Finance & ZATCA

Review patient responsibility before billing

Establish a documented basis, responsibility and authorized disposition for each amount.

Current source · source reviewed · 7 min read

Before you begin

Claim/episode financial facts and evidence for the responsibility basis.
Authorized named reviewer for a patient-receivable determination.

1. Read the liability decision

Open Patient Liability or the claim detail liability facts. Review basis, disposition, responsibility, disclosure evidence and review timestamps separately.

2. Distinguish estimate from debt

Presenting an estimate posts and settles nothing. Review any unresolved insurance shortfall separately from the patient-billable portion.

3. Obtain an authorized determination

Before an amount moves to patient_receivable, record its legitimate basis, named reviewer and review timestamp. Missing review is a refusal condition, not an invitation to enter an anonymous override.

4. Use the invoice surface to issue

The finance issue check returns what may be issued and explicitly marks posted: false. Actual invoice posting belongs to the invoice workflow and its additional controls.

Amounts that must not migrate automatically

A provider contractual obligation, undetermined responsibility, missed submission deadline or absent authorization does not become patient debt just because the payer has not paid.

Claims and collections

Denial reasons and patient liability are different classifications. A payer’s rejection taxonomy alone cannot authorize collection from the patient.

Troubleshooting

Issue returns excluded amounts

Review contractual_adjustment, unresolved_insurance_shortfall and patient_receivable_without_reviewer. Correct the underlying determination and evidence; do not force these values into a cashier balance.

Source evidence

References are pinned to the private MANSOQ source repository. Repository access is required to open these links.