Coverage & benefits
Review the patient’s membership, policy, and applicable benefits.
Insurance claims management
Your clinic did the work.
Get paid for it.
Unpaid claims should not be the price of providing care. Help your team catch claim issues, follow up rejections, and reconcile what insurers actually pay.
Customer story
Queen Hospital, Qatar
27% → Single digits
Insurance rejections, within one month
“Our insurance rejection rate was 27%. Within a month, we brought it down to single digits. We streamlined our processes, trained our staff, and used QHealth to bring the numbers, claims, and action items onto our managers’ dashboards. Everyone had a clearer picture of what needed attention.”
01 · Before a claim leaves the clinic
Start with a complete claim.
Bring the coverage, approval, clinical record, and billed services together so your team can check the information the payer needs.
Approvals
Keep authorization references and supporting documents with the workflow.
Clinical evidence
Review notes, diagnoses, and services against the recorded encounter.
Payer requirements
Prepare the claim using the configured output format and submission channel.
Direct eligibility, approval, and submission connections depend on the payer’s available interfaces and your configured integration.
02 · AI assistance before submission
Catch claim problems before the payer does.
Use AI to highlight documentation gaps, coding concerns, and potential coverage issues while your team can still correct them.
- Review the clinical note and services together.
- See the reasons behind the claim readiness score.
- Check the suggestions before updating the record.
A review aid, with your team in control. The score is not a probability of insurer approval. Staff review the findings; the insurer decides the outcome.
AI claim reviewQHealth
03 · Rejections & resubmissions
Keep the reason.
Track the response.
A rejection should lead to a clear next action. Review the comment, correct the record, and keep the resubmission details visible to the next person handling the claim.
- See rejection and resubmission comments together.
- Check payments already received against the invoice.
- Follow the remaining insurer balance after resubmission.
Rejections & resubmissionsQHealth
04 · Insurer payment reconciliation
Submission is not settlement.
Match insurer payments to the invoices behind them. See which amounts were paid, rejected, or remain outstanding, instead of treating a submitted claim as collected revenue.
- Review billed amounts, payments, and balances by insurer.
- Allocate individual payments or validate a payment batch.
- Check invoice references and remaining balances before posting.
Insurer balancesQHealth
Can AI predict or guarantee insurer approval?
No. AI highlights potential documentation, coding, and coverage issues for your team to review. The claim readiness score is not a probability of insurer approval. Your team checks the output, and the insurer makes the final decision.
Can QHealth connect directly with our insurers?
Payer connections depend on approved interfaces, credentials, and the agreed implementation scope. QHealth includes QLM workflows for eligibility, benefits, preauthorization, supporting documents, approval status, and appeals. We confirm the supported workflow for each payer before implementation.
How are different claim formats handled?
Claim exports use configured payer formats, with the required identifiers, diagnosis and service data, authorization references, and financial values. The format and submission channel depend on the payer’s requirements and your setup.
Can we track partial payments and resubmissions?
Yes. Teams can review billed insurer amounts, recorded payments, remaining balances, and rejection comments. Resubmission records retain the follow-up comments so staff can see what was corrected and sent again.
Which plan includes insurance tools?
Professional includes Insurance Claims, Insurance Reconciliation, and Insurance AI. Payer integrations depend on external access and the agreed implementation scope. The pricing page shows the applications included in each plan.
See the insurance workflow
Follow a claim through to payment.
Walk through claim review, rejection follow-up, and insurer reconciliation with our team.