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A claim asks an insurer to pay for care you have already delivered. Claims is your hospital’s claim register: you prepare each claim here, send it to the insurer the way you already do, and track its answer against the record. Nothing is transmitted to the payer electronically from this screen. Claims needs the Insurance care area in Settings → Facility. See Care areas.

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Prepare the claim

The claim form opens as a set of tabs you work through in order. Each one answers a question the insurer will ask.
1

Create the claim

Select New.
2

Basic Info

The patient, the encounter and the dates. This is what ties the claim to the care that was actually delivered.
3

Items & Services

Every service, medicine and consumable you are billing for. Prices come from the payer-specific rates on the Pricing tab of the Insurance Dashboard, not from your standard service list.
4

Insurance & Diagnosis

The insurer, the patient’s cover, and the diagnosis codes that justify every item on the claim. An item with no supporting diagnosis is the denial you will spend next month arguing about.
5

Review & Submit

Read the whole claim, then submit it. If you obtained a pre-authorization, quote it — an approved request is the fastest route through an insurer’s review.

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Track it

The Claims screen has three tabs, and each answers a different question: Record the payer’s decision on the claim when it arrives, and record the money against it when that arrives. A claim marked as paid with nothing reconciled against it is a claim you have not actually been paid for.

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Check it worked

  • The claim appears in the Claims list with a status and the payer’s name.
  • Nothing you meant to bill this month is still unclaimed.
  • When money arrives, the claim moves to paid and has a payment recorded against it.

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If something goes wrong

Add the insurer on the Companies tab of the Insurance Dashboard first, then record the patient’s cover on Coverage. See Insurance in ClinikEHR.
Payer-specific prices live under Insurance → Pricing. Fix the rate there so every future claim is right, rather than overtyping each one.
Read their reason against what you submitted. Most denials are a missing supporting diagnosis, a quantity beyond what the plan allows, or an item the patient’s cover excludes. Correct the record and re-submit rather than arguing the original.
They are self-paying for that visit. Raise an invoice instead — a claim against expired cover is a denial you can see coming.
Either the Insurance care area is off, or the workspace is not on the Enterprise plan. See Change your plan.