Insurance billing in Egypt involves pre-authorisation, claim submission, and reimbursement tracking across multiple payers. Clinit structures the entire workflow to reduce rejections and accelerate payment.
The Insurance Billing Complexity
Egyptian private clinics increasingly deal with a mix of private insurance (Allianz, AXA, MetLife, GIG), corporate self-insurance schemes, and — in expanding governorates — the Universal Health Insurance (UHI) system. Each payer has different pre-authorisation requirements, claim forms, and reimbursement timelines. Without a structured system, claims pile up, rejections go unchallenged, and accounts receivable become unmanageable.
Clinit's Insurance Claims Workflow
Patient Insurance Setup:
Each patient profile includes an insurance section: insurer name, policy number, network, co-payment amount, and primary/secondary coverage.
Pre-Authorisation:
For procedures requiring pre-auth, Clinit generates a pre-authorisation request form pre-populated with the patient's details, diagnosis (ICD-10), proposed procedure (CPT/local code), and clinical justification. The pre-auth reference number is stored against the appointment.
Claim Generation:
At session completion, the system auto-generates a claim draft from the session services, diagnosis, and applicable tariff. The clinician reviews and submits. Claim components:
- Patient demographics and insurance details
- Treating doctor and facility
- Diagnosis (ICD-10, up to 4 codes)
- Procedures performed (CPT codes or local Egyptian coding)
- Itemised costs vs. insurance tariff
- Supporting documents attached (lab results, referral, pre-auth number)
Claim Tracking:
Each submitted claim has a status: Submitted → Under Review → Approved → Paid / Rejected / Partially Paid. The claims dashboard shows ageing by status and payer, outstanding claim value, and average days to payment by insurer.
Rejection Management:
Rejected claims display the rejection reason code and suggest the most common corrective actions. The clinician can edit and resubmit without recreating the claim from scratch.
UHI Readiness
Clinit's claim workflow is designed with UHI data standards in mind — ICD-10 coding, CPT codes, and facility registration requirements are all structured to be UHI-compatible as the programme expands.
