How to set up your business for medical aid claims

Bookem lets you submit claims to medical aids directly from an invoice in Bookem and see the response within moments. Before you submit your first claim, you need to register your practice for switching, map client fields for essential information, and register the team members who will submit claims. This article walks you through each of these steps.

What you can do with medical aid claims

Once your business is set up, you can:

• Check a client's medical aid eligibility from the booking before their appointment.
• Request a member dependent information check.
• Create a claim from an invoice, with Bookem flagging any missing details before you submit.
• Submit claims and receive the medical aid's response in near real time.

Register your practice for switching

Bookem submits claims through a switching provider, which passes each claim on to the client's medical aid. Your practice must be registered for switching before you can submit claims. Registration is free.

Follow these steps:

1. Ask the Bookem team for the switching registration form
2. Complete the form. You'll need your practice number, the name of the clinician in charge or business owner, their effective date and HPCSA number
3. Email the completed form to [email protected]

The Bookem team will let you know when your registration is complete and claims are ready to set up.

Note: The billing doctor must be the practice owner.

Start the claims setup

Once you have successfully registered with the switching provider, you can start the claims setup.

Follow these steps:

1. Go to Sharing & integrations
2. Scroll to Real-time medical aid claims
   
3. Click Set up claims
4. The setup screen lists the three things you'll complete: medical billing information, claiming team members and client medical aid details
   
   Click 'Start setup' to begin

Connect the information claims need

Each claim needs specific client, team member, invoice and line item details. In this step, you choose which of your existing Bookem fields hold each detail, so claims use information you already capture.

Bookem suggests a match for each detail:

• Client information: date of birth and sex
• Team member information: practice number and professional registration number
• Invoice information: authorisation number and treating provider
• Line item information: date, tariff code and diagnosis codes

To connect your fields:

1. Review each suggested match
   
2. To change a match, select a different field from the dropdown
3. To see more details you can include, click Show optional fields
4. Click Confirm and continue

Note: If Bookem can't find a matching field, it shows 'New field'. Bookem creates these fields for you when you continue.

💡 Pro-tip:

To change these matches later, go to Payments and invoicing, click the vertical ellipsis (⋮) next to Customise fields, then select field mapping.

Choose who can submit claims

Every claim identifies the treating provider and their professional registrations. In this step, you choose which team members can submit claims and confirm their details.

1. Turn on the toggle next to each team member who will submit claims
2. For each selected team member, check or add their:
3. • Categories, for example Physiotherapist, Dietitian or General Practitioner
   • Practice number
   • Professional registration number

4. Click Save and continue

Check your client forms

The following client profile fields are added automatically during the claims setup:Medical aid scheme, Plan, Membership number and Dependant code

If Bookem finds fields that may contain medical aid details, it will just move existing data and client fields for you. Howver, Bookem adds these medical aid fields to the bottom of your client forms. In this step, move the fields to where it belongs or where you want it on your form.

Follow these steps:

1. Go to Forms
2. Open each client form that collects medical aid details
3. Drag the medical aid field to the right position on the form
4. Save the form

Check team member categories

A category describes a team member's discipline, for example Physiotherapist. Bookem uses categories to show each team member the modifiers that apply to their discipline, so anyone who uses modifiers needs one. This includes physiotherapists, doctors and specialists.

Categories you choose during setup are saved to each team member's profile. Check that every billing team member has the right category before you start claiming.

Follow these steps:

1. Go to Settings > Team members
2. Open the team member's profile
3. In the Categories field, select the team member's category
   
4. Save your changes

Note: If a team member doesn't have a category, they won't see any modifiers on their invoices.

Learn more

• Set up referring doctors and invoice header fields
• Set up line item modifiers
• Create and submit a medical aid claim
• How to do split billing for medical aid claims