How to handle insurance payment in OpenERP ?

Basically once a sales order created, there are two ways how it can be paid.

  1. Self Pay (using cash or credit card)
  2. Insurance

For cash and credit card is pretty obvious that the invoice will be settled there and then. However with insurance is different. In some cases we have to submit the patient records (including their billing) to the insurance company and await for their approval. During the waiting for approval period the invoice is still not paid. My questions:

  1. How can I keep track which invoice is going to be paid using a particular insurance (there will be different kind of insurance that we accept in the hospital) ?
  2. Do I need to create new Chart of Account and Journal as well for the above need ? Can someone give me example on this ?

I hardly use any accounting software before thus my knowledge on this is very basic. Any ideas or information is very much appreciated.

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@abiieez

We can tag the Customer/Quotations in OpenERP with codes to indicate if it is Self pay or Insurance. This tag will enable us to distinguish between them.

To achieve this: Step 1: In OpenERP click on your “Username” on top right corner, click “About ERP”. Select the link “Activate Developer Mode”.

Step 2: For tagging Quotations with the code Click on “Quotations” on the left pane. On the right pane click on any Customer Quotation.

Step 3: Click on Debug View# and then select Manage Views, then Edit because the corresponding view will already be preselected.

Go to the last line of the view and click the blue plus (+) sign to add a “Category” field to the current view, then click the Update button. You can change the display string or make the new column searchable. Click Update. Choose preview to confirm the position of the new column.

Once the above steps have been completed, every Quotation can be edited to fill in the Category column. The same process can be followed for the Quotations Screen itself to include the new column to the table.

For more information please refer to the link below https://doc.odoo.com/book/2/3_CRM_Contacts/contacts/

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Quite a few people have asked the same question on how they can use OpenERP/Bahmni for an insurance workflow. Ability to tag a patient / customer in OpenERP as suggested by @vmalini seems like a good idea. Maybe you can try that out and tell us if it helps.

But I guess you would also need to create some account heads in ERP, so that maybe you can mark that amount against those heads, for reporting / tracking purposes. And, then also until that amount isn’t reimbursed by the insurance company, you might want to track that against the patient in ERP as Credit.

OpenERP Documentation: https://doc.odoo.com/book/#books-link

//cc @arjun: Can you maybe share how JSS Hospital tracks Insurance payments in OpenERP currently?

Maybe you can create a new Account Head for tracking Insurance payments. See this: https://doc.odoo.com/7.0/book/3/3_9/chart_of_accounts/#creating-a-chart-of-accounts

If someone has good advice on this topic of managing Insurance – we would love to hear about it.

Hi Gurpreet,

JSS is also using tags to mark and segregate the collections from insurance schemes. However they have been asking similar feature as what mustafa asks in this post, that is being able to end to end track the payments from different payment mechanisms. As a further step they might be trying using tags on quotation side as well but we will have to see whether with that we can achieve the end-to-end usecase or not.

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@arjun, I know this is a long time ago. Is there a better way now to manage payment claims? Our implementation requires defining up to 10 insurance companies and a particular insurance company requires patient to pay certain amount from the billable amount.

Hi Jaghatise,

We have some experience in working with Government insurance system however it might be different in your usecase. We have integrated ODOO with OpenIMIS to cover the requirement of Nepal. Feel free DM me.