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Claims

Use the Claims screen to submit, review, and track reimbursement claims for medical expenses.
Access this screen from the Claims List or from a Policy Card. The screen supports signed-in patients only.


Claims screen with details, expenses, and status history tabs

This screen includes

  • A Details tab that displays visit information and reimbursement summary.
  • An Expenses tab that lists expense items with amount, currency, and attached documents.
  • A Status History tab that displays the claim lifecycle and status changes.es.

Workflow​

This sequence describes how a patient submits and tracks a claim.

  1. Open the Claims screen.
  2. Select New Claim to open the claim form.
  3. Complete all required fields and add expense details.
  4. Submit the claim for insurer review.
  5. View the submission confirmation.
  6. Track claim progress through the following statuses:
    • Open
    • Clarification
    • Send to Insurer
    • Submitted to Insurer
    • Ready for Payment
    • Internally Paid
    • Cancelled

Validations​

These rules ensure claim accuracy and insurer compliance.

ScenarioApp behavior
Claim submission completes.Locks all editable fields after submission to the insurer or after payment.
Expense amount entered.Requires a valid currency for each expense.
Adjustment includes a negative value.Accepts the value only when the insurer allows adjustments.
Requested amount differs from approved amount.Requires a clarification note.
Patient cancels a claim.Requires a cancellation reason note.

Actions​

Claim behavior reflects lifecycle status.

ScenarioApp behavior
Claim enters Clarification.Keeps the claim open for additional information or documents.
Claim enters Send to Insurer.Submits the claim for insurer validation and approval.
Claim enters Ready for Payment.Enables refund preparation.
Claim enters Internally Paid.Sets the claim to read-only.
Claim enters Cancelled.Records the cancellation note and closes the claim.

Refund Flow​

This sequence describes reimbursement processing.

  1. Claim reaches Ready for Payment.
  2. Insurer approval triggers refund processing.
  3. Claim status updates to Internally Paid.d.

Endpoint Resources​

🧰 Endpoint Resources under construction