Enrolling an HMO provider
Add an insurance/HMO partner to your clinic — name, contact, claim format, fee schedule.
Overview
An HMO (Health Maintenance Organisation) or insurer partners with your clinic to cover patient costs. Each provider has its own claim format, contact, and fee schedule. This article covers adding a provider.
Prerequisites
- Owner, Admin, or Billing Staff role
hmo_modulefeature flag (Professional+)- Provider details: name, claim contact, payment terms, accepted CDT codes, negotiated rates
Steps
Open HMO providers. Top nav → HMO → Providers.
Click "+ New provider".
Enter provider basics. Name, registration number, claim address, claim email, phone.
Set payment terms. Net 30, Net 60, etc. Used to flag overdue claims.
Choose claim format. PDF, electronic via API, or paper. Determines how submissions render.
Set negotiated fee schedule. Rates per CDT code. Differs from your standard fees.
Save. Provider appears in the dropdown when enrolling patients.
Test the connection. Test claim with a dummy claim; provider acknowledgement confirms format correct.
Expected outcome
- A new HMOProvider entry exists with terms and fee schedule
- Patients can be enrolled with this provider
- Claims for enrolled patients use this provider's format
Troubleshooting
| Symptom | Likely cause | Fix |
|---|---|---|
| HMO module missing | Tier doesn't include hmo_module | Upgrade or buy HMO addon |
| Test claim rejected | Format wrong | Check provider's format spec |
| Negotiated rates not applying | Patient not enrolled with this provider | Enroll first |
| Provider archived | Status changed | Change status to Active |
| Claims address wrong | Edit provider | Updates apply to new claims |