> ## Documentation Index
> Fetch the complete documentation index at: https://docs.ndumed.co/llms.txt
> Use this file to discover all available pages before exploring further.

# Set up HMOs, bill covered patients and manage claims

> Import HMOs and packages into NduMed, enroll patients, split invoices between HMO and patient, batch and submit claims, record remittances and track AR aging.

NduMed supports patients covered by HMOs (health maintenance organisations). You set up each HMO and its packages, enroll patients, and NduMed splits each invoice between the HMO and the patient. The HMO's share is then claimed in batches.

## 1. Set up HMOs and packages (administrators)

HMO setup is done by CSV import at `/admin/hmos` (also linked from the empty **HMO claims** page). Select **Download template**, fill it in, then **Import CSV**.

```csv theme={null}
hmo_name,hmo_code,package_name,package_code,coverage_type,copay_percent,coverage_limit,active
Acme Health,ACME,Gold,GOLD,FULL,0,500000,true
Acme Health,ACME,Silver,SILVER,PERCENTAGE,20,200000,true
```

| Coverage type | HMO pays |
| - | - |
| `FULL` | The whole invoice |
| `PERCENTAGE` | The invoice minus the copay percentage |
| `NONE` | Nothing |

The HMO's share is capped at the package's coverage limit; the patient pays anything above it. You can deactivate an HMO or a single package.

## 2. Enroll the patient

On the patient record, open the **Billing** tab and select **Add or change enrollment**. See [Patients](https://docs.ndumed.co/front-desk/patients.md).

## 3. Invoice with HMO cover

When generating the invoice, choose the **Payer (HMO)** and **Package**. The invoice shows the HMO share and the patient share. The cashier collects only the patient share.

## 4. Claim from the HMO

Open **HMO claims**.

**1. Select HMO**

Choose the HMO you are claiming from.

**2. Create a draft batch**

Select **Create draft batch**, then **Add to batch** for each unclaimed invoice.

**3. Submit**

Select **Submit batch**. The batch moves from Draft to Submitted.

**4. Send it to the HMO**

Select **Export CSV** and send the file to the HMO in the format they accept.

## 5. Record what the HMO pays

For each claim:

* **Record remittance**: enter **Amount received** and **Received on**. Part-payments are allowed; the total cannot exceed what is outstanding.
* **Reject claim**: enter a reason. Not possible once any remittance has been recorded.

| Claim status | Meaning |
| - | - |
| Submitted | Waiting for payment |
| Partially paid | Some remittance received |
| Paid | Fully paid |
| Rejected | Refused by the HMO |

## HMO AR aging

**HMO AR aging** shows what each HMO owes, in 0 to 30, 31 to 60, 61 to 90 and over 90 day buckets. Unclaimed amounts age from the invoice date; submitted claims age from the submission date.

## Who can do this

Administrators set up HMOs and manage claims. Cashiers and administrators can view claims.


This documentation is built and hosted on [Mintlify](https://mintlify.com), a developer documentation platform.