Managing Patient Insurance Profiles - hmislk/hmis GitHub Wiki

Managing Patient Insurance Profiles

Overview

Insurance profiles are stored directly on the patient record so that credit company details, policy numbers, and coverage limits are available across all visits. Once recorded, they are automatically suggested the next time the patient is admitted under a credit payment method — staff do not need to re-enter the same information on every admission.

This page explains how to add, edit, and deactivate insurance profiles from both the patient's clinical profile page and the patient registration / edit page.

How to Get There

From the Patient Clinical Profile

Menu path: (Stethoscope icon) > Patient Search

  1. In the top navigation bar, click the stethoscope icon (Clinical menu).
  2. Click Patient Search.
  3. Search for the patient by name, phone number, or registration number.
  4. Click the patient row to open their Patient Clinical Data Profile.
  5. In the tab bar, click the Insurance Profiles tab.

From the Patient Registration / Edit Page

Menu path: (Stethoscope icon) > Add New Patient (for a new patient) — or — Navigate to any patient's clinical profile (steps above), then click the Edit button at the top of the profile page. This opens the Edit Patient Demographic Details page, which includes the Insurance Profiles panel below the demographic form.

The Insurance Profiles Panel

The panel has two sections:

  • Add New Profile — a form at the top for entering a new insurance record
  • Profiles Table — a list of all existing profiles for this patient, editable inline

Adding a New Insurance Profile

  1. In the Add New Profile form, fill in the following fields:

    Field Description
    Insurer / Credit Company Start typing the insurer name and select from the autocomplete dropdown
    Member ID The patient's membership or card number issued by the insurer
    Policy No The policy number on the patient's insurance card
    Reference No Pre-authorisation or referral reference number, if available
    Credit Limit Maximum amount the insurer will cover per admission
    Valid From Policy start date (dd/MM/yyyy)
    Valid To Policy expiry date (dd/MM/yyyy)
    Primary Tick this to mark the policy as the main / preferred payer

  2. Click Add. The new profile appears immediately in the table below.

A patient can hold multiple active profiles — for example, a primary health insurer and a secondary corporate credit scheme.

Editing an Existing Profile

All fields in the profiles table are editable in place:

  1. Click into any field in the row you want to change — for example, update the Credit Limit, Policy No, Valid To date, or toggle the Primary checkbox.
  2. Click the Save button (disk icon) on that row to persist the change.

Changes take effect immediately and will be used the next time this patient is admitted under a credit payment method.

Deactivating a Profile

If a patient's insurance has lapsed or changed and you want to stop it from being suggested at future admissions — without deleting the historical record:

  1. Click the Deactivate button (ban icon) on the profile row.
  2. Confirm the prompt that appears.
  3. The profile's Active column changes to No and it is removed from the active list.

Deactivated profiles are no longer auto-suggested at admission or billing. They remain in the database for audit and reporting purposes.

Expired Policy Indicator

Profiles with a Valid To date in the past are highlighted in red in the table. The word (Expired) appears next to the date.

This gives registration staff a quick visual cue to renew or replace the policy before the next admission.

If the configuration option Patient Insurance – Show Expiry Alert on Admission is enabled (see Inpatient Configuration), an additional warning message is shown on the admission form when an expired profile is auto-populated.

How Profiles Feed into Admission

When a patient is admitted and the payment method is set to Credit, the system automatically loads all active, non-retired insurance profiles for that patient and pre-fills the Credit Companies section of the admission form. Staff can review and adjust the entries before saving the admission.

After the admission is saved, any changes made to policy numbers, reference numbers, or credit limits on the admission form are automatically written back to the patient's insurance profile — keeping it current for future visits without requiring manual updates.

See Inward Admission – Insurance and Credit Company Details for the full admission workflow.

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