Insurance claims

Where patients are covered by insurance, CuspFlow helps you track claims from submission to outcome. Claims live under Financials → Insurance Claims.

Raising a claim

Create a claim against the patient with the carrier, policy number and the amount claimed. The Insurance Claims screen shows a running total of what's been claimed, approved and rejected across the clinic, plus a per-carrier breakdown.

The claim lifecycle

Each claim moves through:

Draft → Submitted → Approved (or Rejected) → Paid

so you always know which claims are still with the carrier, which have been settled, and which have actually been paid out. Filter the list by status, or group it by carrier.

The shortfall

When a claim is Approved for less than the amount claimed, record the approved amount, CuspFlow shows the shortfall the patient still owes, so it doesn't get lost. Print or export the claims report to send to a carrier.

Carriers and policies

• Maintain a directory of insurance carriers under Settings → Insurance.
• Record each patient's policy details on their profile, so claims carry the right carrier and policy information.

Insurance as a payment method

At checkout, Insurance is one of the available payment methods, so the portion covered by a claim is recorded alongside any cash or card payment the patient makes directly.

Insurance claim outcomes and outstanding amounts feed into your financial reports.