Insurance Claims

MyDentalPractice simplifies the insurance claims process for Nigerian HMO providers. This guide covers patient insurance setup, claim submission, and tracking.

Setting Up Insurance Providers

Before submitting claims, configure your accepted insurance providers:

Go to Settings → Billing → Insurance Providers

Click + Add Provider

Enter the provider details:

- Provider name (e.g., "Leadway Health", "Hygeia HMO", "AXA Mansard")

- Provider code

- Contact email and phone

- Claims submission method (portal, email, or manual)

Click Save

Adding Insurance to Patient Records

Open the patient profile

Click Insurance tab

Click + Add Insurance

Fill in:

- Insurance Provider — Select from your configured providers

- Policy Number — The patient's HMO enrollment number

- Group/Employer — The sponsoring organization (if applicable)

- Plan Type — Individual, Family, or Corporate

- Effective Date — When coverage started

- Expiry Date — When coverage ends

Click Save

The system verifies the policy number format and flags obvious errors.

Pre-Authorization

Some treatments require prior approval from the HMO:

Open the patient's appointment or profile

Click Request Pre-Authorization

Select the planned treatment(s)

Add clinical justification notes

Attach supporting documents (X-rays, clinical photos) if required

Click Submit Request

The request is sent to the HMO via their configured submission method. Track the status from Billing → Pre-Authorizations.

Pre-Authorization Statuses

Status	Meaning
Pending	Submitted, awaiting HMO response
Approved	HMO approved the treatment
Denied	HMO denied the request
More Info	HMO requires additional information

Submitting a Claim

After completing treatment for an insured patient:

Generate the invoice as normal (see Creating Invoices)

On the invoice, click Submit Insurance Claim

The system pre-fills:

- Patient and insurance details

- Treatment codes and descriptions

- Pre-authorization number (if applicable)

- Total amount to claim

Review the claim details

Attach any required documents

Click Submit Claim

Claim Tracking

Track all submitted claims from Billing → Insurance Claims:

Claim Statuses

Status	Meaning
Submitted	Sent to the HMO
Under Review	Being processed by the HMO
Approved	Claim approved for payment
Partially Approved	Only part of the claim was approved
Denied	Claim rejected by the HMO
Paid	Payment received from the HMO

Handling Denied Claims

If a claim is denied:

Open the claim to view the denial reason

Common reasons:

- Treatment not covered under the plan

- Pre-authorization not obtained

- Policy expired or inactive

- Documentation insufficient

If the denial is incorrect, click Appeal to resubmit with additional information

If valid, convert the balance to a patient invoice

Patient Co-Payments

For treatments partially covered by insurance:

The system calculates the co-payment amount automatically

Generate a patient invoice for the co-payment portion

The insurance claim covers the remaining balance

Insurance Reports

Track insurance billing performance at Analytics → Insurance Reports:

Total claims submitted by period

Approval rate by provider

Average processing time

Outstanding claims by age

Revenue from insurance vs. out-of-pocket

For general billing, see Creating Invoices. For revenue tracking, see Financial Reports.

Insurance Claims