Claims
Process and manage medical claims
These are your real-time medical claims, as entered by the provider. This section is allowed to managers, approval employees, and accountants, yet only managers and approval employees can process claims. This section is divided into: Prescriptions, Laboratory, Radiology and Hospitals. Under each section, you will find two sections: Pending (for cases awaiting approvals) and Completed (for cases already processed). It is important to note that for auto-approved items, such as medications, laboratory tests, and radiology services, the system will automatically process the claim without requiring any manual intervention. This is based on the predefined rules set by the insurer. In any case, once the claim is processed, the patient will be notified and the provider will be able to access the processed claim details.
Prescriptions
These are mainly written by doctors to patients. A Prescription might include medications, laboratory tests, or radiology services. To process a prescription request, click on the item, and you will find a detailed description of the clinic visit, and what the doctor recommended. Simply click Process Claim, for each prescribed medication choose the appropriate status, whether accepted, substitution allowed, or rejected. Then proceed to select the approved quantity, and write any notes you may find useful. Same goes to other lab/radiology services. Once submitted, you will find the record under Completed. This processed claim is readily accessible by the patient and the provider.
Pharmacies
These are mainly requested by pharmacies. A Pharmacy request will include multiple medications. To process a pharmacy request, click on the item, and you will find a detailed description of the pharmacy visit, and what the pharmacy user has submitted. Simply click Process Claim, for each requested medication choose the appropriate status, whether accepted, substitution allowed, or rejected. Then proceed to write any notes you may find useful. Once submitted, you will find the record under Completed. This processed claim is readily accessible by the patient and the pharmacy.
Laboratory
These are mainly requested by laboratory centers. A Laboratory request will include multiple laboratory tests. To process a laboratory request, click on the item, and you will find a detailed description of the laboratory visit, and what the laboratory user has submitted. Simply click Process Claim, for each requested test choose the appropriate status, whether accepted, or rejected. Then proceed to write any notes you may find useful. Once submitted, you will find the record under Completed. This processed claim is readily accessible by the patient and the laboratory center.
Radiology
These are mainly requested by radiology centers. A Radiology request will include multiple radiology tests. To process a radiology request, click on the item, and you will find a detailed description of the radiology visit, and what the radiology user has submitted. Simply click Process Claim, for each requested test choose the appropriate status, whether accepted, or rejected. Then proceed to write any notes you may find useful. Once submitted, you will find the record under Completed. This processed claim is readily accessible by the patient and the radiology center.
Hospitals
These are mainly requested by hospitals. A Hospital request will include multiple services. To process a hospital request, click on the item, and you will find a detailed description of the hospital visit, and what the hospital user has submitted. Simply click Process Claim, for each requested service choose the appropriate status, whether accepted, or rejected. Then proceed to write any notes you may find useful. Once submitted, you will find the record under Completed. This processed claim is readily accessible by the patient and the hospital.