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Prior approval

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.

What the insurer’s message says: “[NPHIES display text for BE-1-5]”

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

GroupPrior approval
Who usually fixes itBilling, with the doctor
Deadline15 days from the rejection

What it means

For example: Ten physiotherapy sessions were approved, and the claim is for twelve.

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

Why it usually happens

  • More sessions or units were given than were approved.
  • The service code on the claim differs from the approved one.
  • The amount is higher than the approved amount.

How to fix this claim

  1. Compare the claim with the approval, line by line.
  2. Correct the codes, units or amounts to match, and resend.
  3. For care beyond the approval, request an extension or a new approval first.
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

Request an extension before the approval runs out, not after the service.

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

After the rejection

Nabdah keeps this rejection in front of you.

Each claim line is checked against its approval before sending, and extensions are requested from the approval itself. Each rejection sits in today’s list with its reason and its appeal date, so your biller works it in time.

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CLM-2026-00961 · Insurer BRejected: BE-1-5Appeal by 22 March
Claim differs from what was approvedReason
Compare the claim with the approval, line by line.
Correct the codes, units or amounts to match, and resend.
Sample · in today’s list, by deadline

Often seen with

BE-1-4

No prior approval

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

Front desk or billing, before the service
BE-1-6

Claim amounts do not add up

The totals on the claim don’t match its lines: the sum, the patient’s share or the tax.

Billing

All rejection codes