NPHIES

Queue an NPHIES claim and confirm its eventual outcome

Distinguish a queued exchange from transport delivery, payer acceptance and adjudication.

Current source · source reviewed · 6 min read

Before you begin

A ready claim and claim-management permission.
Environment-appropriate NPHIES configuration and production gates where applicable.

1. Review the ready claim

Confirm required data, attachments, coding and the intended payer route. Review environment and deployment readiness before any live submission.

2. Queue NPHIES claim

Use Queue NPHIES claim from the case. The API queues the claim and returns HTTP 202 with claim and exchange details, status, message type and correlation identifier.

3. Follow the exchange lifecycle

Read the NPHIES transaction lifecycle, attempts and subsequent received messages. Poll through the configured workflow if the protocol requires a later response.

4. Read processing and adjudication separately

A successful HTTP call or batch acknowledgement does not establish per-claim payer acceptance. Inspect the claim’s processing outcome, adjudication outcome and payer claim reference.

Production is separately gated

The public development package cannot authorize production delivery. Live submission requires the configured certified package, usable certificate, matching environment and deployment evidence.

Manual adjudication boundary

The manual adjudicate endpoint is blocked outside DEBUG and production payer decisions must arrive through NPHIES. It also refuses using adjudication to assert bank cash.

Troubleshooting

The exchange remains queued

Inspect integration errors, worker/queue health, certificate state and named work queues. Preserve the original exchange identity when the authorized retry path is appropriate.

Source evidence

References are pinned to the private MANSOQ source repository. Repository access is required to open these links.