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Curacel is the service many HMOs use to receive claims and pre-authorization requests. Once you connect it, you can send a claim or a request to the HMO straight from ClinikEHR instead of by email or portal, check whether a patient’s cover is active, and see the HMO’s decision on the claim without leaving the page. Connecting Curacel is optional. Everything in Claims and Pre-authorization still works by hand if you do not.

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Connect your account

1

Open the Curacel card

On the HMO setup tab, the Curacel card shows Not connected. Only an owner or manager sees Connect Curacel.
2

Choose the account

Pick My clinic’s own Curacel account if your hospital has its own Curacel sign-in. Pick The shared ClinikEHR account only if ClinikEHR has told you to; you then enter the account number Curacel gave you.
3

Enter your sign-in

Use Email and password or An API key. If your Curacel login covers several accounts, you are asked to Choose which Curacel account to use.
4

Select Connect

ClinikEHR checks the sign-in with Curacel first. If it is accepted the card reads Connected; if not, nothing is saved.
Your password or key is saved encrypted and can not be shown again. To change it, connect again and enter the new one. Select Update HMO list afterwards to match your insurers to Curacel’s list.

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Send a claim to the HMO

1

Open the claim

In Claims, find a draft claim that is ready to send.
2

Select Submit to HMO

It is in the claim’s Actions menu and appears on a claim that has not been sent. Set the insurer’s Submission channel to Curacel first (see How claims reach your HMOs). Read the confirmation, which says the claim goes through Curacel and what is sent, then select Submit to HMO.
3

Follow the decision

The claim reads Submitted with a line beneath it saying With the HMO. When the HMO decides it changes to HMO approved, HMO part-approved or HMO declined, and the approved amount fills in. Select Check HMO status to look now.
A pre-authorization request is sent the same way from its Actions menu. If Curacel is busy, you are told it will be sent again automatically. If the HMO or Curacel refuses it, you are told what to fix, such as a missing diagnosis or insurance number. Fix it and select Submit to HMO again; a claim that has already reached the HMO is never sent twice.

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What is sent

The patient’s name and insurance number, the visit date, the diagnoses and the billed lines (and, on a pre-authorization request, the patient’s sex). Nothing else about the patient is sent. Because this is patient information going to an outside service, only people who can edit claims can send them, and each send is recorded in the audit log.

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Status updates from Curacel

By default ClinikEHR checks Curacel for decisions regularly. If your hospital uses its own Curacel account, you will also be able to have Curacel tell ClinikEHR the moment an HMO decides. Status updates appears on the card once ClinikEHR switches these updates on; until then, decisions arrive through the regular check.
1

Open Status updates

On the Curacel card, select Status updates. Only an owner or manager sees it, and only when the card reads Connected with your clinic’s own account.
2

Copy the address

Select Copy next to Address for Curacel, then paste it into Developer Access in your Curacel account as the address for claim and pre-authorization updates.
3

Create a token in Curacel

In your Curacel dashboard, create a token for these updates and copy it.
4

Paste it into ClinikEHR

Paste it into Token from Curacel and select Save token. The sheet then shows Token saved. The token is stored encrypted and can not be shown again; to change it, enter a new one.
Until a token is saved the sheet shows No token saved and statuses keep arriving through the regular check. To stop accepting updates, select Remove token and confirm; statuses then arrive only through the regular check, which can take longer. Disconnecting Curacel removes the token too.

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Disconnect

Select Disconnect on the card and confirm. Claims and requests already sent stay with the HMO and keep their status here. You can not send new ones, check cover or refresh statuses until you connect again. The saved sign-in and the status-update token are deleted.

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Common issues

Your hospital’s Insurance setting must be Outside the US, and Curacel only works in the live product. A test or preview workspace shows the card as not available.
Check the email and password by signing in to Curacel yourself. If your hospital has several Curacel accounts, choose the right one when asked.
The claim must be a draft that has not been sent, Curacel must read Connected, and you need permission to edit claims. Two-factor sign-in must also be complete if your hospital requires it.
Curacel or the HMO refused the details. The message names what to fix, such as the insurance number, a diagnosis or a line’s price. Fix it and send again.