Revenue
Pre-authorisation, Claims & Doctor Fees
Pre-authorisation requests where the plan demands them, claim batches per payer built from the covered charges, submission, remittance and rejection handling, and doctor fee statements computed from the same charges — revenue share without a second reconciliation.
For:Insurance deskBilling officersFinance
Where:Billing › Pre-authorisations · Claims · Doctor Fees · Statements
How to
Request a pre-authorisation
- On the bill or the admission, Pre-authorisation › New: the services, the estimated amount, the clinical justification; attach the payer’s form.
- Send; record the payer’s answer (approved amount, number, validity) when it comes; the bill shows the approval.
Build and submit a claim batch
- Billing › Claims › New: payer, period; the covered charges of closed bills are pulled in.
- Check the lines; export the payer’s file or print the claim forms; Submit.
- Record the remittance when paid: per line, paid, partially paid or rejected with the reason.
- Rejected lines go to a resubmission batch or are written off; the activity view keeps the follow-ups.
Produce doctor fee statements
- Billing › Doctor Fees: the share rules per practitioner (percentage or fixed per service).
- Statements per period: the fee lines from the charges, the amount due to each practitioner; approve and hand to payroll or accounts payable.
See also: Payers, Plans & Memberships Bills, Charges & Cashier Staff, Roster, Attendance & Payroll