Pre-authorization transaction can be sent to MRE (Medical Rule Engine) for clinical validation. Only following types of product or services are covered for MRE validation: -
• Procedure
• Laboratory
• Transportation SRCA
• Imaging
• Services
• Dental
Note: This is a configuration-based feature. It will only be visible to any provider, if Waseel Admin have enabled MRE Configuration for you.
To perform MRE validation, provider need to follow below mentioned steps: -
Step 1: Create Pre-Authorization request, navigate to NPHEIS -> Pre Authorization -> Request Pre Authorization page.
Step 2: Enter “Pre Authorization Info” section (all fields with * are mandatory)
Step 3: Enter Care team.
Step 4: Enter Diagnosis Information (Field with * are mandatory)
Step 5: Provide Supporting Info. (optional)
Step 6: Enter Items Information (Field with * are mandatory). For PBM please add items out of mentioned categories (Procedure, Laboratory, Transportation SRCA, Imaging, Services
& Dental).
Step 7: Enter accident details. It is an optional section under which Healthcare provider need to enter details, if patient encountered any accident.
Step 8: Click on the “Request Authorization” to submit the authorization Request. After filling all the authorization request details, this is the last step to submit authorization.
Step 9: Click upon request MRE button. PBM response will appear on screen
Note: While submission of Pre-Authorization request, if user missed to enter any mandatory information, then system will give details of missed.