Advanced authorization detail

What the payer decided, with the services and amounts it applies to.

This screen answersUS-23 US-09a US-04 OP-3

Acceptance criteria

US-23 Advanced Auth Coverage Display HIGHEST

As a user, I want insurance/coverage information displayed on the Advanced Auth record, so that I can see coverage details already retrieved from NPHIES.

APA record with coverage data displays insurance/coverage info on detail view.

US-09a APA Polling Without Bundle Reference (TC-AUTH-010) HIGHEST

As the system, I need to poll NPHIES for payer-initiated Advanced Prior Authorizations without a reference Bundle ID, so payer-issued APAs are retrieved successfully.

Given a payer has issued an APA with no prior request from us, when Poll NPHIES runs, then the APA is retrieved and appears in the Advanced Auth module.
Given the poll runs without a bundle reference, when NPHIES returns results, then the system correctly parses and links the APA to the correct patient/provider without requiring a pre-existing internal reference.
Given the APA exists, when a communication or cancellation/change is sent against it, then the related change reflects correctly.

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.

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.

Wireframe state

DefaultCancelledNotes

Cancelled. The payer cancelled this advanced authorization on 05 Oct 2026. No answer is needed.

SummaryDiagnoses (2)Services (2)Supporting Info (1)Financials (3)Raw PayloadRelatedPoll History

Patient

Name: Noura Al Harbi
ID Number: 1087654321
Date of Birth: 17 Apr 1991

Authorization

CompleteCancelled

Prior authorization reference: APA-0412
Insurance Company: Bupa Arabia
Auth Period: 04 Oct 2026 to 18 Oct 2026
Claim Type: Professional
Funds Reserve: Patient
Created: 04 Oct 2026, 17:20

Coverage

Insurance Company: Bupa Arabia
Member Card No.: 4410 2287 6035
Policy Number: BP-77120934
Coverage Type: EHCPOL
Class: Group GRP-4471
Coverage Period: 01 Jan 2026 to 31 Dec 2026
Subscriber Relationship: Self

Decision

Reason: Approved as requested
Adjudication Outcome: Approved
Processing Outcome: Complete
Status: Complete
Claim Sub-Type: Inpatient

Services (2)

#	Service	Quantity	Eligible	Benefit	Outcome
1	Total knee replacement, right	1	18,500.00	14,800.00	Approved
2	Knee prosthesis implant	1	6,400.00	5,120.00	Approved

Owner

OAOmar Al-Zahrani

Assign toTake over

Latest note

Claim can be prepared after the surgery on 14 Oct.

Omar Al-Zahrani, 05 Oct 2026, 08:10

All notes (3)

Providers

Service Provider: Al Raneem Hospital
Referring Provider: Dr. Faisal Al Otaibi
Payee Type: Provider

NPHIES IDs

Internal request IDNone, started by the payer

NPHIES request IDe72b0a19-6c43-48d5-9f10-b85d3c07a2e6

NPHIES responseAPA-RES-03321

NPHIES response ID2d95c1f8-4e07-4a63-b1d2-86a0f9e37c54

Process notes

Authorization valid for 14 days from the issue date.

Internal notes

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

Your role can read notes but not add them.

Your answer

Your role can read advanced authorizations only. Ask an approval officer to answer it.

Communications about this APA

Communication	Subject	Status
CM-7716	Surgeon confirmation attached	Sent	Open

Poll history

Received from Bupa Arabia 04 Oct 2026, 17:20

Found by Poll NPHIES, no earlier request needed.

Poll NPHIES 04 Oct 2026, 17:21

Run by Hadeel Al-Qahtani.

Cancellation received 05 Oct 2026, 08:05

Bupa Arabia cancelled it. No answer is needed.

Received from Bupa Arabia 04 Oct 2026, 17:20

Found by Poll NPHIES, no earlier request needed.

Poll NPHIES 04 Oct 2026, 17:21

Run by Hadeel Al-Qahtani.