Help & Onboarding

A claims-processing workspace for member reimbursements. When a Medocare member pays for covered treatment out of pocket — usually at a non-accredited hospital, clinic, or doctor, or in an emergency — they submit documents to Medocare and this system tracks the claim through requirements checking, computation, attorney endorsement, decision recording, audit, payment preparation, and release.

Reimbursement processors (such as Ralyn Ybañez) who work claims end to end, plus reimbursement managers and administrators who manage users and the requirements checklist template. It is exclusively for the Reimbursements Department — it does not include Customer Service functions.

It replaces manual tracking with one source of truth: a live dashboard of what needs attention, an enforced document checklist per claim, an auditable status history, a computed-vs-approved amount record, bank details capture, payment release tracking, and a full activity log.

Go to Claims → New Claim. Select the member (add them under Members first if they are new), enter the date received, the provider, the amount claimed, treatment details, and the reason the member paid directly. On save, the claim gets a claim number (RMB-YYYY-#####) and a document checklist is generated automatically from the requirements template.

Open the claim and click "Start requirements check". Verify the member, policy/account, company, benefits, MBU, room entitlement, treatment, provider, and reason for direct payment — the Verification card on the right records these checks.

Tick each document in the Requirements checklist as you confirm it (claim form, official receipts, itemized statement of account, medical certificate, IDs, bank details form, and so on). You can add extra required documents for a specific claim. If documents are missing, click "Flag incomplete requirements" and follow up with the member — log every follow-up under Communications.

When all required documents are complete, click "Requirements complete → For computation". In the Reimbursement computation card, enter the recommended amount (the member's MBU limit and the amount claimed are shown for reference) and your computation notes, then Save computation.

Still in the computation card, enter the medical attorney's name and click "Endorse to attorney". This records that the complete paper records and your recommendation were forwarded. The decision itself happens outside the system.

When the records come back, open the claim and use the Attorney decision card: choose Approved, Partially approved, or Denied; enter the decision date, the approved amount (for approvals), and any notes. Denied claims can be closed after you inform the member.

Approved claims show a "Send to audit" button. When the audit is done, record the result with "Audit passed → payment preparation" (add audit notes as needed).

In Payment preparation, confirm the amount (pre-filled with the approved amount), choose the method, and — for bank transfers — select the member's bank account. If no bank details are on file, add them from the member's profile first. "Prepare payment" moves the claim to For Release.

Once funds are actually sent, record the release date and the bank reference/transaction number. The claim becomes Released; close it to archive. The payment appears in the Payments module and in analytics totals.

The dashboard shows live counts from the database: open claims, claims in intake/checking, claims with the attorney, the payment pipeline, open amounts, total released, and average days from receipt to endorsement. "Needs attention" lists claims with incomplete requirements, pending decisions, and pending releases. A Getting Started widget appears while the system has no claims yet.

The Claims list shows every claim with its status, pending document count, amounts, and dates. Use the search box (claim number, member, company) and the status filter. Click a claim number to open its workspace, where all workflow steps happen.

Members are the primary records — every claim belongs to a member. A member profile stores coverage details (policy, plan, MBU limit, room entitlement, effective/expiry dates), contact details, bank accounts for crediting reimbursements, and the member's claim history.

The Payments page shows the pipeline of approved claims (audit → preparation → release) and every payment record with amount, method, status, release date, and reference number. Payment actions themselves are performed inside the claim workspace.

Import Data bulk-loads members from Excel (.xlsx) or CSV. The wizard maps your file's columns to system fields, validates rows, previews the data, and reports per-row errors. Rows with an existing member_no update that member instead of creating a duplicate.

Messages is a manual communication log — record calls, emails, SMS/Viber messages, and internal notes, optionally linked to a member or a claim. V1 does not send messages; it documents them so any processor can see the full history.

Claims → New Claim → select member → fill in received date, provider, amount claimed, and treatment details → Create claim. If the provider is not in the list, use "+ Provider not in the list? Add one" on the same page.

Open the claim → tick each checklist item as you verify the document. When every required item is ticked, click "Requirements complete → For computation" in the Workflow panel. The button rejects the move if required documents are still pending.

Open a claim in For Computation status → Reimbursement computation card → enter the recommended amount and notes → Save computation. The card shows the amount claimed and the member's MBU limit for reference.

Open a claim in Endorsed to Attorney status → Attorney decision card → select the decision, date, approved amount (if approved), and notes → Record decision.

Open a claim in For Release status → Payment section → enter the release date and reference number → Record payment release. Prepare the payment first (from Payment Preparation status) if you have not.

Click "Flag incomplete requirements" on the claim. The claim moves to Incomplete Requirements so it shows up under "Needs attention" on the dashboard. Log your follow-up with the member under Communications. When the documents arrive, tick them off and proceed to computation.

Intake details (member, provider, treatment, amounts claimed) stay editable through "Edit details" until the claim is closed or cancelled, but the recorded decision, approved amount, and status history are preserved — status changes only move forward through the allowed workflow steps. If an approval was recorded in error, an administrator can return the claim from Denied to Endorsed to Attorney, or the claim can be cancelled with a reason.

Record the denial with the attorney's reason in the decision notes. Inform the member (log the call or email under Communications), then click "Close claim". Denied claims remain in the system for reporting and can be re-endorsed if the decision is reconsidered.

During payment preparation the system warns you and links to the member's profile. Open the member, add the bank account under Bank details (bank, account name, account number), mark it verified once checked against the member's bank document, then return to the claim and prepare the payment.

Only administrators and reimbursement managers, via the Create User button on the login page or Settings → Create user. Accounts created any other way stay inactive and cannot access the system.

If the dashboard shows a "Database not initialized" banner, the reim_ tables have not been created yet — an administrator must run the migration SQL in Supabase. If a specific member or claim is missing, check the search filters first (click "Clear"), then check the Activity Log to see whether it was edited or cancelled.

Document uploads accept files up to 20 MB. If an upload fails, check your connection and file size, and try a PDF or image format. For import files, save the sheet as .xlsx or .csv, make sure the first row contains column headers, and check the per-row error report after importing.

The system records — it does not compute benefits for you. If the recommended and approved amounts differ, that is expected: the attorney may adjust. Keep your computation notes complete (benefits applied, exclusions, room and board adjustments) so differences can always be explained. Check the member's MBU limit and room entitlement on their profile.

The Workflow panel on the claim always lists the available next actions for its current status. Common causes: required checklist items are still pending (blocks "For computation"), no recommended amount saved (blocks endorsement), or no prepared payment (blocks release). The status history card shows exactly when and how the claim reached its current status.

Your account exists but has not been activated. An administrator or reimbursement manager must activate it and assign your role under Settings → Users.

Contact MediPaid support through your MediPaid coordinator. A dedicated support email and escalation path for the Reimbursements Department will be announced here once available. When reporting an issue, include: your account email, the claim number (if applicable), what you were trying to do, and any error message shown.