Insured patients without the paperwork pile
Record the policy once. Every invoice after that splits itself between the patient's co-pay and the insurer's share, and claims assemble themselves from what was actually billed.
Everything this module covers
- Insurers, schemes and patient policies on file
- Pre-authorizations tracked against treatments
- Per-line co-pay and insurer split on every invoice
- Claims built automatically from billed items
- Claim lifecycle from draft to submitted to settled
- Settlements post income and TPA fees to finance
- Patient and insurer balances tracked separately
- Outstanding-claim visibility at a glance
Record the policy once
Insurers, their schemes and the members you serve, with the co-pay rules that make every subsequent invoice split itself.
What this does for you
Insurers, their schemes and the members you serve, with the co-pay rules that make every subsequent invoice split itself.
- Insurer directory with contacts and TPA fee
- Schemes per insurer with their co-pay rules
- Patient policies with member number and validity
- Active policy applied automatically at billing
- Expired policies retained on record
Who you bill
Every insurer and scheme you work with, with the members currently covered.
Adding an insurer
Name, contact and TPA fee, enough for claims and settlement reconciliation to work.
Schemes and their co-pay rules
Each insurer's schemes with the split that every invoice will apply automatically.
Who is actually covered
Active member policies with their numbers and validity, the list billing checks against.
Claims that assemble themselves
Each insured invoice splits into the patient's co-pay and the insurer's share. The insurer's side accumulates on a claim that you submit, track and settle.
What this does for you
Each insured invoice splits into the patient's co-pay and the insurer's share. The insurer's side accumulates on a claim that you submit, track and settle.
- Claims built from what was actually billed
- Lifecycle: draft, submitted, approved, paid, rejected
- Claimed against approved, line by line
- Settlement posts income and the TPA fee separately
- Patient and insurer balances tracked apart
Every claim and its state
Submitted, approved, paid and rejected in one list, you always know what is owed.
Claimed against approved
Line by line, with the invoice behind each, differences are visible, not buried.
Approval on file before the treatment
Track the pre-authorization the insurer issued, its number, amount and validity, and attach it to the invoice it covers.
What this does for you
Track the pre-authorization the insurer issued, its number, amount and validity, and attach it to the invoice it covers.
- Pre-authorization number and approved amount
- Validity window per authorization
- Linked to the patient and their scheme
- Attached to the invoice it covers
- Visible before treatment begins
Authorizations alongside claims
Pre-authorizations live beside the claims they support, so the approval trail is one click away.
Frequently asked
Does it work with TPAs?
Can one patient hold more than one policy?
What happens if the insurer rejects a line?
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The live demo is a fully loaded facility, open it and click through every screen on this page.