How to Add a New Insurance Company

🧭 Overview

Helix allows clinics to seamlessly manage insurance workflows by enabling them to:

• Register any number of insurance companies or TPAs (Third Party Administrators)

• Upload and manage insurance price/tariff lists

• Submit insurance claims directly from Helix

• Track approvals, rejections, and balances via ledger mapping

This guide walks you through the process of adding a new insurance company to Helix and configuring related settings.

🧭 Where to Find It

1. From the Helix Home Screen, go to: Control Panel → Insurance (Under the "Patient Billing" section)

2. On the Insurance Companies screen, click the + icon on the top-right corner to add a new insurance payer.

📝 Add Insurance Company

Upon clicking the + icon, you'll see a popup window titled "Add Insurance Company".

Fill in the following fields:

• Branches – Select the branches where this insurance is applicable

• Name – Insurance or TPA name

• Type – Insurance or TPA

• Phone, Email, Address, Website – Optional contact details

• Provider Code / Company Code – Use the code provided by the insurance company

• TPA ID / TRN – Identification details if applicable

• Eligibility – Toggle ON if insurance eligibility checks are required

• Requires Approval – Toggle ON if pre-approvals are needed before claim submission

• Ledger – Link to a ledger to track receivables from this insurance provider

Click Submit to save the new insurance payer.

⚙️ Post-Creation Actions

Once the insurance company is added, it appears in the list. Click the Options (3 dots) next to the company name to:

• Open – View or add more details

• Edit – Modify existing information

• Delete – Remove the company from your system

Clicking Open takes you to the Insurance Company Profile screen.

➕ Additional Insurance Configurations

On the top-right corner of the Insurance Company Profile page, you will see 5 key action buttons:

1. Upload Price List

• Bulk upload an Excel file containing insurance tariff codes and pricing.

• Make sure the codes in the upload match with the existing cash price codes in your Medical Services section.

2. Add Price List

• Add individual services manually using their unique codes and rates.

3. Add Consumables Price List

• Upload or add consumables/medications included in the insurance tariff.

• These items should already exist in your Inventory Items List.

4. Add Network

• Add network names (e.g., GN+, GN-) and assign DRG Factors to each.

• DRG Factor may influence pricing or eligibility for claims.

5. Add Policy

• Register specific insurance policies with:

  • Payer name

  • Policy Name & Number

  • Effective From and Expiry Date

✅ Pro Tips

• Always map a ledger when creating an insurance payer to track unpaid claims.

• Ensure your Medical Services cash price list is up-to-date before uploading an insurance price list.

• Use Eligibility and Requires Approval toggles for better claim validation.

• Regularly update Networks and Policies to stay aligned with the insurance provider's requirements.