This window is used to report on Insurance Claims.

The query fields are as follow:

  • Id
Finds claims by OpenVPMS identifier, policy number or insurer claim identifier
  • Status

Finds claims by their status. Use:

  • All
 to find all claims
  • 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
  • Insurer
Finds claims for the specified insurer. Leave blank to find claims for all insurers.
  • All/Date range
Allows claims to be found by date, or use All to find claims for all dates.
  • Gap Claim Status

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

  • previewed as a PDF
  • printed
  • emailed as a PDF
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