Step by step
Claim from insurers, SHA and schemes
Check each insured bill on the Claims check, batch the ready ones into a claim, mark it submitted and record what the payer pays.
Insurers, SHA and schemes are payers: customers on account, each with its own rules (a co-pay, an excess, the most it pays on a bill, when it needs a pre-authorisation). When the billing desk bills a payer, the patient pays their share and the rest waits on the payer’s account to be claimed. The claims office checks those bills, sends them as claims and records what each payer pays.
Check the bills waiting to be claimed
Claims check lists each insured visit billed and not claimed yet, with what payers reject claims for: Member number, Cover in force on the visit day, Pre-authorisation, Diagnosis coded, Notes signed, Clinician’s registration number and Within the payer’s window (with the days left). A visit that passes them all is Ready. Choose a payer at the top to see only theirs.
Steps 1 and 2. Batch the ready ones
Tick them, or tap Choose all ready, then tap Batch 1 ready claim (the button counts them, by payer). Kila makes one claim for each payer:
Open the claim
Tap Batches, submissions and remittances. Under Claims, the new claim says To submit, with its bills and amount. Tap it, then Submit.
Say how you sent it
Send the claim through the payer’s portal, by email or on paper, as you do today. Then choose Through: Manual (portal, email or paper), how it was Sent by (Insurer portal, Email, Paper or SHA portal) and Their reference.
Steps 4 and 5. Tap Mark submitted
The claim is Submitted, and its history says Recorded as sent by Insurer portal. Nothing was sent from Kila. If the payer asks something, tap Payer queried it; if they approve it, Payer approved it.
Record the remittance
When the payer pays, open the claim and tap Record remittance. For each bill, type what was Paid now, and what was Rejected and why. Choose how the Money received by came and its Remittance reference. Tick This settles the claim: close it when nothing more is coming.
Steps 6 and 7. Tap Record
The claim is Paid (or Part paid while money is still to come), and the payer’s account shows what they still owe. By the business’s settings, a rejected amount is billed to the patient and what is still not paid when you close a claim is written off; change it for one remittance under What was rejected and What is still not paid.
A claim needs attention
Link to this section: A claim needs attentionA visit that fails a check is To fix, with the check that failed crossed out, such as Notes signed.
When it is the clinician’s to fix (the notes signed, the diagnosis coded), tick it and tap Ask the clinicians (1). Kila says 1 clinician asked. and tells the clinician The claims office needs the notes signed and the diagnosis coded on this visit. Open it to finish., without the patient’s name. The claim is ready once they have.
Claims to SHA
Link to this section: Claims to SHASHA is a payer like the others (SHA or public scheme), with its own rules, such as at most KES 2,500 a bill.
Not available yet
Kila is not connected to SHA yet: SHA (Social Health Authority) (not connected yet). Send SHA claims through the SHA portal and record them with Manual (portal, email or paper), Sent by: SHA portal. SHA (test mode, simulated: nothing is sent) lets you practise the SHA steps: every answer is simulated and marked TEST, and nothing leaves Kila.
Good to know
Diagnosis codes are checked here but not shown: they go to the payer only for patients who agreed to sharing with the insurer. Each payer’s window is set under Clinic settings. Member cover lists each patient’s cover, and Pre-authorisations the requests waiting for a payer’s answer.
- Bill a visit: where the patient’s share and the payer’s share are split.
- Register a patient: the payer, the member number and the consent to share.
- Claims officer: the claims office’s day.