Reception
Eligibility and co-payment at the counter, not after the visit.
Insurance
Insurance management for medical clinics
Insurance is where clinic admin goes to die: a price list per company, an approval per procedure, a claim per visit and a reconciliation nobody enjoys. All of it belongs inside the visit rather than beside it.
MedGulf4 plans · Approval requiredActive
Bupa Arabia3 plans · Direct billingActive
Tawuniya2 plans · Pre-approvalActive
Al Rajhi Takaful2 plans · ReimbursementReview
Policies & plans
MedGulf · GoldPOL-81385020% co-pay$50k limitValid
MedGulf · SilverPOL-77120430% co-pay$25k limitValid
Bupa · ExecutivePOL-66091110% co-pay$80k limitValid
Every insurer pays differently, and the system knows it
Every insurer pays differently for the same service. Hold their tariff once and the correct covered amount appears on the invoice without anyone looking it up.
- A tariff per company and per plan
- Covered share calculated at the point of billing
- Co-payment and deductible applied per policy
- Exclusions flagged before the service is delivered
- Annual limits tracked against the patient
Eligibility and approvals where the work happens
Checking cover after the patient has left is how a clinic ends up absorbing the cost. Eligibility and pre-authorisation sit in the visit, before the service.
- Eligibility checked against the policy on file
- Pre-authorisation requests raised from the visit
- Approval reference stored against the service it covers
- Expiring policies and approvals flagged in advance
- Rejections recorded with the reason, not just the outcome
Claims tracked to the money arriving
A submitted claim is not revenue. Claims carry a state — submitted, approved, partially paid, rejected, resubmitted — and the reconciliation is against what the insurer actually paid.
- Claim status per visit and per company
- Batch submission where the insurer accepts it
- Partial payments and shortfalls recorded per line
- Rejection reasons grouped, so the pattern is visible
- Outstanding by company and by age
Who insurance lands on
It is rarely one person, which is why it gets lost between them.
Insurance coordinators
A worklist of approvals, submissions and rejections rather than a pile.
Owners
What each company owes, how long they take, and what they reject.
Insurance on paper versus in the system
The work does not disappear. It stops being done twice.
The way it is done now
- Tariffs looked up per visit
- Cover checked after the service
- Approvals in an email folder
- Claims chased from a spreadsheet
- Rejections handled one at a time
With Medicolize
- Applied from the company price list
- Checked before it is delivered
- Stored against the service they cover
- Tracked with a state per claim
- Grouped by reason, so the cause is fixable
Free tools
Try it free
Runs in your browser, no sign-up, and nothing about your patients leaves it.
Free download
Start with a ready file
No sign-up and no form: the file downloads directly.
Questions
Insurance — what clinics ask
Does it support NPHIES in Saudi Arabia?
Yes. Eligibility, pre-authorisation and claims run through NPHIES where the clinic is enrolled, with the responses stored against the visit.
Can we hold different prices for different insurers?
Yes. Each company, and each plan within a company, can have its own tariff, and the correct one is applied automatically from the patient’s policy.
What happens when a claim is partially paid?
The shortfall is recorded per line, so the reason is visible rather than appearing as an unexplained gap in the month’s income.
Does it flag exclusions before the service?
Yes, where the policy records them. The point is to find out before the patient is in the chair rather than after.
Can we see which insurer is slowest to pay?
Yes. Outstanding is aged by company, which is usually the first thing an owner wants from insurance reporting.
Keep going
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