When an insurer pays for a visit instead of the patient, a claim is created. You collect claims through the billing period and then group them into a billing batch — one XLSX file and one PDF bundle sent to the insurer.
The path has three fixed points: Settings → Insurers (who, and in what column order), Billing → Claims (individual visits), Billing → Billing Batches (the parcels to send).
How to do it
Add an insurer
Settings → Insurers → Add insurer. The dialog has three tabs:
- Details — Insurer name, Code, Tax ID (NIP), Address, Bank account (IBAN), Billing contact email.
- Template — the XLSX Column Layout: you drag the columns into the order the insurer expects and switch off the ones you do not need. Among those available are Policy No., PESEL, Visit Date, Service, Amount, Auth Code, Copay, plus custom columns.
- Billing — the Billing cycle: weekly, bi-weekly or monthly.
The Copy from preset button creates an insurer from a ready-made configuration.
Attach a policy to a patient
On the patient record, on the Insurances tab, click Add insurance. You give the Insurer, Policy number, Member number, Coverage level and the Valid from and Valid until dates. The Set as primary insurance field decides which policy is offered by default.
Create a claim from a visit
At visit settlement, use Bill to insurance. You choose the policy and fill in the Authorization code, Referral number, Referral date, Visit code, Amount claimed and the Patient copay. Heltio acknowledges with Claim created.
You can view claims two ways — as a List or as a Kanban with the statuses Draft, Ready, Batched, Submitted, Paid, Partially paid, Denied, Disputed, Voided.
Gather claims into a batch
Billing → Billing Batches → New batch walks through four steps: Insurer, Period, Select Claims, Review & Generate. The claims step shows how many entries are ready in the period and how many of them are selected.
The warning about missing visit codes matters — it says outright that "The XLSX may be rejected by the insurer". Fill the codes in before you generate the batch.
Generate batch creates the files; you then download the XLSX and the PDF bundle.
Follow what happens to the batch
The batch details carry a Status Timeline: Draft → Exported → Submitted → Settled. After sending, use Mark as submitted, and once the money arrives, Mark as settled.
A claim the insurer denied can be moved onto the patient with the Convert to patient invoice action — a draft invoice is created and the claim stays denied.
When something does not work
Cannot settle batch: some claims are not yet in a terminal state (Paid, Partially paid, or Denied).
What this means: The batch holds claims the insurer has not yet decided on.
Cannot void a settled batch.
What this means: The batch has already been closed as settled.
No READY claims in this period.
What this means: The wizard found no claims with the Ready status in the chosen date range.
This insurer has linked claims and cannot be deleted.
What this means: Claims are attached to the insurer, so deleting it would take the settlement history with it.
No active insurers configured.
What this means: The batch wizard has nobody to settle with — the insurer list is empty, or all of them are inactive.
Who has access
Clinic Admin ReceptionistInsurers and the column layout are configured by the administrator. Adding policies, creating claims and running batches are open to reception as well. The whole module belongs to the plan that includes insurer settlement — without it the Claims and Billing Batches entries do not appear in the menu.
Related
- Invoices and KSeF — a denied claim can become an invoice to the patient.
- Service price list — the claim amount comes from the service price.
- Financial reports — the Insurance report shows how much is waiting with the insurers.
- Patient record — where the policies live.
Related features
Invoices and KSeF
Issuing invoices, proformas and corrections, submitting to the National e-Invoice System, and the KSeF Inbox with invoices from suppliers. Numbering, seller details and the VAT exemption basis are set once, under Billing.
Service price list
The clinic's service catalog — price, duration, VAT rate, visibility in online booking and price overrides for individual practitioners. The calendar, invoices and packages all take their price from here.
Financial reports
Eight reports at one address — revenue, outstanding, cash flow, commission, VAT summary, insurance, packages and wallets — with filters, a chart, a table and an export to XLSX or PDF.
Patient record
The file of a single person — personal details, clinical profile, note history, measurements, consents, guardians and settlements, in the tabs down the left-hand side.