Healthcare providers running Odoo quickly hit a wall when they try to manage the payer side of care. A patient's coverage is not a single field — it is one or more policies, each with an insurer, plan, member ID, coverage percentages, deductibles, exclusions, and validity dates. Native Odoo gives you res.partner, invoices, and maybe a sales flow, but it has no concept of a payer policy, a pre-authorization that must be granted before a procedure, or a claim that is submitted, adjudicated, partially paid, rejected, and resubmitted. Teams end up tracking all of this in spreadsheets, losing revenue to missed pre-auths, denied claims, and coverage that expired between the visit and the billing run.

This module builds the missing payer layer directly on the Odoo data model. We introduce first-class models — for example patient.insurance.policy, insurance.preauthorization, and insurance.claim — linked back to the patient (res.partner) and to the insurer (also a partner, tagged as a payer). Each policy carries coverage rules, co-pay and deductible fields, and validity dates, with @api.depends compute methods that derive the covered amount, patient responsibility, and remaining benefit on any billable line. Pre-authorization records move through a documented state machine (draft → requested → approved / rejected → expired) with the reference number, approved amount, and expiry captured against the specific procedure or product, so nobody performs a service that will not be reimbursed. Claims aggregate the covered charges, generate the submission payload, and track adjudication back to the cent, reconciling against the eventual payment.

Everything is wired into the parts of Odoo your finance and front-desk teams already use. Coverage and patient-responsibility figures flow onto the customer invoice so co-pays are billed correctly at the point of care. QWeb reports produce the claim form, the pre-authorization request, and payer statements as branded PDFs. Automated actions (server actions on a scheduled ir.cron) flag policies nearing expiry, pre-auths about to lapse, and claims that have sat unadjudicated past your follow-up threshold. Access is locked down with ir.model.access.csv plus record rules so a receptionist can request pre-auths but only the billing team can submit or write off a claim, and multi-company rules keep each clinic's data separate. Because it is built on standard models, the whole payer dataset is reachable over Odoo's XML-RPC/JSON-RPC API for any clearinghouse or portal integration you need. The build targets Odoo 17.0, 18.0, or 19.0, and we confirm Community vs Enterprise fit during scoping — the core module runs on Community, and where your edition unlocks features like the accounting follow-up engine we integrate with them rather than reinventing them.

This is a made-to-order engagement, not an off-the-shelf download. After a short scoping call we confirm your policy structure, the payers you work with, your claim format, and the exact fields your billing team lives by, then we build, test on a staging copy of your database, and install into production. Typical delivery is one working week from confirmed scope depending on integration and migration depth. Pricing starts from $999 (indicative, single-company base scope); multi-company or multi-clinic rollout, clearinghouse/EDI integration, payer-specific claim formats, and migrating historical policy and claim data increase the quoted scope. You receive a fixed quote after the scoping call — the from-price is an honest starting point, not a firm figure.