Insurance & Claims Management

We build a dedicated claims backbone as a proper Odoo module. New models (models.Model) capture the payer, the policy/subscriber, and the claim header with its service lines — each line carrying procedure code, modifiers, diagnosis pointers, units, charge amount, and service dates. Computed fields (@api.depends) roll line charges into a claim total, derive the balance after each payment, and flag lines that violate payer-specific edits before you ever submit. The HCFA-1500 (CMS-1500 02/12) form is generated as a pixel-aligned QWeb PDF report that overlays your data onto the red-ink boxes for payers that still require paper or fax. For electronic submission we build an EDI 837P (Professional) generator that emits a compliant ANSI X12 5010 file — ISA/GS envelopes, the 2000/2010/2300/2400 loops, provider and subscriber segments, and the SV1 service lines — ready to hand to your clearinghouse or SFTP endpoint. Status transitions (draft → scrubbed → submitted → accepted/rejected → paid/denied) are driven by a documented state machine, with automated actions that stamp submission timestamps and open follow-up activities on the claim's chatter.

The module is secured the Odoo way. Access rights live in ir.model.access.csv and record rules restrict claims to the owning company and to billing-role groups you define, so front-desk staff, coders, and billers each see only what their role permits — important when protected health information is involved. Remittance handling closes the loop: we can parse an 835 remittance (ERA) or let billers post payments and adjustments against claim lines, with denial and CARC/RARC reason codes tracked so your team can work an aging worklist instead of chasing paper. Everything is exposed over Odoo's XML-RPC/JSON-RPC API, so an existing EHR, a scheduling system, or a clearinghouse webhook can create claims and read statuses programmatically. We target Odoo 17.0, 18.0, and 19.0, and note Community vs Enterprise differences up front — the claims logic runs on Community, while features like studio-style customization or advanced accounting analytics assume Enterprise where your edition provides them.

Because this is build-to-order, nothing is a shrink-wrapped download. After a short scoping call we confirm your payer mix, the standards you must meet (837P today, with 837I institutional or real-time 270/271 eligibility as options), your clearinghouse, and your Odoo version and edition. We build against a staging copy of your database, run UAT with your billers on real claim scenarios, and deploy with a rollback plan. Typical delivery is 2 to 4 weeks from confirmed scope. Pricing starts from $599 (indicative, single-company base scope); multi-company or multi-provider-group setups, additional EDI transaction types, clearinghouse-specific formatting, and encounter-data migration volume increase the quoted scope. You receive a fixed quote after the scoping call — never a surprise.