281 - NPHIES Error Handling

03/07/2022 Handling of all three types of NPHIES errors in both NPHIES Report window and Pending Order Authorization window

 

When sending a request for their NPHIES approval, sometimes they might not be approved due to an error in procedure or source, therefore we can classify these types of errors into three different kinds, according to their characteristics:

1. NPHIES originated errors that don't reach payers

   Errors that come directly from NPHIES, since they could not reach the payer of those charges.

2. Request errors that reach payers

   Other types of request errors when NPHIES actually could reach the payer of your charges but for some reason they were rejected.

3. Item errors that reach payers

   Errors directly linked to the items added to the charges sent to NPHIES; error is not related to the request itself.

   Case 1 & Case 2

   Error messages for cases 1 and 2 will appear in NPHIES Report window after your request got rejected and when the Outcome column is showing you the Error feedback.

   Here below we will show you the whole process for viewing these two error messages:

   i. After performing a search on NPHIES Report, you will be able to see an Error title - if there is any - , in Outcome column:

ii. Click context menu to the right of the request and select NPHIES Response Errors :

iii. It will open a new window whit all of the response errors related. NPHIES Display Error will show the error message with the reason of why it got rejected:

Case 3

If there are errors related with an item (case 3) , you can check those messages in Pending Orders Authorization window.

To do so, select your encounter to see your related charges and verify by following these steps:

i. On the lower part of the encounter you will see the related charges and their NPHIES Status, click on NPHIES Response for the item that got rejected:

ii. You will see a new window that will show a NPHIES Response section, open it:

If your item got rejected, on Benefit line will appear an Adjudication Rejection Reason button, click on it to visualize the reason:

The reason will be the text in NPHIES Display Error column:

We hope this improves your Cirrus experience. Remember to share this information and ask for help if you need it.

Date: March 07, 2022