Claim: CL-20388
Yousef Al Dossary, Institutional, SAR 8,920.00. Everything NPHIES and the payer said about this claim.
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RespondSubmit payment notice
ApprovedYousef Al Dossary, Institutional. Bupa Arabia.
Approved. Bupa Arabia approved SAR 8,028.01 and the patient pays SAR 891.99.
- Name
- Yousef Al Dossary
- ID Number
- 1061452572
- Claim ID
- CL-20388
- Claim type
- Institutional
- Payer
- Bupa Arabia
- Sent
- 28 Sep 2026, 09:20
- Payer answered
- 28 Sep 2026, 09:24
- Outcome
- Approved
- Disposition
- Claim settled as per contract.
- Submitted
- SAR 8,920.00
- Approved
- SAR 8,028.01
- Benefit
- SAR 8,028.01
- Patient Share
- SAR 891.99
- Payer Share
- SAR 8,028.01
- Tax
- SAR 0.00
Adjudicated with no changes.
Internal request IDCL-20388
NPHIES request IDRQ-9981-0388-5044
NPHIES responseComplete, outcome Approved
NPHIES response IDRS-6120-0388-2716
Claim sent 28 Sep 2026, 09:20
Sent to NPHIES by Reem Al-Otaibi.
Payer responded 28 Sep 2026, 09:24
Bupa Arabia approved the claim.
| Service |
Submitted |
Approved |
Patient Share |
Denial Reason |
Outcome |
| 97005-00Cardiology consultation, specialist |
3,286.32 |
2,957.69 |
328.63 |
- |
Approved |
| 11700-00Electrocardiogram, 12 lead |
1,126.74 |
1,014.07 |
112.67 |
- |
Approved |
| 55113-00Echocardiography, transthoracic |
4,506.94 |
4,056.25 |
450.69 |
- |
Approved |
The exact bundle NPHIES returned. Read only.Copy JSON
- Task Status
- Completed
- Task ID
- 7a1f0388-2c05
- Extracted Responses
- 1
- Meta Tag
- N/A
Payer communication requests
No questions from Bupa Arabia on this claim.
No linked requests on this claim.
| Date / Time |
Type |
Result |
| 28 Sep 2026, 09:24 |
Poll |
Complete |