Today at the claims desk
Check the member
Payer + member number → cover, benefits and the copay rule that will apply.
Authorise the encounter
EDI-channel insurers verify the member by OTP; Terminal-channel insurers need a pending terminal session.
Build and submit the claim
Upload the papers and let the desk fill the claim, fetch a website order, or add the dispensed medicines and diagnoses by hand; the receipt shows what the insurer will be billed.
Web checkouts
Every order placed on the website, exactly as the website records it — newest first. Process pulls an order into the claim desk.
0 total| Order | Customer | Status | Total | Odoo SO | Date |
|---|
“Pay with insurance” sessions
Customers who chose insurance at the website checkout. Terminal-channel insurers land here for the desk to finish.
| Order | Customer | Insurer · member | State | Order total | Insurer pays | Updated |
|---|
Claims ledger
Every submission, its steps, payloads and adjudication. Click a row.
| # | Order · refs | Insurer | Member | Patient | Status · stage | Gross | Insurer pays | Paid | When |
|---|
Reconciliation
What each insurer owes, how old it is, and claims that need a response.
| Insurer | Claims | Billed | Approved | Paid | Outstanding | Queried | Rejected |
|---|
Outstanding by age
Needs a response
Activity log
Every call to an insurer API, with redacted request and response bodies.
| Time | Gateway | Step | Call | Status | ms |
|---|
Users & webhooks
Dashboard accounts and outbound webhook deliveries to the storefront.
Users
Staff (admin/staff) see everything; agents are scoped to their insurers and can adjudicate & record payments only for those.
| Username | Name | Role | Insurers | Active |
|---|
Webhook deliveries
| Event | URL | Status | Try | When |
|---|
Settings
Insurers, cover rules and connection health. Credentials live in .env, never here.
Insurers
Which gateway each insurer is billed through, and the scheme sent on claims.
| Code | Name | Gateway | Scheme code | Scheme name |
|---|
Cover rules
* is the default for any insurer without its own row. Fixed = patient pays a fixed copay; Percentage = insurer covers that share.
| Insurer | Category | Type | Value | Discount % |
|---|
Connections
Demo members (mock mode)
| FAC-1001 | First Assurance · EDI channel · 80 % cover, 5 % discount |
| FAC-1002 | First Assurance · low balance (KES 1 800) |
| FAC-9009 | First Assurance · inactive cover (rejected) |
OTP in mock mode is 123456. Add a line with code FAIL-INVOICE to see a partial failure.