Patient Insurance Profiles - hmislk/hmis GitHub Wiki
Patient Insurance Profiles
Overview
HMIS supports a structured insurance profile for each patient, allowing hospitals to record multiple insurance policies and credit payer details directly on the patient record. These profiles are used to auto-populate credit company information at inward admission and OPD billing, so staff do not need to re-enter insurance details on every visit.
Navigating to the Insurance Profiles Panel
Path:
Patient Registration > Patient Profile > Insurance Profiles (tab)
The Insurance Profiles tab is visible on the patient profile page. It lists all insurance and credit payer policies recorded for that patient.
The Insurance Profile Record
Each insurance profile stores the following information:
| Field | Description |
|---|---|
| Credit Company / Insurer | The institution acting as the insurer or credit payer (e.g., Ceylinco Life, AIA, a company credit scheme) |
| Member ID | The patient's membership or card number issued by the insurer |
| Policy Number | The policy number assigned by the insurer |
| Reference Number | An authorization or pre-approval reference number, if available |
| Credit Limit | The maximum amount the insurer will cover per admission or visit |
| Valid From | The date from which the policy is active |
| Valid To | The policy expiry date |
| Primary | Tick this to mark the policy as the primary payer when multiple policies exist |
| Active | Whether the profile is currently active. Deactivated profiles are retained for history but not auto-suggested |
| Description | Free-text notes (e.g., policy type, plan name) |
Adding an Insurance Profile
- Open the patient profile and click the Insurance Profiles tab.
- In the Add New Profile form at the top:
- Type the insurer name in the Credit Company field and select from the dropdown.
- Enter the Member ID, Policy Number, and Reference Number as provided on the patient's insurance card.
- Enter the Credit Limit in the local currency.
- Set Valid From and Valid To using the date pickers.
- Tick Primary if this is the patient's main insurer.
- Click Add. The profile appears in the list below.
A patient may have multiple active profiles (for example, a primary insurer and a secondary corporate credit scheme).
Editing an Insurance Profile
Existing profiles can be edited inline in the list:
- Click the Edit (pencil) icon on the row to enable editing.
- Update the Credit Limit, Policy Number, Reference Number, or validity dates.
- Click Save to confirm.
Deactivating a Profile
If a patient's insurance has changed or lapsed and you want to stop it from being auto-suggested (without deleting the historical record):
- Click the Deactivate button on the profile row.
- The profile moves to an inactive state and is no longer used for auto-population.
- It remains visible in the list for reference; use the Show Inactive toggle to see it.
Expired Policy Warning
Profiles with a Valid To date in the past are highlighted with a warning indicator in the list. This alerts registration staff to update or renew the policy before admitting the patient under credit.
If the configuration option Patient Insurance – Show Expiry Alert on Admission is enabled, an on-screen warning appears on the admission form whenever an expired policy is auto-populated. The admission can still proceed; the warning is informational.
How Insurance Profiles Are Used at Inward Admission
When a patient is admitted and the payment method is set to Credit:
- HMIS checks for active, non-expired insurance profiles linked to that patient.
- If profiles are found, they are automatically loaded into the Credit Companies section of the admission form — no manual entry required.
- Staff can review the pre-filled details, adjust the credit limit for this admission if needed, and remove any profiles that do not apply to this visit.
- If the patient has no saved insurance profiles, the system falls back to the details recorded during the patient's most recent credit-based admission (existing behaviour).
After the admission is saved, any updates made to insurance details on the admission form (policy number, credit limit, etc.) are automatically written back to the patient's insurance profile, keeping it current for future visits.
How Insurance Profiles Are Used at OPD Billing
When an OPD bill is raised and the payment method is changed to Credit:
- HMIS loads the patient's active insurance profiles.
- The primary profile (if marked) is pre-selected in the credit company field.
- Staff can choose a different profile from the list if the patient has multiple active policies.
Managing Multiple Policies (Multi-Payer)
A patient can hold several simultaneous insurance profiles — for example:
- A group health insurance policy from their employer
- A personal life insurance rider with hospitalization cover
- A hospital credit scheme card
All active profiles appear on the admission and OPD billing forms. The Primary flag on a profile determines which one is pre-selected when only one selection is expected.
Configuration Options
Navigate to Admin → Application Options and search for "Patient Insurance" to find these settings.
| Key | Type | Default | Description |
|---|---|---|---|
Patient Insurance - Show Expiry Alert on Admission |
Boolean | false |
When true, a warning is shown on the admission form if an auto-populated insurance policy has expired |
The existing auto-fill configuration for admissions also affects how insurance profiles interact with the admission form:
| Key | Type | Default | Description |
|---|---|---|---|
Inward Admission - Find And Fill Last Used Credit Companies of a Patient |
Boolean | false |
When true, and no active PatientInsurance profiles exist, the system copies credit company details from the patient's last credit admission |
Frequently Asked Questions
Q: Can I record insurance for a patient who has never been admitted? Yes. Insurance profiles are attached to the patient record, not to an admission. You can add profiles during registration, before any admission takes place.
Q: Will changing the credit limit on an insurance profile affect past admissions?
No. Each admission stores its own snapshot of the credit limit at the time of admission (EncounterCreditCompany). Editing the patient-level profile only affects future admissions.
Q: What happens if a patient's policy expires between admission and discharge? The credit limit and policy details captured at admission remain unchanged. The expiry warning only appears at the time of a new admission or billing event.
Q: Can the same insurer appear twice on a patient's profile? The system allows multiple profiles for the same institution (for example, two different policy numbers under the same insurer). Each is managed as a separate profile.