MANSOQ RCM & insurance
Configure products, issued policies and benefit classes
Separate what an insurer sells from the specific policy and class a patient belongs to.
Current source · source reviewed · 7 min read
Before you begin
- Verified policy schedule and program evidence.
- Canonical insurer and published configuration package.
1. Resolve the program first
Choose the insurance program supported by the instrument evidence before product, policy and class. Different programs can carry different coverage boundaries; do not infer the program from a brand name.
2. Create the product and issued policy
Keep the product definition separate from the named holder’s issued policy. Record policy term, source schedule, version and pinned regulatory/configuration package.
3. Define policy-specific classes
Record class code, network, accommodation, benefit, authorization and formulary relationships. Retain the payer-to-local class mapping rather than inventing a class to satisfy an unmapped response.
4. Review inherited values
Inspect program → product → policy → class → authorized member endorsement. An inherited cell should identify its source layer. Apply only evidenced overrides and preserve unrelated inherited properties.
Value states matter
Unknown, not applicable, not supplied and explicit none have different meanings. A blank limit or cost share must not be treated as zero or unlimited.
Registration while setup is under review
Provisional patient coverage capture is supported while configuration is being reviewed. Financial readiness and activation of a benefit class are separate controls; registration should retain the patient and create a resolution task.
Troubleshooting
The payer class cannot be mapped
Keep the received class reference and route it to benefits operations. Create or correct the evidenced mapping, then review the patient coverage.
Source evidence
References are pinned to the private MANSOQ source repository. Repository access is required to open these links.