PSO

Patient insurance information

Check eligibility in-force

Check Policy information for nphies deductible and max limit

Contracts department:

Any problem in contracts shall be updated for correct nphies response.

Physician:

Diagnosis

Orders

Services

PSO:

Pre-authorization screen

Select nphies pre-auth type:Professional

nphies responses:

Empty or Need intervention group

Missing nphies code,procedure group not mapped in system as per nphies requirement.

To fix this :-

You need to make sure that all products in the requested are correctly mapped with the correct CPT Code in the charge master.

And the cpt code already assigned to procedure group in the cpt 4 codes screen

Do not continue with Process:

nphies payer license not updated in Business partner.

nphies server time-out(needs to be resubmitted)

Expected or correct responses from nphies

Pending & Queued :Need to be responded to by the insurance company by approving or rejecting the pre-auth request.

Non-Authorized:

Poll communication:

To be used after a few minutes to check the HIC response for the pre-auth.

Once the pre-auth request response is polled as approved,PSO can continue with the Service order posting & billing process.