Referral Eligibility Request-استحقاقية العلاج للمستفيد المحول

You can check an eligibility for a referred patient to the healthcare facility. 

To perform Referral Eligibility Request Transaction, you need to follow below mentioned steps: -

Step 1: login to https://eclaims.waseel.com/en/

Step 2 : from left side menu click on  Eligibility -> Request Eligibility 

Step 3: Search Beneficiary and turn on the “Referral” button. 

Step 3: Choose the Eligibility Purpose which can be anyone out of following: -

• Benefits: Choosing this purpose will display details of the insurance coverage or benefits
• Validation: Choosing this purpose is to validate the eligibility within the Provider’s network
• Discovery: Choosing this purpose means to discover beneficiary insurance plan with a particular Payer. This option is suitable when a patient does not know the insurance plan details. 
• Note: Submitting an eligibility request by choosing Discovery purpose, automatically fill the insurance section under beneficiary details.

Step 4: Click on “Request Eligibility “button”. This step submit eligibility the request and receive the response in real time from payer via NPHIES platform.