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RCM & insurance

Prepare an insured visit and understand benefit holds

Create a provisional, evidenced financial decision without confusing a reservation with a finalized charge.

Current source · source reviewed · 7 min read

Before you begin

1. Review the visit context

Open the revenue case and inspect the Integrated lifecycle gates and insured-visit preparation area. Confirm coverage, service facts and the applicable configuration package.

2. Enter a meaningful hold expiry

Use the preparation form’s expiry and request context. A benefit reservation is time-bound; it should not remain indefinitely after the planned service window.

3. Prepare and inspect decisions

Run the preparation action and review line-level tariff, benefit, cost share, limit and tax results. A successful draft/preview does not by itself prove all finalization gates are satisfied.

4. Handle a correction explicitly

When superseding a preparation, retain the prior reference and correction reason. Address the refusal list before retrying rather than replacing unknown facts with placeholders.

Preparation versus commitment

The API exposes prepare-insured-visit and commit-insured-visit as separate operations. Preparation builds provisional decisions and holds; commitment requires its own checks. Use the deployed workflow and authorized role for the final step.

Limit concurrency

Limit balances are derived from append-only entries, with serialized bucket access. A displayed balance is not permission to bypass reservation because two encounters can compete for the same entitlement.

Troubleshooting

Preparation is refused

Read the returned field or gate, then route it to the coverage, contracting, pricing or integration owner. Preserve clinical event capture while the financial issue is resolved.

Source evidence

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