Newborns usually do not have their own insurance (coverage) from the date of birth to about 30 days, so the eligibility check provided to the newborn will include the newborn’s (patient) patient information and will use the mother's insurance (coverage). However, the newborn's gender and date of birth in the patient resource do not match that of the insurer-saved subscriber, the newborn extension is specified in the eligibility to notify the insurer that the message is for the newborn. This function is used to check an eligibility for a Newborn patient to the healthcare facility.
To perform Newborn Eligibility Request Transaction, you need to follow below mentioned steps: -
Step 1: login to https://eclaims.waseel.com/en/
Step 2 : from leftside menu click on Eligibility -> Request Eligibility page.
Step 3: Search Beneficiary and select “New Born” check box. Subscriber is the beneficiary (for New born, it can be father or mother). Add new born and subscriber of the beneficiary if information does not exist.
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.