Why it is a separate MicroERP
An in-house or outsourced claims desk can administer payer workflows independently of the care delivery UI.
Clinical CareReviewed functional scope
Healthcare Claims Administration MicroERP
Traceable claim/preauthorization status and patient/payer responsibility evidence
Who it helpsProvider claims administrator
FROM A REAL REQUEST TO A USEFUL RESULT
The working flow.
A proposed or delivered care episode requiring payer processing
- 01
Import authorized episode/payer references
- 02
record eligibility/preauthorization
- 03
prepare/validate claim packet
- 04
submit/handle queries or denial/resubmission
- 05
reconcile responsibility and administrative closure
The useful outcome
Traceable claim/preauthorization status and patient/payer responsibility evidence
ALL FEATURES IN THEIR OWNING PRODUCT5 feature modules.
5 feature modules.
One product scope.
Open each module to review its purpose and actions. These features belong inside Healthcare Claims Administration MicroERP.
02Healthcare Claim Denial Resolution3 scoped actions
Resolve rejected claims with documented review and resubmission.
- Denial reason queue
- Evidence assignment
- Appeal or adjustment closure
03Healthcare Claim Submission3 scoped actions
Submit reviewed episode records to the selected payer channel.
- Claim packet validation
- Submission acknowledgement
- Query and attachment response
04Patient Co-Pay Allocation3 scoped actions
Separate patient and payer responsibility for documented services.
- Benefit reference
- Patient share calculation
- Adjustment explanation
05Payer Eligibility Verification3 scoped actions
Record payer responses relevant to the patient's proposed episode.
- Policy and beneficiary references
- Eligibility response
- Unverified coverage exception
CLEAR OWNERSHIP. CONNECTED FUNCTIONS.
How the scope fits together.
Dependencies to plan
- care-episode-reference-core
- billing-core
- document-evidence-core
- payer-channel-adapters
Outside this scope
- Never guarantees coverage or insurer acceptance.
- Clinical care authorization and final accounting remain their owning domains.
REUSE THE SAME PRODUCT
Mapped to your industry.
Industry compositions select relevant products and modules. Some options apply only under particular operating conditions; review the industry page before choosing.
Start with this scope.
Confirm your workflows, required integrations, team access, migration and acceptance checks in one implementation brief.