Linking patients to HMOs
Enrol a patient with a specific HMO — member ID, plan, effective dates.
Overview
Once an HMO is added as a provider, link individual patients to it. The link captures the patient's member ID and plan — the platform uses this to format claims and apply negotiated pricing.
Prerequisites
- Owner, Admin, Billing Staff, or Receptionist role
- HMO provider added (see Enrolling an HMO provider)
- Patient's HMO card with member ID
Steps
Open the patient profile. Patients → click row.
Switch to "Insurance" tab on the profile (or open HMO → Enrollments → + New).
Click "+ Add HMO enrollment".
Pick the HMO provider. Dropdown of enabled providers.
Enter the member ID. Exact text from the patient's card.
Pick the plan. Bronze, Silver, Gold, etc. — depends on the provider's plan structure.
Set effective dates. Start date (when the cover began) and end date (annual renewal date).
Upload the HMO card. Photo of the front and back — used to verify if the provider audits.
Save. The link is active. Future invoices for this patient use this provider's negotiated rates.
Expected outcome
- A new HMOEnrollment entry exists with patient, provider, member ID, plan, dates
- The patient's profile shows the HMO badge
- Invoices apply the negotiated fee schedule
Troubleshooting
| Symptom | Likely cause | Fix |
|---|---|---|
| Provider missing from dropdown | Provider inactive | Activate in HMO → Providers |
| Member ID validation fails | Provider format check | Re-enter exact text from card |
| Plan dropdown empty | Provider has no plans configured | Configure plans on the provider |
| Patient has multiple HMOs | Multiple enrollments OK | Most clinics let one HMO bill at a time — pick at billing |
| End date passed | Auto-flagged as expired | Renew enrollment with new dates |