Insurer workflows

Give payer-covered care a clearer financial workflow

Configure payer and HMO coverage, apply payer-specific prices, follow billing decisions, and give finance teams a clearer view of what is approved, denied, and settled.

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Configure payer rules

Set up coverage around the services you provide

Give teams a structured place to record payer details and define how covered services are priced and handled.

Maintain payer and HMO details
Store payer contacts, portal details, claims notes, and other information staff use during payer-related work.
Define covered services
Configure coverage across laboratory, imaging, procedures, services, and drugs.
Set payer-specific prices
Apply a payer price to a covered catalogue item while retaining the facility’s default price for comparison.

Handle payer billing

Keep payer billing decisions visible to the right teams

Bring payer handling into the billing workflow so teams can review payer-covered records alongside their status and financial values.

Identify payer-covered billing
Distinguish payer billing from self-pay and family billing when reviewing patient and service activity.
Record payer decisions
Support billing states that reflect pending, approved, denied, and settled payer activity.
Change payer handling when needed
Authorised billing staff can update payer assignment and apply billing adjustments to keep the record aligned with the care journey.

Follow financial outcomes

See what payer activity means for cash flow

Help finance and management teams follow payer performance from approved value through settlement and outstanding receivables.

Review approved and denied amounts
See the value and count of payer billing decisions for a selected period.
Track settlement progress
Compare approved and settled payer activity and review settlement rates over time.
Find open receivables
Identify payer-covered billing that remains open and awaiting settlement or collection.

Explore the workflow

Support each stage of payer-covered care

Use the workflow perspective that matches your team’s responsibility.

Coverage

Configure what each payer covers

Give billing and administrative teams a structured way to maintain payer coverage for the services and products they provide.

Mark laboratory, imaging, procedure, service, and drug items as covered or not covered.
Set payer-specific prices for covered catalogue items.

Explore billing and financials

Questions about insurer workflows.

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Teams can maintain payer or HMO names, contact emails, phone numbers, portal URLs, and internal claims notes. These details give staff a consistent reference point for payer-related work.

See what CuboidOS can do for your facility.

Tell us about your facility. We’ll review your needs and arrange a focused walkthrough.

Request a demo

CuboidOS staff management interface shown on a mobile phone

Give payer-covered care a clearer financial workflow

Set up coverage around the services you provide

Maintain payer and HMO details

Define covered services

Set payer-specific prices

Keep payer billing decisions visible to the right teams

Identify payer-covered billing

Record payer decisions

Change payer handling when needed

See what payer activity means for cash flow

Review approved and denied amounts

Track settlement progress

Find open receivables

Support each stage of payer-covered care

Configure what each payer covers

Questions about insurer workflows.

See what CuboidOS can do for your facility.