Insurance claims

Bill a patient's medicines to their insurance company: the patient pays only the co-pay and the rest stays on the insurer's account as its claim. Claim each insurer's sales in a batch, submit it, then record what the insurer paid on each sale; a part it rejected stays due and can be claimed again. Part of the Insurance claims add-on for pharmacies.

Steps

  1. Open the insurance company's customer record (or add it), tick This customer is an insurance company and type the patient's co-pay %, its cap and your payer ID.
  2. On the pharmacy POS tap Insurance, choose the insurer and type the patient, the member number and the approval number. The Payment screen puts the claim on the insurer's account; the patient pays the co-pay. On the Sales form, choosing an insurer as the customer shows the same Insurance card.
  3. Open Sales → Insurance claims and press New claim batch. Choose the insurer and the dates, tick the sales and save. Press Submit to the insurer when you send it.
  4. When the insurer pays, open the batch, type what it paid on each sale it cut (leave the others blank: paid in full) with the reason, and press Record payment. Each sale gets the payment; what was rejected stays due.

Tips

  • The co-pay is the co-pay % of the sale's total, at most the cap. A different % can be typed on a sale (for example a different class of policy).
  • A sale in a batch that is not settled yet keeps its customer, amounts and member details. A rejected part shows again under New claim batch, so you can send it with the approval the insurer asked for.

In the app, press F1 or ? on this screen to open this guide next to your work.

This guide belongs to the Insurance claims module. Learn more

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