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NduMed supports patients covered by HMOs (health maintenance organisations). You set up each HMO and its packages, enroll patients, and NduMed splits each invoice between the HMO and the patient. The HMO’s share is then claimed in batches.

1. Set up HMOs and packages (administrators)

HMO setup is done by CSV import at /admin/hmos (also linked from the empty HMO claims page). Select Download template, fill it in, then Import CSV.
The HMO’s share is capped at the package’s coverage limit; the patient pays anything above it. You can deactivate an HMO or a single package.

2. Enroll the patient

On the patient record, open the Billing tab and select Add or change enrollment. See Patients.

3. Invoice with HMO cover

When generating the invoice, choose the Payer (HMO) and Package. The invoice shows the HMO share and the patient share. The cashier collects only the patient share.

4. Claim from the HMO

Open HMO claims.
1

Select HMO

Choose the HMO you are claiming from.
2

Create a draft batch

Select Create draft batch, then Add to batch for each unclaimed invoice.
3

Submit

Select Submit batch. The batch moves from Draft to Submitted.
4

Send it to the HMO

Select Export CSV and send the file to the HMO in the format they accept.

5. Record what the HMO pays

For each claim:
  • Record remittance: enter Amount received and Received on. Part-payments are allowed; the total cannot exceed what is outstanding.
  • Reject claim: enter a reason. Not possible once any remittance has been recorded.

HMO AR aging

HMO AR aging shows what each HMO owes, in 0 to 30, 31 to 60, 61 to 90 and over 90 day buckets. Unclaimed amounts age from the invoice date; submitted claims age from the submission date.

Who can do this

Administrators set up HMOs and manage claims. Cashiers and administrators can view claims.