Hospitals and clinics in insurance-heavy markets live or die on their revenue cycle, yet Odoo's native account module has no concept of a payer, a coverage limit, a co-pay, or a claim. Out of the box you can raise a patient invoice, but you cannot split it into a patient-payable and a payer-payable portion, you cannot record a pre-authorization reference against a procedure, and you have nowhere to track a claim through submission, adjudication, denial, and resubmission. Billing teams end up managing eligibility and TPA (third-party administrator) claims in spreadsheets and payer portals that never reconcile back to the ledger — so cash leaks through under-billed co-pays, missed authorizations, and denials that are never reworked.

This is a build-to-order module ECOSIRE develops on top of your existing clinical-core-his-emr and account install. We add a set of ORM models — an insurance payer and plan master (models.Model with covered-service and exclusion lines), patient coverage records carrying policy number, validity dates, and coverage limits, and a claim object generated from a posted patient invoice. Coverage-aware pricing rules run as computed fields (@api.depends on service, plan, and coverage percentage) so every invoice line is automatically split into patient-payable versus payer-payable, with co-pay and deductible applied in the right order. Pre-authorization is a small approval workflow that captures the payer's authorization reference and blocks claimable services that require one. Claims move through a state pipeline — draft, submitted, approved, partially_paid, denied — with denial reason codes and a resubmission path, and an EOB (explanation of benefits) reconciliation screen that compares expected against paid line by line.

Everything is wired to real Odoo primitives your team already knows. Access is governed by ir.model.access.csv plus record rules so billing clerks, coders, and finance see only what their role allows; QWeb reports produce claim forms and payer statements; automated actions can flag aged outstanding claims; and batch claim export emits a structured CSV (or a payer-specific layout) for upload to TPA portals, while the XML-RPC/JSON-RPC API lets you push or pull claim status from an external clearinghouse. Payer-mix and outstanding-claims dashboards give the revenue-cycle manager a single view of what is billed, adjudicated, and stuck. The module is delivered for your target line — Odoo 17.0, 18.0, or 19.0 — and works on Community or Enterprise (Enterprise adds the studio-style report designer and OCR-assisted document capture, neither of which the claim logic depends on).

Delivery is build-to-order: we start with a scoping call, map your payer contracts, plan rules, and TPA layouts, then build, test on a staging copy of your database, run UAT with your billing team, and deploy with a rollback plan. Typical delivery is 2-4 weeks from confirmed scope. Pricing starts from $599 (indicative, single-company base scope); multi-company or multi-branch consolidation, additional payer/TPA export formats, and clearinghouse or portal integrations increase the quoted scope.