HMO and insurance claims management

Name: LinkHMS - Medical Insurance Claims
Brand: LinkHMS
Price: 29 USD
Availability: InStock

Run your insurance billing through one connected workflow

HMO and insurance claims built from EMR records, ready to submit to the insurer, track through every decision, and keep as a complete record for your clinic in the insurance module.

From the insurance companies you work with to the service payments you record

EMR-integrated claim and invoice creation
Multiple insurer management with negotiated HMO and insurance pricing
Real-time claim and coverage statuses with activity log

Ready for every stage of the insurance claims lifecycle

Every claim your clinic processes follows a connected path in the LinkHMS insurance module, from the moment a patient is registered with an insurance plan to the final invoice being settled. Each step builds on the one before it, with visit records feeding into claims, insurer decisions generating invoices, and statuses updating across every clinical view in real time.

Managing your HMO and insurance companies

Keep your insurer list accurate and up to date. You can add new companies, view the number of patients assigned to each insurer, and edit or deactivate companies as your clinic's agreements change. Every insurance company added becomes available for selection on patient profiles and appears on invoices linked to their claims.

Insurance plans, pricing, and coverage configuration

Each insurer your clinic works with operates under its own set of pricing and coverage rules. LinkHMS gives your team a single place to define what each plan covers, what it excludes, and what rate the insurer pays for each service, medication, and lab test. You can create as many plans as needed for each company and configure coverage rules independently for each, so every agreement your clinic has with an insurer is accurately reflected in the system.

Recording services and tracking coverage

Every service, medication, and lab test provided to a patient is recorded and tracked in one place, along with its coverage status and current billing state. Your clinical team can see at a glance what is covered by the patient's insurance plan, what requires authorization, and what is billed directly to the patient. The team can also create an invoice or claim once the relevant items have been recorded.

Full visibility over every insurance claim

The Claims tab provides your HMO officers with a complete view of every HMO claim the clinic has created and processed. Each claim shows its reference number, patient, insurer, type, total value, and current status, with filtering tools to narrow down by status, claim type, or insurance company. You can create new claims, track existing ones, and manage the full claims pipeline across all insurers your clinic works with, from one organized tab.

Claim details, decisions, and linked invoices

The LinkHMS insurance module brings together all the information your team needs about the specific claims. From the claim detail page, your HMO officer can review the patient, insurance company, visit reference, and all included items with their coverage status and cost splits. Once the insurer responds, the decision is recorded directly on the claim, and invoices are generated and updated automatically. One for the insurer to cover the approved amounts at negotiated prices, and one for the patient to cover any remaining balance.

Claim summary document export

Export a claim summary as a .doc file directly from the claim detail page. The summary captures the full details of the patient encounter and can be shared with the insurer alongside the claim to support faster processing and clearer communication between your clinic and the insurance company. Having a ready-to-share document at every stage of the claim means your HMO officer can respond to the insurer's requests quickly or use it in your month-end invoice submission.

Full record of claim activities and changes

The insurance module maintains a complete change log from the moment the claim is created to the final decision. Each entry captures the date, the user, and a detailed description of what changed, including submission references, decision outcomes, authorization codes, and attachments. Whether you need to verify a submission, confirm who recorded a decision, or review the full history of a disputed claim, the activity record gives you the answers without having to chase information across your team.

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How LinkHMS insurance module takes clinics through the claims management process

Our system connects every step into a single workflow, from visit records and cost splits to claim creation, insurer decisions, and final invoicing. Every action is tracked, and every record is accounted for to support complete visibility at your clinic.

1
Set up insurers

2
Record the provided services

Add your HMO and insurance companies, create plans, and configure pricing and coverage rules for services.

Log all patient services, medications, and lab tests to build the claim and invoice.

3
Create claims

4
Review and contact the insurer

Build a claim directly from visit records or the billing module, including all covered, not covered, and partially covered items.

Make any final adjustments to the claim before sending it to the insurer through your usual channel.

5
Record the decision

6
Generate invoices

Once the insurer responds, record the decision in LinkHMS as Approved, Partial, Denied, or Canceled.

Generate the insurance and patient invoices based on the claim outcome. Each invoice reflects the correct amounts for each party.

7
Track payments and review activity

Record payments against the created invoices. The detailed activity log captures every action taken across claims and invoices.

Accurate insurance billing backed by regulatory-grade compliance

Built to handle the complexity of HMO billing without adding complexity to your clinic workflow. Whether you work with one insurer or many, LinkHMS keeps every plan, every price, and every claim organized, secure and accessible.

Full activity log for claims and invoices

Automatic insurer and patient cost split

Negotiated insurance and HMO pricing

HMO claims are already part of any LinkHMS plan

The LinkHMS platform provides full HMO claims management with no extra fees. From the moment you sign up, your clinic can configure insurance companies and plans, set up negotiated pricing, create and submit claims, and manage invoices for both insurers and patients.

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Clinic management

Designed to manage organisations with multiple users, departments, and roles

One plan to fit clinics of all sizes

Simple, flexible pricing. Pay monthly or annually with no extra cost.

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Annually

Save 15% yearly

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100+ Users — Custom Pricing

Monthly cost after the 14-day trial period

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Your profit from

Straightforward per-user pricing. No revenue cuts, no per-record charges

LinkHMS is designed around predictable and transparent pricing model. It is based only on one thing - amount of users in your clinic.

LinkHMS

Other EMRs

Free training and onboarding

Predictable payments

On-site support

Unlimited patient records

Unlimited file storage

Unlimited EMR usage

No need to recharge tokens

No fees on your patient charges

No sudden EMR access restrictions

Local currency prices may be subject to slight variations due to fluctuations in the USD exchange rate. The final amount will be displayed on the subscription page within the LinkHMS Web App.

Insurance claims management for every type of healthcare facility

The LinkHMS insurance module simplifies the entire HMO billing process from the moment a patient walks in. Insurance coverage is checked, services are recorded, and invoices and claims are built directly from the visit or admission. Your billing team gets accurate claims, automatic cost splits, and a clear record of every decision and payment in one place.

Public hospitals Private clinics Small clinics Beauty clinics Dental clinics Clinic chains Individual practices

FAQs

Can I manage multiple HMO and insurance companies in LinkHMS?

Yes. LinkHMS has no limits on the number of HMO and insurance companies you can configure. Each company has a profile with its own contact details, plans, and negotiated pricing, giving your team an accurate and organized record of every insurer your clinic works with.

How are insurance claims and patient invoices connected in LinkHMS?

Invoices and claims in LinkHMS are two sides of the same billing record. Both are generated from the same patient records, with the insurance claim covering the insurer's share and the patient invoice covering any remaining balance. Each claim links directly to its associated invoices, and each invoice links back to its claim. It provides your billing team with a complete and connected view of every transaction, with nothing lost between the claim and the invoice.

Do coverage rules differ between plans under the same insurer?

The LinkHMS administration module lets HMO officers manage multiple plans under the same insurance company, each with its own coverage rules. For every plan, they can specify whether a service is covered, requires authorization, or is excluded to accurately reflect the clinic's agreement with the insurer.

How are lab test and pharmacy charges handled under HMO coverage?

They follow the same HMO coverage rules as other clinic services. Each medication and lab test can be configured with its own insurance price and coverage status under each plan. When lab tests or prescriptions are provided for a patient, the charges are automatically applied at the set rate and included in the claim and invoice alongside all other services.

Recent company news and product update

LinkHMS is rolling out the insurance module with HMO pricing and claims management

July 21, 2026

Managing HMO and insurance claims just got simpler. LinkHMS brings the full claims lifecycle into one connected insurance workflow. Submit claims from your EMR, record insurer decisions, and let the system handle invoice splitting so every claim reaches the right outcome.

LinkHMS opens up for European healthcare teams with full GDPR healthcare-grade compliance

June 16, 2026

LinkHMS is fully equipped for the EU market, built to meet GDPR requirements, and ready to support a new community of healthcare professionals who expect functionality, reliability, and compliance from their management system.