CNHI Pre-authorization Transaction- ارسال التأمين الصحي الموحد

Modified on Sun, 28 Apr, 2024 at 3:58 PM

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