Your role
Claims clerk
Your day billing SHA, insurers and schemes. You gather the bills into claims, record how they went, answer the payers' queries and follow each claim until it is paid.
Kila describes the role: “Insurance, SHA and scheme claims: covers, pre-authorisations, claim batches, remittances and ageing. No till.” The tills bill each payer’s share to its account, and you turn those bills into claims and follow them until the payer pays.
When you sign in
Link to this section: When you sign inKila opens your home page. The Insurance and SHA claims card shows the amount billed to payers and not claimed yet, with how many “bills to put in a claim.”, and the Claims out with what they come to. Open your work from Pharmacy › Insurance and SHA claims, or from Payers and claims in the menu.
Your day
Link to this section: Your day- Open Payers and claims. Its tabs are Payers, Member cover, Pre-authorisations, Claims and Ageing.
- Prepare the claims. Under Claims, Billed, not yet claimed is what the tills billed to the payers. Prepare a claim for each payer, send it the way the payer takes claims, and record how it went: Claim from insurers and SHA.
- Answer the payers. Record a query and send the claim again, or record what the payer paid and rejected on each bill.
- Follow up the claims getting old under Ageing.
What you can do
Link to this section: What you can do- See the payers and their rules, their members’ cover and the pre-authorisations.
- Prepare, submit and follow up the claims, and record the payers’ remittances.
- See the sales, the payments and the customers’ accounts that the claims come from.
Everything the role is allowed to do
- General
- View dashboard
- Point of sale
- View sales
- Customers
- Third-party payers: eligibility checks, pre-authorisations, claim batches and remittances; View customers; Create and edit customers
- Credit
- View credit and agreements
- Finance
- View payments
- Reports
- View reports
What you cannot do
Link to this section: What you cannot do| Approval limit | Up to |
|---|---|
| Refunds | KES 0.00 |
| Discounts | 0% |
Needs a manager
- The till. Your role has no till: the dispensing assistants and pharmacists bill the payers at the counter: Bill an insurer or SHA at the till.
- The patients’ medication records. Their allergies, conditions and chronic medicines are kept by the pharmacists and dispensing assistants: your menu has no Patients and medication records. When a payer asks about a prescription, open it under Pharmacy › Prescriptions, repeats and owings.
Common questions
Link to this section: Common questionsDoes Kila send the claims to SHA or the insurers? Not yet. Send each claim through the payer’s portal, by email or on paper, then record how it went: Claim from insurers and SHA.
A sale is not in any claim. Why? Only what the till billed to the payer can be claimed. A sale the patient paid in full has nothing to claim.
Why can I not see a patient’s allergies and conditions? A medication record is sensitive health information, open only to the roles that keep it: Selling medicines. The prescriptions themselves are open to you, for the payers’ queries.
- Claim from insurers and SHA: a claim from start to finish.
- Bill an insurer or SHA at the till: where the bills come from.
- Pharmacy: how Kila works for a pharmacy.