4 coverage not active | Denied |
| 55113-00Echocardiography, transthoracic | 480.00 | 0.00 | 48.00 | BE-1-4 coverage not active | Denied |