> ## Documentation Index
> Fetch the complete documentation index at: https://help.clinikehr.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Insurance dashboard

> Register the insurers your hospital accepts, price each one separately, set what their plans cover, and put a patient's policy on file.

export const StillStuck = ({topic}) => <div className="ck-callout ck-callout--note" role="note">
    <p className="ck-callout__body">
      <strong>Still stuck{topic ? ` with ${topic}` : ''}?</strong>{' '}
      Check <a href="/platform/help/troubleshooting">Troubleshooting</a> first —
      it covers the failures we see most often. If that does not resolve it,{' '}
      <a href="/platform/help/contact-support">contact support</a> and include
      your workspace name and the time the problem happened, so we can find the
      matching entry in your audit log.
    </p>
  </div>;

export const TaskHeader = ({before, time, after}) => <div className="ck-task">
    {before ? <div className="ck-task__cell">
        <div className="ck-task__title">Before you start</div>
        <p className="ck-task__body">{before}</p>
      </div> : null}

    {time ? <div className="ck-task__cell">
        <div className="ck-task__title">Takes about</div>
        <p className="ck-task__body">{time}</p>
      </div> : null}

    {after ? <div className="ck-task__cell">
        <div className="ck-task__title">When you're done</div>
        <p className="ck-task__body">{after}</p>
      </div> : null}
  </div>;

export const Path = ({steps = []}) => <span className="ck-path">
    {steps.map((s, i) => <span key={i} className="ck-path__step">
        {i > 0 ? <span className="ck-path__sep" aria-hidden="true">
            ›
          </span> : null}
        {s}
      </span>)}
  </span>;

export const Availability = ({editions = ['all'], plans, roles, note}) => {
  const list = editions.includes('all') ? ['clinic', 'pharmacy', 'lims'] : editions;
  return <div className="ck-avail" role="note" aria-label="Feature availability">
      <span className="ck-avail__label">Available in</span>

      {list.map(e => <span key={e} className={`ck-pill ck-pill--${e}`}>
          {EDITION_LABELS[e] || e}
        </span>)}

      {plans ? <span className="ck-avail__label">Plan</span> : null}
      {plans ? <span className="ck-pill ck-pill--plan">{plans}</span> : null}

      {roles ? <span className="ck-avail__label">Who</span> : null}
      {roles ? <span className="ck-pill ck-pill--role">{roles}</span> : null}

      {note ? <span className="ck-avail__note">{note}</span> : null}
    </div>;
};

<Availability editions={['clinic']} plans="Enterprise" roles="Owners, managers, accountants and billers" note="Needs the Insurance care area switched on." />

**Insurance Management** is a register your hospital maintains itself: who your insurers are, what you have agreed to charge each of them, what their plans cover, and which patients hold a policy. Everything on the [Pre-authorization](/hospital/insurance/pre-authorization) and [Claims](/hospital/insurance/claims) screens is built from what you set up here.

<Note>
  Solo and team practices use a different, electronic claims system that transmits to a payer. It is documented separately in [File insurance claims](/practice/money/insurance-claims), and the two share no data.
</Note>

<Path steps={['Sidebar', 'Insurance', 'Insurance Dashboard']} />

<TaskHeader before="The Insurance care area switched on under Settings → Facility" time="20 minutes for the first insurer" after="An insurer you can raise pre-authorizations and claims against" />

## 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:

| Tab           | What it holds                                                                                                                |
| ------------- | ---------------------------------------------------------------------------------------------------------------------------- |
| **Overview**  | Four count tiles, a **Coverage Distribution** chart and **Recent Activity**                                                  |
| **Companies** | Every insurer you accept, with **Company Details**, **Company Code**, **Point of Contact**, **Contact Phone** and **Status** |
| **Pricing**   | **Service Prices** and **Medicine Prices**, side by side, per insurer                                                        |
| **Coverage**  | **Coverage Management** — what each plan actually pays for                                                                   |

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

<Steps>
  <Step title="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.
  </Step>

  <Step title="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.
  </Step>

  <Step title="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.
  </Step>
</Steps>

The insurer now appears on **Companies**. Nothing else in the module works until at least one exists.

## Set the prices you negotiated

Two insurers paying different amounts for the same procedure is the normal case, and this is where that lives.

<Steps>
  <Step title="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**.
  </Step>

  <Step title="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.
  </Step>
</Steps>

Pre-authorizations and claims are priced from these rows, not from your standard service list. An insurer with no pricing produces requests and claims at the wrong value.

## Say what the plan covers

<Steps>
  <Step title="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.
  </Step>

  <Step title="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**.
  </Step>
</Steps>

## Record a patient's policy

A patient's own policy is captured from the request or claim you are raising, not from this dashboard.

<Steps>
  <Step title="Start a request or a claim">
    Open a new [pre-authorization](/hospital/insurance/pre-authorization) or [claim](/hospital/insurance/claims) and choose the patient.
  </Step>

  <Step title="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.
  </Step>
</Steps>

## Who can do this

**Role** decides whether the screen opens at all. On Enterprise, an owner controls which roles reach **Insurance** under **Settings → Role Navigation** — by default the accountant and biller roles do, alongside owners and managers, and a role with no rule of its own is unrestricted.

**Permission** decides what a person may do once inside. The **Billing** section of your staff sheet carries these, in the product's own words:

| Permission                   | What it is for                   |
| ---------------------------- | -------------------------------- |
| **File insurance claims**    | Preparing and submitting a claim |
| **Add insurance payments**   | Recording a payer's settlement   |
| **Request coverage reports** | Pulling what a payer covers      |
| **Edit service fees**        | Repricing what you charge        |

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

<AccordionGroup>
  <Accordion title="Insurance is missing from my sidebar">
    Either the **Insurance** [care area](/hospital/get-started/care-areas) is off, or the hospital is not on Enterprise. Turning the care area off removes the navigation group, the settings tab and the insurance report together. See [Change your plan](/platform/plans/change-plan).
  </Accordion>

  <Accordion title="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.
  </Accordion>

  <Accordion title="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.
  </Accordion>

  <Accordion title="No insurance companies found in the picker">
    The patient's insurer has not been added on **Companies**. Add it there, then reopen the request.
  </Accordion>

  <Accordion title="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.
  </Accordion>
</AccordionGroup>

## FAQ

<AccordionGroup>
  <Accordion title="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.
  </Accordion>

  <Accordion title="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.
  </Accordion>

  <Accordion title="Does insurance replace ordinary billing?">
    No. Patient responsibility — co-pays, excess and uncovered items — is still an invoice. See [Billing](/hospital/revenue/billing).
  </Accordion>

  <Accordion title="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.
  </Accordion>

  <Accordion title="Where do I see claim volume and denials over time?">
    In the **Insurance** report — see [Reports and analytics](/hospital/executive/analytics). It follows this in-house module, not the electronic one.
  </Accordion>
</AccordionGroup>

<StillStuck topic="insurance" />