What is PBM validation in Pre-authorization Transaction? ماهو PBM

 Pre-authorization transaction can be sent to PBM (Pharmacy Beneficiary Management) for clinical validation.

 Only Medication Codes type of product or services is covered for PBM validation. 

Note: This is a configuration-based feature. It will only be visible to any provider, if Waseel Admin have enabled MRE Configuration for you. 

Provider need to follow below mentioned steps to perform PBM validation: -

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. For PBM validation it is mandatory to add “Vital Sign Weight” under supporting info. 

Step 6: Enter Items Information (Field with * are mandatory). For PBM please add medication code under itrm.

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 PBM 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.