Under this feature, we are enabling provider now to send Pre-Auth request to Center for National Health Insurance (CNHI) under GlobeMed TPA via NPHIES to submit Emergency and Referral Inpatient Pre-authorizations as well as extending the earlier preauthorization with new services (CNHI Pre-authorization Follow UP Request). The healthcare provider may not receive real time final decision from payer (Auto adjudication) rather request can be Queued by NPHIES or Pended by Payer on a successful transaction.
The Request CNHI Preauthorization feature also enables healthcare providers to: -
- Receive Communication Request for a submitted CNHI Pre-authorization request from Payer
- Initiate a Communication to Payer (Center for National Health Insurance (CNHI) under GlobeMed TPA)
- Cancel or Nullify the CNHI authorization request
- Receive notification for processed authorization
- Make an inquiry against submitted CNHI Pre-authorization
- To do status check against submitted CNHI Pre-authorization
Question: What are the different types and subtypes of Pre-authorization request?
Answer: There are 5 types of pre-authorization: -
S.No | Type | Sub-type | Definition |
1. | Institutional | Emergency Inpatient | Hospital, clinic inpatient claims |
2. | Dental | Outpatient | Dental, Denture and Hygiene claims |
3. | Pharmacy | Outpatient | Pharmacy claims for goods and services |
4. | professional | Outpatient | Outpatient claims from Physician, Psychological, Chiropractor, Physiotherapy, Speech Pathology, rehabilitative, consultation |
5. | Optical | Outpatient | Vision claims for professional services and products such as glasses and contact lenses |