HMO
Get paid by HMOs.
Authorization, Letter of Authority and claims in one flow, so a visit is not billed against an approval that has run out.
- Prior authorization, one card per course of care, so payor calls can be batched
- Letter of Authority tracking: the earliest-expiring LOA is used first, and billing against an expired or used-up one is blocked
- Claims queue with 30, 60, 90 and 120+ day ageing and a 60-day filing warning
- Accreditation expiry blocks filing, and a denial can convert to self-pay