Record how a patient's visits are paid for
Add a patient's medical insurance or payment method on the Billing & insurance tab, and check the cover with the insurer before you send a claim.
Every patient needs a cover on their record, including the ones who pay you directly. Practor won't let you invoice a patient who doesn't have one: Cannot create invoice - patient profile incomplete. Missing: billing information. Their record also shows a Profile incomplete banner. It lists what's missing.
Open a patient's cover
- Go to Patients and open the patient.
- Press the Details tab.
- Choose Billing & insurance in the sidebar.
Coverage methods lists what's on file. An insurance cover shows the scheme's name. Someone who pays for themselves shows as Self-funded, with the payment method underneath.
Rows stay in the order you added them. Primary on the top row just means it was added first, and there's no way to reorder them. When you send a claim, Practor picks the first insurance cover for you. That isn't always the one marked Primary, and you can change it on the claim.
Add a cover
Press Add, then choose Self payment or Insurance under Coverage type.
Self payment asks one more question. Pick a Payment method: Cash, Card, Bank transfer, Debit order or Cheque.
Insurance asks five.
| Field | What it takes |
|---|---|
| Insurance provider | The scheme. Pick it first: the plan list comes from it |
| Insurance plan | Stays greyed out until you've picked a provider |
| Member/Policy number | The number on the patient's insurance card |
| Plan owner | Who the policy belongs to. Self, Spouse, Child, Parent, Common law spouse, Other or Injured |
| Dependent code | 00 for the main member |
If the patient has an identity number on their record, a button appears beside the member number and copies it in. Some schemes use it as the membership number.
Verify eligibility is at the bottom of the insurance form and starts switched on, so Practor sends the check as soon as you save. You only see it if your practice can run checks.
Press Add coverage to save.
Check a cover with the insurer
Open the row's actions menu and press Verify cover. The Insurance verification card below the list does the same thing. It has a Verify button for each cover, and it appears as soon as the patient has any insurance on file.
The check runs in the background and the badge changes on its own.
| Badge | What it means |
|---|---|
| Verifying | The request is with the insurer |
| Verified | The insurer confirmed the member. The card below reads Eligible |
| Not eligible | The insurer didn't confirm them |
| Error | Practor couldn't finish the check. The reason is on the card |
An eligible cover can still show Warnings underneath it. A refused one shows Rejection details, the insurer's own list of codes. Practor doesn't save those codes. Write down what you need before you leave the page. Come back and the card still has the insurer's reason, but the list is gone.
A cover goes back to unverified when you change the insurer, the plan, the member number or the dependent code, because the insurer's answer was about the old details. Check it again.
You're only charged for a check when the insurer confirms the member, so a refusal costs you nothing. The family lookup below is charged the same way. What Practor costs has the rates.
See everyone on the same membership
Press Look up family in the row's actions menu. It's greyed out until the cover has both a member number and a plan.
Family on this plan checks what it needs before it sends anything. It either says Ready to look up, or counts what's missing and lists it. Fix those, then open the dialog again.
Press Look up family to run it. The result lists everyone registered under that membership with their dependent code, and marks which one is this patient.
| If it comes back refused | What it means |
|---|---|
| We couldn't find this patient on the plan | The member number or the date of birth doesn't match the scheme's record |
| This member is currently suspended | The scheme won't answer while the membership is suspended |
| Couldn't reach the insurance | The scheme's service is unreachable. Try again shortly |
| The lookup didn't go through | Anything else |
Practor picks that heading from what the insurer sent back, and shows their own wording underneath.
Turn the checks on
Enrol the practice for insurance claims, and put a practice number on its billing profile. Neither check runs without both. Until then Verify cover and Look up family aren't in the menu, and the Insurance verification card shows a panel instead of the buttons.
| What the panel says | What to do |
|---|---|
| Not enrolled for insurance claims | Press Enrol for insurance claims |
| Billing profile required | Press Configure, then fill in your practice number |
Submit a claim to a medical insurer covers enrolment and the rest of those panels.
Change or remove a cover
Open the row's actions menu and press Edit or Remove. Removing asks you to confirm, and it can't be undone.
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