Welcome to Accounts!
This page helps you manage accounts used to settle patient bills on Serenity
Health insurance 101
Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. Health insurance providers are the organizations that make this possible. Within the context of Serenity, they create policies for businesses. Based on these policies, businesses can provide health insurance benefits to their employees and their dependents.
A policy is simple "a contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (that is an employer or a community organization). The contract can be renewable ( annually, monthly) or lifelong in the case of private insurance. It can also be mandatory for all citizens in the case of national plans. The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or "Evidence of Coverage" booklet for private insurance, or in a national [health policy] for public insurance."
Register an insurance provider
Insurance providers are registered by super administrators on Serenity.
This endpoint allows you to add a new insurance provider on Serenity
URL: {{base_url}}/organzations/insurance-providers
{
"country": "GH",
"name": "Sanlam AG", // will need to unique
"address": "15 Sesame Street",
"primary_location": "13 Radway Capetwon, South Africa",
"admin_first_name": "Chris",
"admin_last_name": "Dare",
"admin_email": "[email protected]" ,
"admin_mobile": "+233262260986"
}
Add an insurance organizations as a client of a medical provider
Insurance organizations can be added as provider clients. When these providers are not already set up on Serenity, then they will also be created as new insurance organizations
{
"name" : "Test company", // if new
"tax_identification_number": 2635634, // required
"address": "some street, some town, in a country", // if new
"owner": user_id, // if admin already exists
"admin_first_name": "Chris",
"admin_last_name": "Dare", // if new
"admin_email": "[email protected]" , // if new
"admin_mobile": "+233262260986" // if new
"authorized_by": "practitionerrole_id" // if new
}
Add a patient's insurance coverage
The Coverage resource is intended to provide the high-level identifiers and descriptors of an insurance plan, typically the information which would appear on an insurance card, which may be used to pay, in part or in whole, for the provision of health care products and services.
This endpoint allows you to add insurance coverage for a patient
{
"policy_holder":"Name of policy Holder",
"beneficiary": "patient_id",
"period_start":"date",
"period_end": "date",
"payor": "insurance_organization_id",
"cost_to_beneficiary_type": "fixed_amount", //options: fixed_amount, percentage
"cost_to_beneficiary_value": decimal,
"cost_to_beneficiary_currency": "GHS", // currency type if type is fixed_amount
}
Suspend a benefactor
This endpoint is used to suspend a payer's benefactors
URL: https://api.serenity.health/v1/providers/{{provider_id}}/clients/<client_id>/benefactors/{{benefactor_id}}/actions
Method: POST
{
"action": "SUSPEND"
}
Reactivate a benefactor
This endpoint is used to reactivate a suspended payer's benefactors
URL: https://api.serenity.health/v1/providers/{{provider_id}}/clients/<client_id>/benefactors/{{benefactor_id}}/actions
Method: POST
{
"action": "ACTIVATE"
}
{
"success": true,
"message": "Action successfully performed",
"data": {
"uuid": "ea84dacb-bf40-4449-a93f-42cd0c0cf6b1",
"first_name": "Jean baptiste",
"last_name": "Tuyizere",
"other_names": "",
"companyId": "77d1f2ca-c085-4316-a18f-9a354ff4287a",
"occupational_role": "",
"employee_tags": "",
"gender": "UNKNOWN",
"maximum_dependents_allowed": 0,
"address": "",
"date_of_birth": null,
"email": "[email protected]",
"mobile": "+250781633004",
"department": "",
"credit_amount": 0.0,
"health_programme_detail": null,
"patientId": 14496,
"userId": "b6180d80-d4c4-4765-8563-6b98515ba730",
"health_policy": null,
"contribution_type": "COPAY",
"contribution_value": "0.00",
"contribution_currency": "GHS",
"out_of_pocket_limit_amount": "0.00",
"out_of_pocket_limit_currency": "GHS",
"deductible_amount": "0.00",
"deductible_currency": "GHS",
"annual_limit_amount": "0.00",
"annual_limit_currency": "GHS",
"card_no": null,
"policy_holder": null,
"beneficiaries": [
{
"id": 14622,
"uuid": "a02d1e08-7ff4-47f9-81c2-90d7ffb21a36",
"account": 14596,
"patient": 14496,
"relationship": "SELF",
"first_name": null,
"last_name": null,
"policy_name": null,
"contribution_type": "COPAY",
"out_of_pocket_limit_currency": "GHS",
"contribution_value": "0.00",
"contribution_currency": "GHS",
"birth_date": null,
"card_no": null,
"policy_holder": null,
"period_start": null,
"period_end": null,
"gender": "UNKNOWN"
}
],
"is_active": true
},
"errors": null
}