ClaimDesk

Most small private clinics in Nigeria still run on paper cards, a WhatsApp group and a cashier’s notebook. It works until money is involved.

HMO claims are filled in by hand at the end of the week, sent late, and rejected for small things like a missing diagnosis code or a plan that ended last month. Each rejection means fixing the claim, sending it again and waiting again, often for weeks. The owner can’t say how much the HMOs owe her, or which one pays slowest, until someone adds it up at month end.

Four people handle a claim before it’s paid. The front desk officer checks the patient in and confirms their plan. The doctor records what was done. The billing officer turns the visit into a claim and chases payment. The owner watches the money.

Each of them sees the claim at a different moment, and most of the errors that get claims rejected start with the first two.

Billing looked like the natural place to begin. I started at the claim instead and worked back to check-in, because a rejected claim costs a clinic more than anything else in its day.

I asked one question of every screen. What does this need to collect so the claim is right later? That’s why the plan is checked at the front desk, and why the doctor’s notes carry diagnosis codes from the start.

Before a claim is sent, ClaimDesk runs it through the same rules the HMO will. It looks for missing diagnosis codes, lapsed plans, prices above the HMO’s tariff and services that needed pre-authorisation.

I put each fix inside its flag. A missing code comes with the one from the doctor’s note. A test priced above the tariff comes with two options, bill the difference to the patient or lower the price. The billing officer stays on one screen, and Send only wakes up when every check passes.

Some rejections can be stopped hours earlier. When the front desk checks in a patient whose plan has ended, ClaimDesk says so before the visit starts. The officer can switch the visit to self-pay, call the HMO to renew, or check the patient in and let the owner decide.

HMOs often approve part of a claim and reject the rest. Treating that as one failed claim hides the money that did come in, so every claim is split line by line.

The billing officer sees what was approved, what wasn’t and why. For each rejected line she picks what happens next. She can appeal with a pre-auth form attached, bill the patient, or write it off.

The Today screen opens on the owner’s first question, which is how much she’s owed and by whom. Each HMO gets one row with its claims split into approved, in review and rejected, the age of its oldest claim and the total. Opening a row lists the oldest claims with a button to chase them.

The front desk works from a live queue with each patient’s doctor, payer and wait time. A screen in the waiting room shows the same queue with first names only, so patients can see their place without asking.

Emergencies move to the front with one drag. Everyone behind them gets a new wait time, and the move can be undone. If the internet drops, check-ins are saved on the computer and synced once it’s back.

A single visit is often paid three ways, part HMO, part cash and part transfer. The bill splits as you drag, and the remaining balance updates as you go. Staff without billing access can still open a bill to see the services and request access from the same screen.

Two patients booked into one slot is a bad start to anyone’s morning. Dragging an appointment snaps it to the next free time with the same doctor.