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Medical Aid & Claims
Claims that go out on time.
Revenue that doesn't leak.
Medical aid scheme configuration, ICD-10 coding integrated into clinical workflow, pre-authorisation tracking, claims submission, and reconciliation — connected end to end.
Everything claims requires
From scheme setup to reconciliation — the complete medical aid billing lifecycle in one system.
Scheme configuration
Configure tariff schedules, benefit rules, and plan structures. System applies correct rates automatically.
ICD-10 coding
Codes assigned during consultation in clinical notes. Flow through to treatments and claims automatically.
Pre-auth tracking
Full lifecycle: pending, approved, denied, expired. Linked to patient bookings. Patient-initiated via portal.
Claims submission
From consultation to claim in one flow. Notes, treatment, invoice, claim. Everything already there.
Claims lifecycle
Track: submitted, acknowledged, queried, approved, partially paid, rejected, reconciled.
Practice management
Operating hours, practitioner profiles, staff accounts with clinical vs admin role separation.
Revenue protection
Missed claims, rejected submissions, expired pre-auths flagged. Close the gaps that cost thousands monthly.
Reconciliation
Payment received and matched to claim. No spreadsheets, no manual tracking.
The claims lifecycle
Every step from consultation to reconciliation — connected and trackable.
Clinical assessment performed
ICD-10 assigned during notes
Treatment plan created
Billing codes applied
Submitted to medical aid
Payment matched to claim
Why it matters
Less time on admin, more time on patients — claims are built from clinical work already captured during the consultation
Fewer claims that bounce — ICD-10 codes are assigned during the consultation, not reconstructed after the fact
Pre-auths that don't expire unnoticed — every authorisation is linked to the booking and tracked through its full lifecycle
Reduce rejections at the source — scheme rules are applied at claim creation so errors are caught before submission
No more chasing payment status in spreadsheets — every claim is tracked from submission through to reconciliation
Protect patient data without slowing down your team — clinical and admin roles have separate, appropriate access levels
Cut front-desk phone traffic — patients submit their own pre-auth requests directly through the portal
Revenue protection
Stop the revenue leaks that cost practices thousands every month.
Related features
See claims in action
Book a demo and we'll walk you through scheme setup, ICD-10 coding, claims submission, and reconciliation — using real workflows.