Authorization result

The payer answer for one request. The 14 day window starts on the issue date.

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This screen answersUS-14 US-20 US-16 US-04 US-03 OP-2 OP-3 OP-6

Acceptance criteria

US-14 Pre-Auth Result Page Fixes HIGHEST

As a provider user, I want the Pre-Auth Result page to clearly show Approved amount, Patient Share, and Outcome, so I understand the payer's decision without guessing.

"Approved" displays the confirmed Net Amount from the payer response (not blank/zero).
Patient Share is visibly displayed, sourced directly from the NPHIES response payload.
Given any outcome (Approved/Partial/Denied/Error), when displayed, then the Outcome text matches the actual NPHIES response status - no default/placeholder text.

US-20 Related Requests Traceability MEDIUM

As a provider user, I want related requests shown on the Pre-Auth Result page, so that I can see linked requests without manual lookup.

Pre-Auth Result shows a Related Requests section (via US-03 linkage) with type/status/link.
None exist → "No related requests" shown, not hidden.
Click → opens the record directly.

US-16 Pre-Auth Validity Window MEDIUM

As a provider user, I want the system to enforce the 2-week pre-auth validity window, so that expired authorizations are flagged and can be extended correctly.

2 weeks elapsed without extension must show as Expired.
Extension request results in real-time reset with new service date.
Near-expiry requests to show highlighted as "Expiring Soon."

US-04 NPHIES ID Traceability HIGHEST

As a support/functional user, I want the full NPHIES ID chain visible on each request, so that I can trace a request end-to-end when troubleshooting.

Internal Req ID, NPHIES Req ID, Response, Response ID all visible per request.
Queued requests show "Pending," not blank/error.
Copy-to-clipboard on each ID.

US-03 Linking ID Standardization HIGHEST

As the system, I want cross-request links to always use the NPHIES Response ID (never the internal or bundle ID), so that linked requests resolve correctly and pass NPHIES validation.

Cross-request links store the NPHIES Response ID, never internal/bundle ID.
Related-claim references tie to the original response's Response ID.

OP-2 Case owner, assign and take over P1 OPERATIONAL REVIEW

As a desk user, I need a case to have an owner I can change, so work does not get stuck when someone is absent.

A case shows its owner, or "No owner".
A colleague of the same role and facility can Assign to someone or Take over. Each is logged.
Deactivating a user shows their open drafts and cases and asks who takes them over.

OP-3 Internal case notes P1 OPERATIONAL REVIEW

As a desk user, I need to leave a note on a case that stays inside RaneemHCP, so the next person knows what was tried.

A note shows its author and time. It is never sent to NPHIES and says so.
Notes appear on the case timeline and on the authorization, claim, advanced authorization and message pages.
A note cannot be edited or deleted after it is saved. A correction is a new note.

OP-6 CSV export and print P1 OPERATIONAL REVIEW

As a desk user, I need to export a list to CSV and print a result, so I can hand it to finance or file it with the patient.

Every list has Export with CSV. The export says how many rows it holds and is logged.
Eligibility, authorization and claim results have Print or save as PDF.
A role that cannot read a list cannot export it.

Wireframe state

ErrorApprovedPartialDeniedExpiring soonExpiredQueuedNo relatedAssignNotesPrint view

Al Raneem Hospital, authorization result

Printed 05 Oct 2026, 10:12 by Reem Al-Otaibi

Partly approved. The payer approved 2 of 3 services. The knee prosthesis implant was denied: not covered under the plan.

Denied. The payer denied all services: the member has a 12 month waiting period for orthopedic surgery that ends 01 Mar 2027. You can amend the request or send a follow-up.

Amend

NPHIES returned an error. NPHIES could not process the request: the care team member sequence 3 has no matching role. Fix the request and send it again.

Amend

Waiting for the payer. The request is queued at NPHIES and the payer has not answered. Poll NPHIES or wait.

Poll NPHIES

Authorization expires in 12 days (17 Oct 2026). The approval is valid for 14 days. Extend it now so the service date stays valid.

Extend

Expired. The 14 day window ended on 02 Oct 2026 without an extension. Extend it to get a new service date.

Extend

Assign to

Only people with the same role in Facility A are listed.

Note (optional)

The note is saved with the case.

Logged in the audit log.Cancel Save owner

SummaryItems (3)Errors (1)Raw payloadRelatedPoll history

Ref: PA-10977

ApprovedPartialDeniedErrorExpiring soonExpired

Noura Al Harbi, ID 1087654321

Prior authorization reference: PA-10977
Claim Business Identifier: CBI-2026-770514
Payer: Bupa Arabia
Claim Type: Professional, inpatient
Facility: Al Raneem Hospital
Outcome: CompleteError
Disposition: Approved as requestedPartly approved, 2 of 3 servicesDenied: 12 month waiting periodNot processed: care team sequence 3 has no role

Request REQ-10970

Queued

Maha Al Zahrani, ID 1054321987

Prior authorization reference: Not issued yet
Payer: Al Rajhi Takaful
Claim Type: Pharmacy
Facility: Al Raneem Hospital
Outcome: Pending
Disposition: Waiting for the payer

Approved (SAR)

27,600.00

Net amount confirmed in the NPHIES response

Payer Share (SAR)

22,080.00

80%

Patient Share (SAR)

5,520.00

From the NPHIES response

Approved (SAR)

21,200.00

Approved lines only, 2 of 3

Payer Share (SAR)

16,960.00

80%

Patient Share (SAR)

4,240.00

From the NPHIES response

Approved (SAR)

0.00

Nothing approved

Payer Share (SAR)

0.00

Nothing approved

Patient Share (SAR)

0.00

Nothing approved

Approved (SAR)

Pending

Waiting for the payer

Payer Share (SAR)

Pending

Waiting for the payer

Patient Share (SAR)

Pending

Waiting for the payer

Authorization period

Auth Period: 03 Oct 2026 to 17 Oct 2026
Expiry: 17 Oct 2026, 12 days left

Auth Period: None, nothing was approved

Auth Period: 03 Oct 2026 to 17 Oct 2026
Expiry: 17 Oct 2026 12 days left

Auth Period: 18 Sep 2026 to 02 Oct 2026
Expiry: 02 Oct 2026 Expired 3 days ago

Auth Period: Set by the payer when it answers
Expiry: Not set yet

Owner

OAOmar Al-Zahrani

Assign to Take over

Latest note

Called Bupa Arabia. They confirmed the request is in review and will answer by noon.

Omar Al-Zahrani, 05 Oct 2026, 09:40

All notes (3)

Internal notes

Notes stay inside RaneemHCP. They are never sent to NPHIES or the payer.

Your role can read notes but not add them.

Items (3)

Service	Qty	Submitted	Approved	Outcome
Total knee replacement, right	1	18,500.00	18,500.00	Approved
Inpatient room, semi-private (3 nights)	3	2,700.00	2,700.00	Approved
Knee prosthesis implant	1	6,400.00	6,400.00	Approved

Items (3)

Service	Qty	Submitted	Approved	Outcome
Total knee replacement, right	1	18,500.00	18,500.00	Approved
Inpatient room, semi-private (3 nights)	3	2,700.00	2,700.00	Approved
Knee prosthesis implant	1	6,400.00	0.00	Denied

Items (3)

Service	Qty	Submitted	Outcome
Total knee replacement, right	1	18,500.00	Denied
Inpatient room, semi-private (3 nights)	3	2,700.00	Denied
Knee prosthesis implant	1	6,400.00	Denied

Items (3)

Service	Qty	Submitted	Approved	Outcome
Total knee replacement, right	1	18,500.00	-	Queued
Inpatient room, semi-private (3 nights)	3	2,700.00	-	Queued
Knee prosthesis implant	1	6,400.00	-	Queued

NPHIES errors

Code	Display	Severity
BV-00204	Care team member sequence 3 has no matching role	error

NPHIES IDs

Internal request IDREQ-10977

NPHIES request IDc3a91e50-2d74-4f08-b6e1-7a05d9c28f13

NPHIES responsePA-RES-55187

NPHIES response ID9e61b4d7-0a32-4c5f-8e29-d1f7a63b04c8

Internal request IDREQ-10958

NPHIES request IDc3a91e50-2d74-4f08-b6e1-7a05d9c28f13

NPHIES responseError response received

NPHIES response IDNo ID issued

Internal request IDREQ-10970

NPHIES request ID3f8c1d27-5e90-4b6a-a2c4-91d7e0b35f68

NPHIES responsePending: queued at NPHIES

NPHIES response IDPending: queued at NPHIES

Request	Type	Status
EL-30551	Eligibility	Active	Open
PA-10984	Follow-up authorization	Approved	Open

No related requests

Nothing is linked to this authorization yet.

Poll history

Response from Bupa Arabia 03 Oct 2026, 11:42

Net amount, shares and outcome received.

Sent to NPHIES 03 Oct 2026, 11:30

Submitted by Omar Al-Zahrani.

Draft saved 03 Oct 2026, 10:58

Created from an eligibility check.

Queued at NPHIES 05 Oct 2026, 10:15

Waiting for Al Rajhi Takaful to answer.

Sent to NPHIES 05 Oct 2026, 10:15

Submitted by Omar Al-Zahrani.

Ref: PA-10977

ApprovedPartialDeniedErrorExpiring soonExpired

Noura Al Harbi, ID 1087654321

Prior authorization reference: PA-10977
Claim Business Identifier: CBI-2026-770514
Payer: Bupa Arabia
Claim Type: Professional, inpatient
Facility: Al Raneem Hospital
Outcome: CompleteError
Disposition: Approved as requestedPartly approved, 2 of 3 servicesDenied: 12 month waiting periodNot processed: care team sequence 3 has no role

Request REQ-10970

Queued

Maha Al Zahrani, ID 1054321987

Prior authorization reference: Not issued yet
Payer: Al Rajhi Takaful
Claim Type: Pharmacy
Facility: Al Raneem Hospital
Outcome: Pending
Disposition: Waiting for the payer

Approved (SAR)

27,600.00

Net amount confirmed in the NPHIES response

Payer Share (SAR)

22,080.00

80%

Patient Share (SAR)

5,520.00

From the NPHIES response

Approved (SAR)

21,200.00

Approved lines only, 2 of 3

Payer Share (SAR)

16,960.00

80%

Patient Share (SAR)

4,240.00

From the NPHIES response

Approved (SAR)

0.00

Nothing approved

Payer Share (SAR)

0.00

Nothing approved

Patient Share (SAR)

0.00

Nothing approved

Approved (SAR)

Pending

Waiting for the payer

Payer Share (SAR)

Pending

Waiting for the payer

Patient Share (SAR)

Pending

Waiting for the payer

Authorization period

Auth Period: 03 Oct 2026 to 17 Oct 2026
Expiry: 17 Oct 2026, 12 days left

Auth Period: None, nothing was approved

Auth Period: 03 Oct 2026 to 17 Oct 2026
Expiry: 17 Oct 2026 12 days left

Auth Period: 18 Sep 2026 to 02 Oct 2026
Expiry: 02 Oct 2026 Expired 3 days ago

Auth Period: Set by the payer when it answers
Expiry: Not set yet

Owner

OAOmar Al-Zahrani

Assign to Take over

Latest note

Called Bupa Arabia. They confirmed the request is in review and will answer by noon.

Omar Al-Zahrani, 05 Oct 2026, 09:40

All notes (3)

Items (3)

Service	Qty	Submitted	Approved	Outcome
Total knee replacement, right	1	18,500.00	18,500.00	Approved
Inpatient room, semi-private (3 nights)	3	2,700.00	2,700.00	Approved
Knee prosthesis implant	1	6,400.00	6,400.00	Approved

Items (3)

Service	Qty	Submitted	Approved	Outcome
Total knee replacement, right	1	18,500.00	18,500.00	Approved
Inpatient room, semi-private (3 nights)	3	2,700.00	2,700.00	Approved
Knee prosthesis implant	1	6,400.00	0.00	Denied

Items (3)

Service	Qty	Submitted	Outcome
Total knee replacement, right	1	18,500.00	Denied
Inpatient room, semi-private (3 nights)	3	2,700.00	Denied
Knee prosthesis implant	1	6,400.00	Denied

Items (3)

Service	Qty	Submitted	Approved	Outcome
Total knee replacement, right	1	18,500.00	-	Queued
Inpatient room, semi-private (3 nights)	3	2,700.00	-	Queued
Knee prosthesis implant	1	6,400.00	-	Queued

NPHIES IDs

Internal request IDREQ-10977

NPHIES request IDc3a91e50-2d74-4f08-b6e1-7a05d9c28f13

NPHIES responsePA-RES-55187

NPHIES response ID9e61b4d7-0a32-4c5f-8e29-d1f7a63b04c8

Internal request IDREQ-10958

NPHIES request IDc3a91e50-2d74-4f08-b6e1-7a05d9c28f13

NPHIES responseError response received

NPHIES response IDNo ID issued

Internal request IDREQ-10970

NPHIES request ID3f8c1d27-5e90-4b6a-a2c4-91d7e0b35f68

NPHIES responsePending: queued at NPHIES

NPHIES response IDPending: queued at NPHIES

What you can do

Submit claimFollow-upExtendAmendSend communication View case