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Insurance

Insurance sales, split at the counter and tracked to settlement

PharmaEdge handles insurance the way an Egyptian pharmacy deals with it: the patient pays their share at the counter, the rest becomes a receivable on the payer, and claims, settlements and rejections are tracked invoice by invoice.

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What you can do with insurance

  • Payers

    Medical insurance companies and TPAs, government schemes, corporate contracts and syndicates.

  • Schemes and co-pay

    Each scheme sets the patient's share, so the split is calculated for you at the counter.

  • Members

    Add members one by one or import them from a CSV file, and find them by card number at the counter.

  • The split at the counter

    Choose the member and the sale splits into what the patient pays now and what the payer owes.

  • Approval numbers

    Require an approval number where the payer demands one, so claims aren't rejected for missing it.

  • Claim files

    Batch a period's insurance invoices per payer, submit and export them as a file.

  • Settlements and rejections

    Record what the payer paid and rejected per invoice, then resubmit, write off or charge the patient.

  • What each payer owes

    A payer aging report and an insurance receivable kept in the accounts.

The co-pay split, done for you

At the counter the cashier picks the member; PharmaEdge applies the scheme's share, collects the patient's part and records the rest as owed by the payer — on the same invoice.

Claims and rejections, invoice by invoice

Build a claim for a payer and period, export it, then record the settlement. Rejected invoices go to a worklist so nothing is quietly lost.

Good to know

  • Insurance applies to sales at the counter: credit sales, delivery orders and offline sales can't carry an insurance share yet.
  • Claims are exported as files; there is no direct connection to payers' systems yet.

Common questions

Which insurance companies does it support?

Any payer you work with — you add them yourself with their schemes and co-pay rules: insurers and TPAs, government schemes, companies and syndicates.

What happens to rejected claims?

They land on a worklist where you can resubmit them, write them off, or charge the amount to the patient.

Does it affect my accounts?

Yes. The payer's share is recorded as an insurance receivable, and settlements and write-offs post automatically.

  • Customers & credit

    Credit accounts (آجل) without the notebook, statements, loyalty points, gift cards and WhatsApp refill reminders.

  • Online store

    Your own pharmacy page where customers browse, order for delivery and track their order.

  • Accounting & reports

    Double-entry accounts that post themselves, VAT, expenses, treasury, 17 reports — and HR and payroll.

Try it on your own pharmacy for a week

No card. A real person contacts you on WhatsApp within 24 hours and sets it up with you.

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