You can create a medical aid claim from any invoice in Bookem and submit it straight to the client's medical aid. The response comes back within moments, so you know whether the claim was accepted before the client leaves.
Before you start, make sure:
Your business is set up for medical aid claims and the treating provider is registered to submit claims
The client's medical aid details are filled in on their profile, including scheme, plan, membership number and dependant code
Check eligibility from the booking
An eligibility check confirms the client's medical aid details with their scheme before you treat them.
Follow these steps:
Open the client's booking
Run the eligibility check or member dependant information check
Review the response, including the member and dependant details
If any details are wrong, update them on the client's profile
Tip: Check eligibility for new clients and anyone whose medical aid details may have changed.
Create a claim from an invoice
Create and finalise or open an existing invoice
In the header fields, check the Place of service and Treating provider, and add the Authorisation number if the treatment needs one
Check or add line items, or line item group with the tariff code and ICD-10 codes for each
To use the rates for the client's medical aid plan, apply scheme rates
Click 'Create claim'
If any required details are missing, Bookem highlights them in red. Click Fix it to go to each one and fill it in.
Note: Scheme rates are based on the client's medical aid plan, so check the client's plan is correct before you apply them.
Submit the claim
When all the details are complete, click 'Submit'. Bookem sends the claim to the client's medical aid, and the response usually comes back within moments.
The claim status shows where it stands:
Submitted/ Accepted: the medical aid has received the claim and has provided feedback on the cover.
Rejected: the medical aid has declined the claim.
Note: A fee of R7 applies to each claim you submit.
Fix a rejected or incorrect claim
How you fix a claim depends on whether the medical aid rejected it or you spotted a mistake after submitting.
If the medical aid rejected the claim:
Check the rejection reason
Correct the details on the invoice
Click 'Submit' to send the claim again
If you submitted a claim with a mistake, such as the wrong ICD-10 code:
Click 'Reverse claim'
Correct the details on the invoice.
Click 'Submit' to send the corrected claim.
Note: Only reverse a claim when you need to correct a claim that was submitted. You don't need to reverse a rejected claim before resubmitting it.
Track your claims
Go to Accounts > Claims to see all your claims and their status in one place.