Workspace/Exceptions
NPHIES connectedAA
Oversight

What needs a person.

Cases the agents will not decide on their own. Each one names the rule that stopped it, what it is worth, and the options — so the decision takes a minute rather than a morning.

Open exceptions
3
Value held up
SAR 99,200
Claims blocked pre-submission
1
rejections prevented
Hard stops
0
held until a person resumes them
PA-2026-00930.95

Coronary artery bypass graft · Aisha Al-Ghamdi

GulfCare Takaful · Dar Al Shifa Hospital

SAR 95,000
What stopped it
Request exceeds the remaining benefit

Requested exceeds the remaining inpatient benefit. A person has to choose: reduce the request, take the balance from the patient, or defer to renewal.

MN-021 documentation requirement not met

Anaesthesia fitness assessment — nothing in the note evidences anaesthesia fitness. Attaching the pre-anaesthesia assessment would also satisfy it. Submitting now predicts an MN-02 rejection.

What the physician needs to add
  • Anaesthesia fitness assessment — nothing in the note evidences anaesthesia fitness. Attaching the pre-anaesthesia assessment would also satisfy it.
Open the case
PA-2026-00830.95

Upper GI endoscopy, diagnostic · Fatimah Al-Zahrani

Al Salam Cooperative Insurance · Al Noor Polyclinic

SAR 2,400
What stopped it
MN-021 documentation requirement not met

Alarm symptoms, or a failed 8-week PPI trial — nothing in the note evidences alarm symptoms. Submitting now predicts an MN-02 rejection.

MN-011 payer criterion not met

Age 50 or over with new dyspepsia, or alarm features. Submitting now predicts an MN-01 denial.

What the physician needs to add
  • Alarm symptoms, or a failed 8-week PPI trial — nothing in the note evidences alarm symptoms.
Open the case
PA-2026-00820.94

Physiotherapy, 12-session course · Maria Santos

GulfCare Takaful · Al Noor Polyclinic

SAR 1,800
What stopped it
Request exceeds the remaining benefit

Requested exceeds the remaining outpatient benefit. A person has to choose: reduce the request, take the balance from the patient, or defer to renewal.

Open the case