Coverage Creation

Automatic Coverage

When a patient with active insurance receives healthcare services, Biograph can automatically calculate insurance coverage:

1. The system checks the patient's active insurance policy
2. Matches the service item against the payor's eligibility plan
3. Calculates the covered amount based on coverage percentage and limits
4. Creates a Patient Insurance Coverage record

Coverage from Service Request

Coverage can also be triggered when specific service requests are made:

1. A practitioner orders a lab test, procedure, or medication
2. The system checks if the patient has insurance coverage for that service
3. A coverage record is created showing:

Field	Description
Patient	The insured patient
Insurance Policy	Which policy applies
Service Item	The healthcare service being covered
Total Amount	Full cost of the service
Coverage Amount	Amount covered by insurance
Patient Liability	Amount the patient must pay (co-pay)
Status	Active / Claimed / Settled