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Prior approval

BE-1-4 No prior approval

The insurer needed a prior authorisation for this service, and none was on the claim.

What the insurer’s message says: “[NPHIES display text for BE-1-4]”

In our own words, from the NPHIES Codeable Concept list v5.4. Reviewed by [name, role], [date].

GroupPrior approval
Who usually fixes itFront desk or billing, before the service
Deadline15 days from the rejection

What it means

For example: A patient with Insurer B has an MRI. The policy needs approval for imaging, and none was requested.

The rejection is about the claim as it was sent, not about whether the care was right.

Why it usually happens

  • The service needs approval under the patient’s policy, and nobody requested it.
  • An approval was requested but not granted before the service.
  • The approval existed, but its number wasn’t on the claim.

How to fix this claim

  1. Check whether an approval exists for this patient and service.
  2. If it does, add the approval number and resend.
  3. If none was asked for, appeal only if the visit was an emergency, with the doctor’s note on why it couldn’t wait. Check your contract with the insurer.
Mind the deadline. You have 15 days from the rejection to answer it (CHI Unified Health Insurance Contract, clause 5.4). Your contract with the insurer may set a different window, so check it.

How to stop it next time

At booking, check whether the patient’s policy needs approval for the service, and ask for it before the visit. Don’t send the claim until the approval number is on it.

Easily confused

CodeWhat happened
BE-1-4No approval at all
BE-1-5Approved, but the claim differs from the approval
AD-2-6Approved, but the service fell outside the approval’s dates [confirm against v5.4]

This page explains the common causes. Your insurer’s policy and your contract decide each claim.

Before sending

Nabdah catches this before you send.

A claim that needs an approval and has none is held, with the line to fix, until someone on your team adds the number and presses send.

Book a 30-minute demoChat on WhatsApp
CLM-2026-01067 · Nasser Al-MutairiChecked before sendingHeld
Authorisation on fileFix
Patient’s cover activeChecked
Price matches the contractChecked
Sample · fix 1, then send

Often seen with

BE-1-5

Claim differs from what was approved

The claim doesn’t match the approval: a different service, more units, or a higher amount than the insurer agreed.

Billing, with the doctor
CV-1-4

Service not covered by the policy

The patient’s policy doesn’t include this service, so the insurer won’t pay for it under this claim.

Front desk, at check-in

All rejection codes