Insurance & Claims
Insurance billing, approvals, and claim follow-up without slowing down the front desk.
7
Insurance data models
4
Claim and patient payment metrics
3
Coverage calculation layers
Overview
Keep insurance setup, patient cards, approvals, invoice coverage, and claim follow-up connected to the same sessions and payments your team already runs every day.
Claim follow-up flow
How coverage is split
Illustrative — based on configured insurer and policy rules
Approval capture
A compact view of the approval data staff keep with each claim
Real-world use cases
Bill insured visits accurately
Use insurer price lists, policy class deductibles, coverage discounts, and max coverage caps to split session invoices between patient and payer.
Track approvals at the line level
Attach confirmation number, date, amount, status, notes, and files directly to invoice units or insurance-backed package subscriptions.
Follow up claims from payments
Review insurance payment transactions by company, separate claimed from unclaimed amounts, and mark selected payments as claimed after operational follow-up.
What you get
Contract-aware insurer setup
Store insurer contacts, tax data, NPHIES metadata, coverage rules, contract dates, attachments, and examination-specific prices.
Policy classes for real coverage rules
Model policy numbers, statuses, class names, deductible percentages, maximum deductible amounts, and optional class-level coverage overrides.
Patient insurance cards everywhere
Link patient profiles to policy classes once, then reuse the card from patient screens, sessions, packages, payments, and insurance reports.
How it works
- 1
Configure payer rules
Add the insurance company, price list, policies, classes, contract files, and coverage settings.
- 2
Select insurance during care
Choose the patient insurance card in a session or package and capture approval details when needed.
- 3
Review and claim
Use the insurer workspace to review patients, invoices, payments, claimed totals, unclaimed totals, and attachments.
Need implementation details, APIs, or workflows?
Read the full documentationRelated modules
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