Insurance pre-authorisation letter
The letter that goes with an approval request: who the patient is, what you plan to do and why, what it will cost and what is attached. In Saudi Arabia the request itself goes through NPHIES, and this is the document behind it.
How to use it
Enter the insurance details
Insurer, policy and member numbers and the plan. Insurers you write to often can be saved to a list.
Set out the case
Diagnosis and procedure, each with its code, the setting and planned date, the clinical justification and the conservative treatment already tried.
Add the cost and attachments
An estimated cost table with item codes, and a tick list of what is attached: report, results, imaging, photos.
Print and attach
Signed by the treating doctor and numbered, ready to attach to the request or send to the insurer.
Why approvals come back refused
Most refusals are not a judgement on the treatment. They are a missing code, a justification that does not say why now, or no record that the simpler option was tried first.
A letter that names the diagnosis and the procedure with their codes, says what was tried and for how long, and lists what is attached answers the reviewer’s questions before they are asked.
Save your design
Without saving, your clinic details, design and templates are cleared when the page reloads. Leave your email and they are kept in this browser from now on, and we will show you how they work in a Medicolize account, on every device and attached to patient files.
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Insurance
Company price lists, eligibility, approvals and claims tracked to payment. Medicolize stops insurance work being done twice.
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Eligibility answered at the counter, pre-authorisation raised from the visit, and claims tracked through NPHIES to the payment that actually arrived.
Read more From the blogWhy NPHIES claims get rejected, and what to do about it
Rejections read one at a time look like bad luck. Grouped by reason they are usually two or three fixable documentation habits.
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Questions
Does this replace NPHIES?
No. In Saudi Arabia the pre-authorisation request itself is submitted through NPHIES. This letter is the supporting document you attach to it or keep on file, and a line saying so prints in the footer.
Which codes should I use?
The ones your insurer asks for, usually ICD-10 for the diagnosis and the insurer’s own procedure coding. The fields take any code as you type it.
Is the pre-authorisation letter free?
Yes. No sign-up, no watermark and no limit.
Is patient or policy information stored?
No. The patient, policy and member numbers stay in the page and are gone when you close it. Only insurer names you choose to save, and your letterhead, are kept.
Approvals raised from the visit
In Medicolize pre-authorisation is raised from the visit with the clinical documentation attached, and the approval reference is stored against the service it covers.