Private insurance

Money & claims

Private insurance

Payers, member verification, benefit reservation, claims, attachments, remittances and reconciliation.

Who uses it: Insurance desk and claims officers
Where to find it: Insurance, Insurance Claims, Remittances, Payers

1Set up payers

1
Payer directory
Go to “Payers” → “Add payer”. Enter the name, payer code and type (for example Slade360 or direct insurer).
2
Sync
If you use Slade360 click “Sync from Slade360” to load the payers and schemes.
3
Code mappings
Under “Code mappings” map your service and diagnosis codes to what the insurer expects (for example ICD-10), then “Save mapping”.

2Verify the member and start the visit

1
Add insurance to the patient
On the patient’s Insurance tab click “Add insurance”, choose the provider and scheme and enter the member details.
2
Authenticate
Click “Authenticate & start visit”. Choose the authentication method, “Send OTP” to the member’s phone and enter it, then “Verify & start visit”.
3
Reserve the benefit
Use “Reserve benefit” and enter the amount to reserve against the member’s cover.

3Claims and payment

1
Create the claim
Open “Insurance Claims” → “Create claim” from the visit’s invoice.
2
Attach documents
Use “Upload attachment” for the signed claim form, lab results and so on.
3
Send
Click “Send invoice to payer”, then “Refresh status” to follow it.
4
Remittances
Under “Remittances” click “Fetch remittance” and “Reconcile” to match payments to invoices. Short payments can be settled with a credit note.

Need help with this? Our team can show you on a call.