Pre-authorisation and claims
DK-120
Each insurance, scheme or group case of an admission, from the pre-authorisation to the last rupee received. Every step is kept as it happened; the figures are added up from them.
Pending claims by payer
| Payer | Claims | 0 to 30 days | 31 to 60 days | 61 to 90 days | Over 90 days | Oldest (days) |
|---|
No claim is waiting on a payer. A claim appears here from the day it is submitted until it is settled or closed.
Open cases
| Admission | Payer | State | Asked for | Approved | Awaited from payer | Actions |
|---|
No case is open. Open an admission above to start a pre-authorisation.
No admission is open on this page. Type the admission number above to see its covers and cases.
Insurance and cover
Register the patient or open a file first; the patient's covers are recorded against the record.
| Payer | Policy / member | Card holder | Valid | Pays how | Warnings | Actions |
|---|
No cover is recorded for this patient. If the patient pays for themselves there is nothing to add.
Add a cover
No payer is set up yet. The administrator adds insurers, TPAs, schemes and groups on DK-119.
Cashless - the payer settles with the hospital. Reimbursement - the patient pays and the payer or group pays the patient back.
Cases of this admission
| Payer | Pays how | State | Approved | Actions |
|---|
No case is open for this admission. Pick a cover below and open one.
This patient has no cover in use. Record one in the cover card above first.
Case
Pre-authorisation
The pre-authorisation has been sent. Record the payer's answers below.
The payer's answer
Documents sent
No document is recorded as sent yet.
The claim
Leave the amounts empty to take the bill's total and the approved amount as the payer's share.
A settlement posts to the patient's bill (DK-05) as an insurance payment with the payer named.
Under reimbursement the patient pays the hospital and the payer or group pays the patient back. Record each payment back here.
What happened, in order
| When | What happened | Amount | Reference | Reason | By |
|---|
Nothing has happened on this case yet. Record the pre-authorisation when it is sent.