Insurance and partner billing inside one clinic.

A patient record carries the policy held with their insurer, and that policy states the co-payment percentage - the share the patient covers themselves. When an invoice is opened, HospiX uses that percentage to split the total into a patient amount and an insurer amount.

Invoicing follows the same split: only the patient amount is collected at the desk. If payment is combined, cash and card, the system checks that the two add up to exactly that amount - not to the full price of the service.

• Policy per patient, with a validity period and co-payment percentage
• Automatic split into patient amount and insurer amount
• Split payment (cash and card) with a sum check

The same service rarely costs the same for everyone. HospiX keeps several parallel price lists - standard, per insurer, per partner, and purpose-built - and selects the one that applies at the moment of billing.

Price lists apply in a fixed order: partner, the specific insurer, the general insurance list, then standard. The first price found goes on the invoice.

• Four levels: partner, insurer, general insurance, standard
• One insurer can hold more than one price list
• Promotional price with a validity period
• Every price change is kept - who changed it, from what to what

A referral is an insurer approval for specific services for a specific patient. It is entered with its number, date, and expiry, and a scan of the original can be attached as a PDF.

Once a referral is linked to an invoice its status becomes used, so the same referral cannot be spent twice. A single invoice can carry several referrals.

• Referral with a list of covered services and an expiry date
• Scanned PDF attachment, checked to be a real PDF
• Status: active, used, or expired

The insurer share does not disappear from the invoice - it remains a receivable until it is collected. When the money arrives, the payment date is entered and the invoice is marked as paid by the insurer.

Clearing that mark is not a routine action: it requires a written reason, is restricted to administrators, and is recorded - who did it and when. A specification for the insurer is generated as a PDF, and the invoice received from them is attached to the record.

• Receivables by insurer, for any given period
• Insurer specification generated as a PDF
• Reversing a collection requires a reason and stays in the audit trail

Partner institutions that send or receive patients are kept with their own percentages for inbound and outbound referrals, and the monthly settlement per partner is calculated from those.

The monthly report goes out by e-mail on a set schedule, and every report sent is archived exactly as it left.