Solo and team practices use a different, electronic claims system — payer directory, eligibility checks and claims transmitted to the payer. It is documented separately in File insurance claims. The two share no data.
What it is for
It is built for hospitals that deal with insurers directly — an HMO, a corporate scheme, a state programme — and negotiate their own tariffs. Nothing is transmitted electronically to a clearinghouse: claims are prepared here, sent to the insurer the way you already send them, and tracked here afterwards. This module is the record.The Insurance Dashboard
Two further pages hang off it: Pre-Authorization, for approval before you treat, and Claims, for billing after you have.
Set it up in three passes
1
Add your insurers
On Companies, add every insurer you deal with. Nothing else in the module works until at least one exists.
2
Set what you charge them
On Pricing, enter the negotiated service and medicine prices for that payer. Claims are priced from these, not from your standard service list, so a payer with no pricing produces claims at the wrong value.
3
Record patient coverage
On Coverage, record a patient’s insurer, plan and membership details. A claim cannot be raised against a payer the patient is not recorded as covered by.
Pre-authorization
Pre-Authorization is its own page. Raise a request on the form, which includes a medical-codes picker so the procedures and diagnoses you are seeking approval for are coded from the start. Quote an approved request on the claim that follows — it is the fastest route through an insurer’s review, and the cheapest way to avoid a denial you cannot appeal. See Request a pre-authorization.Claims
Claims is a list plus a multi-tab claim form. Create one with New, work through the tabs, then submit and track it against the payer. See File and track claims.What the module assumes
- The patient’s coverage is recorded. No claim can be raised against an insurer the hospital does not know the patient has.
- Your services carry codes. A Procedure Code on a service carries through to the claim.
- Insurance sits next to ordinary billing, not instead of it. Patient responsibility — co-pays, excess, uncovered items — is still an invoice.
- Prices are per payer. Two insurers paying different amounts for the same procedure is the normal case, and Pricing is where that lives.
If Insurance is missing from your sidebar
- It needs the Insurance care area switched on. Turning that off removes the navigation group, the settings tab and the insurance report together.
- It is an Enterprise feature — see Change your plan.
- If the group is there but you cannot open it, that is your role and permissions — see Permissions.