In this article we will show you the full process for NPHIES pre-authorization of charges in Pending Order Authorization window and their application in Pharmacy Dashboard/Service Orders.

Pending Order Authorization

In Pending Order Authorization please select an Encounter:

While at the Encounter information, select Claim Type:

Institutional. For services

Oral. For dental services

Pharmacy. For medications

Professional. For consultations

After selecting it, the Send Nphies Pre-Auth button will unlock. Click on it to send the NPHIES pre-authorization request:

Please consider you're selecting the correct claim type that apply your selected charges:

NPHIES Inbox

After sending the Pre-Authorization request, NPHIES will response will appear on NPHIES Inbox window.

Here you can apply two date filters: Poll date for your request date and Payment date for those who were already paid. If you know the payment status already please select it.

If you want to check the current status of your requests please clear payment date values and click on search icon.

The results will appear below, please click your result to check the NPHIES response.

On Pre-Authorization you will be able to find the response status for each item on Item Response Status. PreAuth Reference column shows the NPHIES authorization number than can be associated on POA with the approval status. The full NPHIES response will appear as a json format file.

Example:

To see more about the NPHIES response json, please check the Notes section at the end of this article.

Pending Order Authorization change of status

Once you have confirmed that your request has been approved, go back to Pending Order Authorization window and click on your encounter.

While at the encounter, click on context menu of the approved charge and click Document Action:

The Status must be changed to Approved

You can enter the Auth. No. from NPHIES Inbox or generate it automatically from the right button.

Enter the approved amount

Click OK.

Now the services or medications can be dispensed.

Application of charges

Pharmacy Dashboard / Outpatient Pharmacy Dashboard:

Search for a patient and select it from the results

While at the Encounter you will see the list of medications and their dispense status.
Please choose the medication you would like to dispense to create the Deliver.

In Medication you can select the correct presentation and click on the inventory icon to check their availability on inventory.

If there is inventory available, select the amount to deliver and click Save.

Remember you can also perform this action by entering the lot barcode and then clicking Delivery Confirmation:

Service Orders:

Go to Service Orders window, perform a search and select an encounter:

You will be addressed to the Application of Services window, click on Process and Confirm.

Confirmation window:

Notes:

json relevant information:

Currency and Quantity:

Item Number: If you sent many items, they will appear listed one by one and the approval status will appear for each one of them

Approval Status: Here you can confirm that the charges were approved

Source: NPHIES outcome source

json files can also be viewed as tables, here you can see that our two items and their amounts were approved by NPHIES:

We hope this improves your Cirrus experience. Remember to share this information and ask for help if you need it.

Date: February 19, 2022

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