Solo and team practices use a different, electronic claims system that transmits to a payer. It is documented separately in File insurance claims, and the two share no data.
What you’re looking at
The heading reads Insurance Management — “Manage insurance companies, pricing, coverage, and patient insurance details”. A date-range picker, Refresh and New Insurance sit beside it. Four tabs:
The Overview tiles count Insurance Companies (with how many are active), Service Prices, Medicine Prices and Coverage Items. They are counts of what you have configured, not money.
Empty states. A hospital that has configured nothing sees No Partners Registered on Companies, with an Add Your First Company button; No service prices found and No medicine prices found under Pricing; and No Coverage Profiles under Coverage. Work the tabs in the order below and each fills in turn.
Add an insurer
1
Open the insurance form
Select New Insurance. The form opens as five tabs — Company, Plans, Services, Medicines and Coverage — which is the same order this page’s tabs fill up in.
2
Enter the company
On Company, Company Name is the only required field. Company Code, Contact Email, Contact Phone, Website and Contact Address are what your billing clerk needs when chasing a claim. Leave Active Status on.
3
Add the insurer's plans
On Plans, choose the Insurance Company and enter a Plan Name. Then set Plan Type, Coverage Type, Network Type, Deductible Amount, Maximum Coverage Amount, Copay Percentage and Waiting Period (Days). Switch on Pre-authorization Required where the plan demands approval before treatment — that is the flag that tells your team to raise a request first.
Set the prices you negotiated
Two insurers paying different amounts for the same procedure is the normal case, and this is where that lives.1
Price the services
On the Pricing tab select Add Service, or use the Services tab of the insurance form. Service Prices is “Fee-for-service pricing by insurance company” — each row carries a Service, a Company, a Category, a Price and a Status.
2
Price the medicines
Select Add Medicine. Medicine Prices is “Medication pricing with dosage and strength details”, so the Details column carries dosage and strength — the same drug at two strengths is two rows.
Say what the plan covers
1
Add a coverage rule
On Coverage, select Add Coverage. Coverage Management configures “coverage for services, medications, lab tests, and wards”, so a rule can attach to any of the four.
2
Set the share and the ceiling
Each rule records a Medical Item, the Insurance Body, a Category, a Coverage % and a Max Benefit. A blank ceiling shows as Unlimited.
Record a patient’s policy
A patient’s own policy is captured from the request or claim you are raising, not from this dashboard.1
Start a request or a claim
Open a new pre-authorization or claim and choose the patient.
2
Add their insurance
Where the form says No insurance information on file, select Add Insurance. The Add Insurance Details dialog takes the insurer, the Policy Number, the Expiry Date, Coverage %, Co-pay %, Discount %, Payment Terms (Days) and Special Instructions. It is saved against the patient and reused next time.
Who can do this
Role Navigation is what decides who gets here. The screens themselves check nothing — their old hardcoded role lists were retired — so anyone who can reach the Insurance group can use all of it. Under Settings → Role Navigation the accountant and biller roles reach it by default, alongside owners and managers, and a role with no rule of its own is unrestricted. Your staff sheet’s Billing section does carry File insurance claims, Add insurance payments, Request coverage reports, Edit service fees and View financial dashboard, and they are recorded against each person — but no insurance screen reads them, so they change nothing today. Restrict insurance at the Role Navigation layer instead. Enforcement is opt-in per person: a colleague never saved in the permissions sheet is unrestricted, and the sheet warns “Saving starts enforcing” before that changes. A denied action is recorded; an allowed one is not. Hiding Insurance from a role is a convenience, not a security boundary.Check it worked
- The insurer is on Companies with a Status of active.
- Service Prices and Medicine Prices show rows against that company’s name.
- The Overview tiles have moved off zero, and Coverage Distribution has something to plot.
- A new claim offers that insurer in its company picker.
Common issues
No Partners Registered, but we have insurers
No Partners Registered, but we have insurers
You are on a hospital with nothing configured yet, or the date-range picker is narrowed past your records. Select Refresh first.
A claim priced itself at the wrong amount
A claim priced itself at the wrong amount
The payer has no negotiated price for that service or medicine, so nothing overrode your standard fee. Add the row under Pricing rather than overtyping each claim.
No insurance companies found in the picker
No insurance companies found in the picker
The patient’s insurer has not been added on Companies. Add it there, then reopen the request.
No Coverage Profiles even though prices exist
No Coverage Profiles even though prices exist
Pricing and coverage are separate: one is what you charge, the other is what the plan pays. Add rules on the Coverage tab.
FAQ
Does this transmit anything to the insurer?
Does this transmit anything to the insurer?
No. Requests and claims are prepared here and sent to the payer the way you already send them. This module is the record and the tracker.
Can one insurer have several plans?
Can one insurer have several plans?
Yes, and it usually does. Add each on the Plans tab — deductible, ceiling, copay and Pre-authorization Required are per plan, not per company.
Does insurance replace ordinary billing?
Does insurance replace ordinary billing?
No. Patient responsibility — co-pays, excess and uncovered items — is still an invoice. See Billing.
What happens if I deactivate a company?
What happens if I deactivate a company?
It stops being offered on new requests and claims. Existing records keep the insurer they were raised against.To deactivate one, open the row menu on the Insurance Companies list and choose Edit, then turn Active off and save. Prefer this to Delete whenever the insurer has any history: deactivating keeps every claim and pre-authorization readable, while removing takes the company out of the list for good.
What can I do from the companies list?
What can I do from the companies list?
Each row has View, Edit and Delete. View shows the contact details on file without any risk of changing them; Edit opens the same fields for correction, including the Active switch; Delete removes the insurer after a confirmation that spells out what is lost.Edits apply to new claims and pre-authorizations. Anything already filed keeps the details it was filed with, so correcting a payer’s phone number today does not rewrite last month’s paperwork.
Where do I see claim volume and denials over time?
Where do I see claim volume and denials over time?
In the Insurance report — see Reports and analytics. It follows this in-house module, not the electronic one.