Insurance & Claim Management

Introduction

The Insurance and Claim Management module enables laboratories to manage insurance-based billing workflows and insurance claim processing directly from the LIMS platform.

This module was introduced to support the end-to-end lifecycle of insurance billing and claim processing while maintaining accurate financial responsibility calculations between patients and insurance providers.

The system supports the following capabilities:

• Configuration of insurance providers and pricing models
• Categorization of insurance pricing through insurance groups
• Automatic application of insurance price lists during billing
• Handling patient financial responsibilities such as copay, deductible, and co-insurance
• Eligibility verification through third-party insurance processors
• Creation and submission of insurance claims
• Claim tracking and response handling
• Resubmission of rejected or partially approved claims