Insurance and coverage
Coverage details for this patient. Enter them on every claim.
Some details are missing. Choose the facility type before you continue.
Insurance and coverage
Type of healthcare provider submitting this request. NPHIES rejects the claim without it.
EHCPOL (Employee) or PUBLICPOL (Public).
The patient's relationship to the policy subscriber.
Coverage class and network
Required, with a value below, only when Policy Number is blank.
Rendering practitioner
Required by the payer for professional claims.
Link to eligibility check
Link to eligibility check (optional)Enter reference manually
Pick the eligibility check that covers this visit. It is linked by its NPHIES response ID.
Claim linkages
Institutional only. Claim.billablePeriod requires both dates.
The NPHIES response ID of prior authorization PA-10977.
Payment recipient (payee)
Facility information
Legal or official facility name.
Required when a facility name is entered. NPHIES rejects the claim without it.
Choose a facility type. NPHIES rejects the claim without it.
Shown for Institutional claims. Kept here so the facility rule is visible.
Coverage review
Eligible
- Insurance Company
- Bupa Arabia
- Member Card No.
- 4410 2287 6035
- Policy Number
- BP-77120934
- Coverage Type
- EHCPOL
- Provider Type
- Hospital
- Facility Name
- Al Raneem Hospital, Riyadh
- Facility Type
- HospitalNot selected