1. Halaxy Help Guide | Philippines
  2. Finances
  3. Claims & Billing

Set up billing for HMO (Health Maintenance Organization)

In Halaxy, an HMO funder for practices located in The Philippines.

The HMO funder includes the correct billing structure for patients with private health insurance, such as the required identification fields for practitioners and patient claims. All you need to do is set up the funder, create appointments with your fees, add your practitioner identification, and set up patient claim details.

In just a few clicks, the appointment invoice automatically configures all the necessary information for you.

The HMO billing setup checklist

This checklist outlines what you need to do to set up your practice billing.

For step-by-step guides for each of these checklist items, refer to the subsequent sections in this article.

Task

What it does

Details

  • Set up your HMO fees

  • Adds your services and their corresponding pricing to your practice

  • Automatically sets up the correct billing and claim structure in invoices that contain HMO fees

Where to set up: When creating appointments

You only need to import each fee once.

  • Set up the patient claim

  • Adds the patient's HMO details to their patient profile

  • Automatically adds the patient's claim details to any invoice billed to them that contains HMO fees

Where to set up: Calendar appointment

You only need to set up each patient's HMO claim once.

  • Add your required identification

Sets up your required IDs to automatically populate in invoices.

Where to set up: Appointment invoice

You only need to add your identification once per practice location.

When all your requirements are in place, your invoices containing HMO fees are automatically set up with all relevant information.

Set up your HMO fees

This step adds fees and services for your patients with HMO coverage. This step can be done as needed when creating patient appointments.

  1. On the calendar, click on a timeslot to create a patient appointment.

  2. For Fees, enter the name of the service you are providing, then click it in the dropdown to add it as a new fee.

    Billing-PH-01.png

  3. In the pop-up, configure your fee.

    Billing-PH-02.png

    • Funder: Set up the funder for HMO.

      • Type Private, then select Add Private as a new funder in the dropdown.

      • In the pop-up, set Funder Type to HMO.

    • Amount: Enter the amount you charge for this service.

    • Rebate: Set the same value as Amount.

    • (Optional) Configure any other details for your fee as needed. (For a complete guide to fee details, see this article.)

  4. Click Add Fee. This service has now been saved to your practice and can be reused in new appointments.

  5. To add multiple fees to add to this invoice, click Add Another Fee and repeat Steps 2 to 4.

  6. In the appointment panel, click Save to create the appointment and automatically generate the invoice. (In the newly created appointment, click Invoice to open it.)

You have successfully added your fee - and also created an appointment, clinical note and invoice.

Tip

If you want to set up all your fees and services without needing to create appointments, you can also import them from the Fees List.

Set up the patient claim

This step adds the patient's claim identification with their HMO. This step can be done as needed when creating patient appointments.

  1. From the patient's appointment on the calendar, under the claim section, click the Icon-Edit.svg pencil icon.

    Billing-PH-03.png

  2. In the pop-up, enter the patient's details for their claim:

    • HMO ID Number

    • Employer Name

  3. Click Save.

  4. If required, click Add Referral to enter the patient's referral details.

The claim is added successfully to the patient's profile and any of their appointment invoices that contain any fees under the Private funder.

Tip

If you want to set up your patient's claim without creating an appointment, you can enter their claim in the Funding tab of their profile.

Add your required identification

This step sets up your practitioner identificaton, which appears on any invoice containing Private (HMO) fees.

  1. From the patient's appointment on the calendar, click Invoice.

    Halaxy Invoice

  2. Under the Practitioner Details section, under Identification, click the Icon-Edit.svg pencil icon.

    Billing-PH-03b.png

  3. In the pop-up, enter your practitioner identification.

  4. Click Save.

  5. (Optional) If you haven't entered your practice address yet, next to Practitioner Details, click Edit to set up your practice details.

You have successfully added your identification for this funder. Whenever you create an invoice with Private (HMO) fees, your license number is automatically displayed on the invoice.

If you've completed all these steps, all you need to do is create appointments with Private (HMO) fees, and your invoices are automatically set up with the correct information.

When the patient is ready to pay, you can process their invoice, which you provide to the patient for them to process their claim with their HMO.

Updated

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