Insurance

Complete

This window is used to report on Insurance Claims.

The query fields are as follow:

Finds claims by OpenVPMS identifier, policy number or insurer claim identifier

Finds claims by their status. Use:

All	to find all claims
Incomplete	to find claims that haven't been Settled, Declined, or Cancelled.
Not Submitted	to find claims that are Pending or Finalised
Pending	to find claims that are still being edited
Finalised	to find claims that can no longer be changed but haven't been submitted to the insurer
Submitted	to find claims that have been submitted, but not yet accepted by the insurer
Cancelling	to find claims that are in the process of being cancelled
Cancelled	to find claims that have been cancelled
Accepted	to find claims that the insurer has accepted, but has not yet settled or declined.
Settled	to find claims that the insurer has settled
Declined	to find claims that the insurer has rejected

Finds claims for the specified insurer. Leave blank to find claims for all insurers.

Allows claims to be found by date, or use All to find claims for all dates.

Finds claims by their gap claim status. Use:

All	to find all claims
Pending	to find gap claims where no Benefit Amount has been determined by the insurer.
Received	to find gap claims where a Benefit Amount has been received from the insurer.
Paid	to find gap claims where the claim has been paid, but the insurer has yet to be notified. The insurer must be notified in order for them to reimburse the customer, if full payment was made, or the practice, if gap payment was made.
Notified	to find gap claims where the insurer has been notified of payment.

Finds claims by the practice location where they were created.
Leave blank to find claims for all locations.

Finds claims by the clinician responsible for them, or use All to find claims for all clinicians.

The results table columns are as follows:

Id	The OpenVPMS identifier for the claim.
Date	The date the claim was created.
Customer	The customer making the claim.
Patient	The patient the claim is for.
Location	The practice location where the claim was created.
Insurer	The insurer handling the claim.
Policy Number	The policy number.
Claim Number	The claim number.
Claim Status	The claim status.
Amount	The claim amount.
Gap Claim	If selected, indicates the claim is a gap claim.
Gap Claim Status	The gap claim status.
Benefit Amount	The agreed benefit amount, determined by the insurer for a gap claim. If the Gap Claim Status is Pending, the insurer has not yet set the amount.
Clinician	The clinician responsible for the claim.

The buttons are as follows:

Edit	Edit the selected claim.
Delete	Delete the selected claim. Claims that have been submitted cannot be deleted.
Submit	Submits the selected claim to the insurer. Once submitted, the claim cannot be changed
Pay Claim	Pays a gap claim.
Cancel Claim	Cancels the selected claim.
Settle Claim	Mark a claim as being settled by the insurer. This is only applicable to offline claims.
Decline Claim	Mark a claim as being declined by the insurer. This is only applicable to offline claims.
Print	Prints the selected claim.
Report	Generates a report of all claims matching the query criteria.

Report

The Report button displays a window to generate a report of all claims matching the query criteria.

This can be: