Medical insurance policy setup, patient co-pays, and claim batching
Manage insurance companies, policy coverage tiers, patient co-pay deductions, and insurer claim submissions.
Handle private health insurance claims with automated co-pay calculations.
1. Insurance Providers: Under Clinics → Insurance, set up payer companies (TPA), agreed price lists, and coverage discount matrices.
2. Patient Policy Attachment: Attach the insurance card, policy number, member ID, expiry date, and patient co-pay percentage (e.g., 20% co-pay up to maximum 10 OMR/SAR).
3. Split Billing on Invoices: When generating the clinic invoice, the system automatically splits the bill into Patient Co-pay (payable at the reception desk) and Insurer Receivable (tracked under Insurance Claims).
4. Claim Batch Export: At the end of the billing period, export the claim submission batch with pre-authorization codes for insurer reimbursement.