Panel & Insurance Management
Efficiently manage corporate panels, insurance companies, and third-party administrators (TPAs) with full control over patient eligibility, authorization, service limits, billing, and claim processing—all in one integrated module.
Panel & Insurance Company Setup
DOClinic makes managing multiple panels and insurance companies effortless. Add unlimited providers with complete contract, credit, and contact details. Define service rates, billing cycles, and discount policies while assigning panels to specific consultants or departments for seamless coordination.
- Add unlimited panels/insurers with contact and contract details
- Define credit terms, service rates, discount policies, and billing cycles
- Assign departments or consultants to specific panels
Patient-Panel Mapping
Assigning insurance or panel coverage to patients is simple with DOClinic. Capture card numbers, policy details, and coverage plans directly at registration or during visits. The system auto-fills details for returning patients while tracking covered services, co-pays, and policy validity for hassle-free processing.
- Capture insurance card number, policy type, and plan
- Auto-fill from past visits for regular patients
- Track covered services, co-pay requirements, and validity
Preauthorization & Approval Workflow
DOClinic streamlines pre-approvals for high-cost or restricted treatments. Submit requests with diagnoses, cost estimates, and supporting documents directly in the system. Track approval statuses in real-time and attach scanned or digital approval slips, ensuring every treatment plan is properly authorized.
- Submit approval request with diagnosis, cost estimate, and documents
- Track approval status (Pending, Approved, Rejected)
- Attach scanned forms or digital pre-approval slips
- Generate treatment plans linked to the authorization
Package & Service Limit Configuration
Create and manage insurer-specific packages with ease in DOClinic. Configure custom health checkups, delivery packages, or specialized procedures with daily, monthly, or annual service limits. Automatic alerts notify staff when caps are exceeded, keeping coverage and compliance in check.
- Create custom packages (e.g., Executive Health Check, Delivery Package)
- Define daily, monthly, or annual visit and service limits
- Apply procedure caps and restrictions automatically
- Alert staff when coverage is exceeded
Credit Billing & Invoice Generation
Billing insured patients is fully automated with DOClinic’s credit billing system. Generate invoices that include consultations, labs, pharmacy, radiology, and procedures with panel-specific co-pay rules. Support multiple invoices per visit or consolidated monthly billing with insurer-preferred formats for smooth claim settlements.
- Consultation, lab, radiology, pharmacy, procedures all included
- Define co-pay amounts and out-of-pocket balances
- Support multiple invoices per visit or bulk monthly billing
- Print/download invoices in insurer-preferred formats
Claim Submission & Documentation Management
With DOClinic, claims are generated, compiled, and submitted in just a few clicks. The system automatically adds ICD-10 codes, attaches prescriptions and reports, and prepares claims in XML or PDF as per insurer requirements. Submission logs and acknowledgments ensure nothing is missed.
- Compile service details, cost, diagnosis (with ICD-10 codes)
- Attach necessary documents (prescriptions, reports, approvals)
- Generate claim summaries and XML or PDF formats as required
- Maintain submission logs and acknowledgment receipts
Claim Tracking & Reconciliation
Track the full lifecycle of claims inside DOClinic. From submitted to approved, partially approved, or rejected, every status is updated in real-time. Payments are auto-matched with invoices, while deductions and rejections are highlighted. Generate remittance reports to stay on top of financial reconciliations.
- Status updates: Submitted, Approved, Partially Approved, Rejected
- Auto-match received payments with billed invoices
- Track deductions, rejections, and pending amounts
- Generate remittance advice reports for analysis
Panel-Wise Financial Reporting
DOClinic gives you complete financial visibility into your panel and insurance operations. Access detailed reports on billed vs. received amounts, outstanding claims, and rejection reasons. Panel-wise revenue, profit/loss, and patient volume analytics empower better financial decision-making.
- Total billed vs received amounts
- Outstanding claim summary
- Claim rejection/deduction reasons
- Panel-wise profit/loss and patient volume analysis
Panel Visit Eligibility Rules
Control patient access to panel services with DOClinic’s intelligent eligibility rules. Limit visits per period, define department-specific restrictions, and auto-alert staff about expired policies or exceeded limits. This ensures accurate usage of panel services while avoiding disputes.
- Limit by number of visits per period (e.g., 4 per month)
- Control eligibility by department or service type
- Auto-alert registration desk about visit caps or policy expiry
Co-pay & Split Payment Support
Simplify shared billing with DOClinic’s co-pay and split payment tools. Configure percentage-based or fixed co-pay amounts, split bills automatically between the patient and insurer, and collect upfront or post-visit payments with ease. Transparency ensures trust for both patients and insurers.
- Co-pay percentage or fixed amount configuration
- Split billing between panel and patient
- Support for upfront or post-visit payment collection
- Panel-wise profit/loss and patient volume analysis
Alerts, Logs & Audit Trails
Stay compliant and in control with DOClinic’s alerts and logs. Receive notifications for policy expiries, pending claims, and service limits. Every panel-related action is tracked in audit logs with time stamps and role-based security, ensuring accountability across staff.
- Alerts for policy expiry, visit limits, pending claims
- Audit log for all actions taken by staff on panel accounts
- Role-based access to sensitive financial or patient coverage data
Patient Communication for Insurance Services
DOClinic keeps patients well-informed about their insurance coverage. Automated SMS and email notifications update them on pre-approvals, co-pay bills, and claim statuses. Patients can also access their claims, balances, and coverage information through the app or portal, enhancing transparency and trust.
- SMS/email notifications for pre-approvals and co-pay bills
- Alert for out-of-coverage services or exceeded limits
- Portal/App view of claims, bills, and balances
Smarter Panel & Insurance Management with DOClinic
DOClinic’s Panel & Insurance Management module simplifies complex insurance workflows for clinics, labs, and hospitals. From patient mapping to claims processing and financial reconciliation, every step is automated to save time, reduce errors, and maximize revenue recovery.
Seamless Panel & Patient
Integration
- Configure unlimited panels and insurance providers with customized credit terms, rates, and policies.
- Map patients to their respective panels during registration with auto-filled insurance details.
- Track covered services, co-pays, and policy validity to ensure smooth operations.
End-to-End Claim & Billing Automation
- Generate accurate invoices with co-pay support, bulk billing, and insurer-preferred formats.
- Submit claims with ICD-10 coding, required documents, and automated logs.
- Track claim status, approvals, rejections, and reconcile payments with built-in remittance advice reports.
Financial Control, Compliance & Communication
- Access detailed panel-wise financial reports for revenue, outstanding claims, and rejection analysis.
- Apply service limits, visit eligibility rules, and audit logs to ensure compliance.
- Keep patients informed with SMS/email alerts for pre-approvals, co-pay bills, and claim updates via portal/app.