Claim setup
Tell NPHIES what kind of claim this is and the day of service.
Leave without saving?
You have changes that are not saved. Nothing is sent to NPHIES until you submit.
Some details are missing. Enter a service date before you continue.
Claim type
Requirements for Professional / Prescriber
- Care team
- At least 1 member, one of them Primary Provider
- Encounter
- Mandatory
- Pricing
- Not required for Professional claims
Service date
The day the service was given. NPHIES checks coverage on this date.
Enter the service date. NPHIES cannot check coverage without it.
Cannot be earlier than the start date.
A claim cannot go further without a service date.
Claim details
Available for Professional / Prescriber.
How urgent this request is.
From an approved authorization. The link uses the NPHIES response ID.
Offline and accounting extensions
Collapsed by default. Optional.