Resubmit claim
Send a corrected copy of the rejected claim CL-20366.
Rejected by NPHIES. Member card number does not match the payer record. (BV-1-7). Fix the member details below, then send the claim again.
Original claim
The resubmission is sent against the original claim. The Related Claims panel cannot link a denied claim, so the link is kept here.
What you are changing
Was 4466 1346 6222. The last two digits were swapped.
Pick the new eligibility check. It is linked by its NPHIES response ID.
Claim after the change
- Patient
- Turki Al Subaie
- Insurance Company
- Bupa Arabia
- Claim type
- Professional
- Grand Total
- SAR 275.00
- Payer Share
- SAR 247.50
The full claim form opens with every section pre-filled from the original.