The following settings control the insurance claim functionality on the department level.
Settings > General > Department > Insurance
- Enable insurance claims: When selected, the insurance section is shown on invoice pages.
- Allow adding insurance claims on finalised invoices: When selected, the +Claim button for adding an insurance claim is available on finalised invoices.
- Allow adding insurance claims on draft invoices: When selected, the +Claim button for adding an insurance claim is available on draft invoices.
- Compensation editable after invoice finalization: When selected, the insurance claim compensation sum can be edited on finalised invoices.
- Allow adding insurance payments: When selected, the insurance claim payment method is available for invoices that have unpaid insurance compensations. This setting is not used if payments are added through a third-party integration.
- Allow adding partial insurance payments: When selected, it is possible to add a partial insurance payment on an invoice. Otherwise, the payment must match the full insurance compensation sum.
- Enable automatic insurance payment refunds during credit note finalization: When selected, insurance payments are automatically refunded when credit notes are created from invoices, including insurance payments. Otherwise, insurance payments must be separately selected to be refunded.
- Use current date for automatically refunded payments: When selected, the current date is used for automatically refunded insurance payments. Otherwise, the original insurance payment date is used.
- Require invoice claim to be ready or rejected before invoice can be finalized: When selected, a draft invoice with an insurance claim cannot be finalised before the insurance claim status is either 'Ready' or 'Rejected'.
- Default items for fee: In this field, you can add items that are added to the invoice by default when an insurance claim is added to the invoice.
Insurance number prefix in insurance emails: You can add a prefix to the insurance claim number used in the emails when insurance claims are sent to insurance companies. The Claim department ID option adds the ID of the department as the prefix to the insurance claim number. With the Custom option, you can define the prefix yourself in the Insurance number custom prefix field. For example, if the insurance claim number is 12345 and you add the prefix 999 using the Custom option, the insurance claim number will be shown as 999-12345 in the email sent to the insurance company.
Additional Country-Specific Settings
The following additional settings are used in some country-specific insurance claim workflows.
- Enable creating insurance claims from multiple invoices: When selected, an insurance claim can be created from multiple invoices, for example, for several treatments related to one specific condition.
- Enable insurance condition: When selected, insurance conditions can be used for insurance claims. For more information, see Adding Insurance Conditions.
Enable insurance claim subtype: When selected, an insurance claim subtype (direct or standard) must be selected for insurance claims.
- Direct claims: The clinic sends the insurance claim to the insurance company that compensates the insurance sum directly to the clinic. The client only pays their share.
- Standard claims: The clinic sends the invoice and other required client and patient information to the insurance company, but the client pays for the whole invoice and claims the compensation sum separately from the insurance company.
Add Insurance Companies
Settings > Items & Lists > Lists
In the list settings, create an insurance company list and add your insurance companies to it.
1. Create a list for insurance companies.
- Select + Add list. The Create list dialogue opens.
- From the Type drop-down list, select Insurance company.
- In the Name field, type a name for the list, for example, 'Insurance companies'.
- Select Save.
To edit the list properties (type or name of the list) after saving, select the pen button on the list row.
2. Add insurance companies to the list.
- Select the list name (shown as a link) to open the list page.
- Select + Add item. The Create list item dialogue opens.
- In the Code field, you can add an optional code for the insurance company. The code is for internal use and can be any identifier you want to use. If codes are used, they must be unique within the list.
- In the Label field, type the insurance company name.
- Select Save.
- On the insurance company row, select the document button. Add the company's contact email address and save. Repeat steps 2 to 6 to add the required companies.
To edit the code or label of an insurance company after saving, select the pen button on the row (7). Note that you cannot edit the code or label if the insurance company has been used in insurance claims.
3. Activate the insurance company list.
The insurance company list has to be activated before the insurance companies can be used when creating an insurance claim. Go to the Items & lists - Lists page, find the insurance company list and select Activate on the list row.
Add Insurance Conditions
Depending on your insurance claim workflow, you may need to set up conditions that are be used in filing insurance claims for patients. When a patient has a medical condition that requires continuous treatment, you can create multiple insurance claims for the same condition.
To set up insurance conditions:
- Go to the client's page > Billing tab.
- Under Insurance claims, select + Condition.
- Select the patient, add the name of the condition and save.
- The Insurance condition dialogue opens. If you want to check the patient's records, select the blue notebook button in the patient box. The patient's history opens on a separate tab.
- In the Internal notes field, you can add any relevant information about the condition.
- A supervising Veterinarian is required.
Tip: If you do not know the veterinarian yet, you can set up a virtual user to use. Go to Settings > Users and select + User. Add the required information, select the Virtual user checkbox and save.
- Skip adding invoice row and attachments at this point (you will do it when creating insurance claims) and select Save.