Services

What was done and what it costs. Totals are calculated for you.

This screen answersUS-01 US-02 US-09b US-38 OP-7 DS-8

Acceptance criteria

US-01 Automate Financial Fields HIGHEST

As a claims processor, I want the system to auto-calculate Net Amount from Quantity and Unit Price, so I don't manually reconcile totals.

Given Unit Price and Quantity entered, when the line is saved, then Net Amount = Quantity × Unit Price (auto-calculated, read-only).
Given a mismatch is detected, when the user attempts to submit, then the system displays a clear inline error identifying the discrepancy amount.
Test-restricted auto-calc fields enabled; editable only for confirmed exceptions.
Manual overrides flagged distinctly in the audit trail.

US-02 Net Amount Calculation Logic HIGHEST

As a claims processor, I want Patient Share + Payer Share validated against Net Amount, so that submissions aren't rejected for inconsistent totals.

Given Patient Share and Payer Share are entered, when both are populated, then the system validates their sum = Net Amount within 0.01 SAR and blocks save on mismatch.
Given a mismatch, when the user attempts to submit, then a clear inline error identifies the discrepancy amount.
Given only one share is entered, when saved, then the system calculates the other.

US-09b Care Team Cascading Dead-End HIGH - SHIP WITH US-09

As a claims submitter, I want the per-service Care Team picker to guide me back to add a member when none exist, so that I'm not stuck in an unrecoverable dead-end.

Care Team empty → each Service line's Care Team picker disabled with "Add Care Team in Step 6 first."
≥1 member → pickers populate normally.

US-38 Wizard Navigability LOW

As a user filling long wizards, I want to save a draft and resume, plus jump between completed steps, so that I don't lose work on long forms.

Persistent step indicator with jump-to-completed-step.
Save-as-draft + resume across Eligibility, Pre-Auth, Claims.
No partial submission to NPHIES from a draft.

OP-7 Permission matrix fixes P1 OPERATIONAL REVIEW

As an administrator, I need the permission matrix to match daily work, so people can do their job and no more.

A/R can read the status checker and reply on messages linked to a claim it chases.
Delete means a draft of your own, never a submitted record. Submitted records are cancelled.
An override above a threshold needs a second person in a later release. The override screen says so.

DS-8 Source badge, lookup and health on daily screens P1 ADDED BY SCOPE: DATA SOURCES

As a desk user, I need to find a patient, practitioner, service, payer or diagnosis from the hospital system while I work, and to know when it is not available, so I keep working.

Pickers offer Find in hospital system. Records from a source carry a source badge and a reference id, show source fields read only and offer Refresh from source.
When the source is down a banner says so. Last known data may be shown where allowed. Creating a request for that entity is blocked or allowed with manual entry, as the per entity fallback setting says.
Roles that can read Data sources see a source health indicator in the top bar and on Home.

Wireframe state

DefaultShares mismatchCare team emptyOverrideFrom source

Shares do not add up. Line 2, Electrocardiogram: patient share SAR 12.00 plus payer share SAR 98.00 is SAR 110.00, but the net amount is SAR 120.00. Fix the difference of SAR 10.00 to continue.

No care team yet. Add the care team in step 6 first, then come back to pick a care team member for each line.

Go to care team

Manual override. Line 1 net amount was changed by hand, from SAR 350.00 to SAR 300.00. Give the reason below. The change is kept in the audit log. A second person, your claims lead Sara Al-Mutairi, is asked to confirm this override before the claim can be submitted. You can still save a draft.

Find in the service catalogue

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Prices are read from the hospital service catalogue and cannot be edited here. Use Override for a confirmed exception.

Code	Service	Price (SAR)	Source
97005-00	Cardiology consultation, specialist	350.00	Catalogue	Add to claim
11700-00	Electrocardiogram, 12 lead	120.00	Catalogue	Add to claim
55113-00	Echocardiography, transthoracic	480.00	Catalogue	Add to claim
93000-00	Exercise stress test	640.00	Catalogue	Add to claim

Services

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Refresh price

Service Code	Unit Price	Net Amount	Patient Share
97005-00Cardiology consultation, specialist	Price list	Manual override Override Override	Payer share SAR 315.00 Payer share SAR 270.00
11700-00Electrocardiogram, 12 lead	Price list	Override	Payer share SAR 98.00 Shares add up to SAR 110.00, net is SAR 120.00. Payer share SAR 108.00
55113-00Echocardiography, transthoracic	Price list	Override	Payer share SAR 432.00

Grand Total: SAR 950.00Patient Share: SAR 95.00Payer Share: SAR 855.00

Mismatch: SAR 10.00

Totals match

Grand Total: SAR 900.00Patient Share: SAR 90.00Payer Share: SAR 810.00Includes a manual override

Reason for the override

Reason

Overrides are written to the audit log as a financial override. Administrators can see financial overrides in the audit log.

Second person: Sara Al-Mutairi gets a task to confirm the override. Submit stays off until she does.

Net Amount is quantity times unit price (and factor) and cannot be edited, unless you confirm an exception with Override. Each line also takes a Service Description, Diagnosis Codes, Serviced Date or Date Range, Tax Amount and optional Body Site and Modifiers. Enter one share and the other is filled in. The two shares must add up to the net amount, within SAR 0.01.

Patient billing (per item)

Patient Invoice # (Item 1)

Patient Share (SAR) (Item 1)

Patient Invoice # (Item 2)

Patient Share (SAR) (Item 2)

Patient Invoice # (Item 3)

Patient Share (SAR) (Item 3)

BackDraft saved 2 minutes agoSave draft Continue

BackFix the shares to continue.Save draftContinue

BackAdd a care team member first.Save draftContinue