Keep the evidence close to the claim.
Organise coverage, payor context and documentation across the patient and financial journey.
Explore the story
Planned core Medrella workflows, to be built from scratch using Schedula as the foundation. Availability requires development and demonstrated acceptance.
What this workflow connects.
The scope below guides discovery and demonstration. The adopted version and local configuration determine availability.
- 01
Payors, contracts and eligibility plans
- 02
Patient policies and coverage records
- 03
Service eligibility and claim preparation
- 04
Supporting documents and claim status
- 05
Scoped TPA, authorisation and settlement interfaces
Coverage is a workflow, not a checkbox
Insurance administration involves several parties and a changing set of documents, decisions and financial responsibilities. A policy on file does not establish that a particular service has been authorised or that a claim will be paid.
Medrella plans purpose-built records for payors, policies, coverage and claims, with their relationships and permissions agreed before implementation. The intended workflow keeps that context connected to the patient episode while making outstanding administrative work visible. Local insurer and TPA connections remain separately scoped. The website does not promise universal eligibility checking, automatic settlement or compatibility with every payer's process.
Preserve the meaning of each decision
Eligibility information, pre-authorisation, an approved amount, a submitted claim and a settlement are different records.
Staff should be able to see the current state and the evidence behind it without interpreting a collection of emails. A change in treatment or the length of stay may affect the administrative process and should be handled through agreed responsibilities. The clinical team needs relevant coverage context without being expected to operate the entire claims workflow. Financial teams need the approved information without receiving unnecessary clinical access. These boundaries are part of implementation design.
Make document completeness visible
Claims work often depends on documents produced across departments. A discharge summary, investigation report and invoice may be ready at different times and have different approval rules.
The system should help staff identify what is missing, who owns it and whether the version is final. Planned AI document assistance could prepare checklists or extract draft information, but staff must verify the source and the payer-specific requirement. An automated completeness suggestion is not an insurer acceptance decision. The workflow should retain the evidence used for submission and distinguish later amendments from the original package.
Design for queries and reconciliation
A claim rarely becomes simpler when a query arrives in a separate inbox with no link to the patient episode. The intended workflow should connect requests for clarification, responses and changes in financial responsibility.
Settlement reconciliation needs to distinguish the claimed amount, approved amount, deductions and remaining balance according to the hospital's accounting policy. Interfaces must handle repeated messages and partial responses without creating duplicate transactions. Begin with the payers and claim types that matter most to the hospital, then expand after the team can reliably trace the complete administrative cycle.
Demonstrate the difficult claim
A useful evaluation includes a pre-authorisation change, missing documentation, a payer query and a partial settlement. Ask the team to locate the current evidence, identify the next owner and explain the financial position.
Check role access and amendment history. Verify any proposed insurer interface with actual agreed test cases rather than a generic integration claim. Measures such as time spent finding documents and the age of unresolved queries can establish a practical baseline. Foundation records support the work, but a reliable insurance service depends on configured processes, trained people and validated external connections.
Connected thinking.
What would more time
for care make possible?
Let's explore it together