Your role
Claims officer at a clinic
Your day in a clinic's claims office. You check each visit before it is claimed, batch the clean ones, send them to insurers, SHA and schemes, and record what each pays.
Kila describes the role: “Insurance, SHA and scheme claims: eligibility, pre-authorisations, batches and remittances. No clinical details beyond the codes a claim needs.”
When you sign in
Link to this section: When you sign inKila opens Clinic office › Claims check: “Check each claim before it goes, and batch the clean ones.” The counts are Ready to claim (1), Need attention (2), Three days or less left and Past the payer’s window, then each payer with how many are ready and how many to fix. Each visit shows its checks: Member number, Cover in force on the visit day, Pre-authorisation, Diagnosis coded, Notes signed, Clinician’s registration number and whether it is within the payer’s window. Choose all ready (3) picks every clean one.
Your day
Link to this section: Your day- Check and batch the ready claims, and ask the clinicians to finish the ones that need their notes or a coded diagnosis: Claim from insurers, SHA and schemes.
- Send each batch through the payer’s portal, by email or on paper, and record it as sent.
- Record the remittances: what each payer paid, and what it did not.
- Follow what the payers owe under Clinic office › Insurers, SHA and claims, on Ageing.
What you can do
Link to this section: What you can do- Check, batch, send and settle the claims to insurers, SHA and schemes, and see the payers’ members, cover and pre-authorisations under Clinic office › Insurers, SHA and claims.
- See End of day and Clinic reports under Clinic office.
- See the registers under Pharmacy: the Controlled drugs register, Prescriptions dispensed and Sales by drug schedule.
Everything the role is allowed to do
- General
- View dashboard
- Customers
- Third-party payers: eligibility checks, pre-authorisations, claim batches and remittances; View customers
- Credit
- View credit and agreements; Record repayments
- Finance
- View payments
- Reports
- View reports
What needs a manager
Link to this section: What needs a managerNo approval limits: anything that needs approval goes to someone else.
Needs a manager
The clinical record. You see the codes a claim needs, not the notes. When a claim needs the notes signed or the diagnosis coded, ask the clinicians from the claim, and they finish it: Claim from insurers, SHA and schemes.
Common questions
Link to this section: Common questionsA claim is marked to fix. One of its checks fails, such as Notes signed. Ask the clinicians from it: Kila tells them what is missing.
Does Kila send the claim to the insurer? Not for a payer Kila is not connected to. You send it through their portal, by email or on paper, and record how: “Nothing was sent from Kila.”
Can Kila send SHA claims? Not yet. Send them through the SHA portal and record them as Manual: Claim from insurers, SHA and schemes.
- Claim from insurers, SHA and schemes: the claims, step by step.
- Bill a visit: where the insurer’s share comes from.