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e-
Pr Aut i
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RequestSt
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W henthehealt
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ovi Tapre-aut
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onrequestoraclai
mt ot
he
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ancecompanyortheTPA thr
oughnphies,
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uesinbelow t
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atusi
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ow:

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VED byt
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ngit

t
Parial Meanstheinsur
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her
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s
NOTFINISHED

et
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her he
i
nsur
ance

Meanst herequestcont
ainsERRORS; t
headjudicat
ion
r
Eror COULD NOTBEPERFORMED; i
tcouldbetechnical
ly
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nphies .,-�' u-

nphies terminology

Pre-Authorization and Claim

Adjudication Result
When the health care provider RECEIVES a response for a pre-authorization or a claim from
the health insurance company or the TPA through nphies, they will get one of the five values
in below that indicates the outcome of the request adjudication as below

Approved Means the request has been APPROVED

Partially
Approved ► Means SOME Items been APPROVED, and SOME
REJECTED

Rejected Means the request has been REJECTED

Pended The request processing is ON HOLD

Not Required*
► Means the services do NOT REQUIRE pre-auth as per
the patient table of benefit
*This is only applicable on pre-auth not claim

www.nphies.sa ----------------------- cl!,l.c._i.m.lm.u.J_<Y-'-!,ill#