Journeys
The journeys a claims officer walks, step by step. Each step opens the screen it happens on.
For a claims officer
Submit a claim
Send a claim whose totals already add up.Open Claims.
Open screen 2Claim setupClaim setup.
Open screen 3Patient identityPatient demographics. Passport country sits with the identity fields.
Open screen 4Clinical contextClinical context and diagnoses.
Open screen 5Care teamCare team.
Open screen 6ServicesServices with auto-calculated net amount and shares.
Open screen 7Review and submitReview and submit.
Open screen 8Claim detailFollow it through NPHIES.
Open screenFix and resend a denied claim
Turn a denial into an accepted claim.Send a pharmacy or vision claim
Add the prescription step.Answer a payer question
Reply with the right attachment.Cancel a queued claim
Stop a claim before NPHIES answers.Save a claim and finish later
A claim draft is never sent to NPHIES.Send a batch
Send up to 200 claims in one go without a surprise.Check for new answers
See what NPHIES has for you.Bill what is ready
Start from the claims that are ready to bill.Work the denied queue
Turn a denial into an accepted claim and leave a trail.Open the Denied queue. The Age column counts from the denial.
Open screen 2Claim detailRead the reason. Assign it to yourself or take it over.
Open screen 3Case timelineAdd a note: called the payer, needs a new report.
Open screen 4Resubmit claimCorrect and resubmit.
Open screen 5Claim detailFollow the new result.
Open screenSave a claim when NPHIES is down
A claim is queued, never lost, and never sent twice.Export a list
Hand a CSV to finance.For everyone
Sign in
Get in safely. After sign in the wireframes ask who you are; the real portal opens the home of your own role.First sign in
Replace the temporary password, then enroll.First time with two-step sign in
Enroll before you continue.Lost your phone
Get in without the Authenticator app.Forgot the password
Recover without calling anyone.Your password expired
Replace it when the policy says so.Ask for an account or for access
No account yet, or the wrong role.Look after your own account
Password, sessions, history and notifications.Time out and sign out
What happens when you step away.When you cannot open something
A clear reason and a way forward.A record of another facility (CL-30091) shows as a hidden row with no patient details. The Administrator and the Auditor read every facility, so they see it listed with its facility in the Multi-facility state.
Open screen 2This record belongs to another facilityClick the hidden row. Read why, then go back.
Open screen 3HomeOpen an area your role does not have.
Open screen 4No access to this areaAsk for access. The request is sent and logged.
Open screen 5Page not foundA wrong address ends here.
Open screenWhen the portal or NPHIES is down
Know what is saved and what is not.Find help
Get an answer without leaving the portal.Hospital flows, end to end
Flows that cross roles. Each step names the role that does it. A step you can open in your own menu is a link. A step that only another role can open is shown as text with that role named.
Patient arrives to cash collected
The revenue cycle, from the front desk to the bank.Check eligibility before the visit.
Opens in the Receptionist menuRead the answer, print it for the file, hand the case to the approval desk.
Open screenAsk for prior authorization.
Opens in the Insurance approval officer menuRead the approval. It now shows in Ready to bill.
Open screen 5Claims officer (you)Work queuesTake it from the Ready to bill queue.
Open screen 6Claims officer (you)Review and submitReview and submit the claim.
Open screen 7Claims officer (you)Claim batchSend it in a batch.
Open screen 8A/RReconciliation detailMatch the payment.
Open screenRecord the payment notice.
Opens in the Accounts payable (A/P) menuRead the notice.
Open screenDenial and resubmission
From a denied claim to an accepted one, with a trail.The denial arrives.
Open screen 2Claims officer (you)Work queuesOpen the Denied queue.
Open screen 3A/RClaim detailSpotted it first and assigned it.
Open screen 4Claims officer (you)Case timelineAdd a note about the payer call.
Open screen 5Claims officer (you)Resubmit claimCorrect and resubmit.
Open screen 6Claims officer (you)Claim detailFollow the new result.
Open screenWhen NPHIES is down
Nothing is lost and nothing is sent twice.A banner says NPHIES is not answering.
Open screenSave and send later.
Opens in the Receptionist menuSave and send later.
Opens in the Insurance approval officer menuSave and send later.
Open screen 5EveryoneNPHIES is not answeringSee what is saved.
Open screenSee what was sent after the recovery (second release option).
Opens in the Administrator menuWhen the hospital system is down
Desks keep working where the fallback allows, and nothing is lost.A banner says the hospital system is not answering.
Open screenLookup is unavailable. Enter the patient by hand if the fallback allows.
Opens in the Receptionist menuPractitioners come from the last known copy, marked as not refreshed.
Opens in the Insurance approval officer menuThe service catalogue is read only until the source is back.
Open screenRead the status and the fallback per entity.
Opens in the Super admin menuAfter recovery, fix the rows that failed.
Opens in the Super admin menu