Medicrest Claims Desk

Today at the claims desk

01

Check the member

Payer + member number → cover, benefits and the copay rule that will apply.

02

Authorise the encounter

EDI-channel insurers verify the member by OTP; Terminal-channel insurers need a pending terminal session.

Check a member first.

03

Build and submit the claim

Add the dispensed medicines and diagnoses; the receipt shows what the insurer will be billed.

Order number

Customer / patient number

Patient name

Add medicine

Diagnoses (ICD-10)

No diagnoses yet. Click a chip to mark it primary.

Copays, NHIF/SHA rebate and notes

Patient paid at checkout (KES)

NHIF/SHA rebate (KES)

NHIF member no.

NHIF site no.

Prescriber

Notes

Reserve balance (EDI channel)

Web checkouts

Orders where the customer chose “Pay with insurance” on the website. Terminal-channel insurers land here for the desk to finish.

Order

Customer

Insurer · member

State

Order total

Insurer pays

Updated

No web checkouts yet. Your storefront creates one with POST /api/checkout/sessions — or click “Create demo checkout”.

Claims ledger

Every submission, its steps, payloads and adjudication. Click a row.

#

Order · refs

Insurer

Member

Patient

Status · stage

Gross

Insurer pays

Paid

When

No claims yet. The first one you submit will appear here.

Reconciliation

What each insurer owes, how old it is, and claims that need a response.

Insurer

Claims

Billed

Approved

Paid

Outstanding

Queried

Rejected

Outstanding by age

Needs a response

Activity log

Every call to an insurer API, with redacted request and response bodies.

errors only

Time

Gateway

Step

Call

Status

ms

Quiet so far. Calls appear here as you work.

Users & webhooks

Dashboard accounts and outbound webhook deliveries to the storefront.

Users

Staff (admin/staff) see everything; agents are scoped to their insurers and can adjudicate & record payments only for those.

Username	Name	Role	Insurers	Active

Webhook deliveries

Event

URL

Status

Try

When

No deliveries yet. Events fire on checkout and claim changes. Configure the receiver with MEDICREST_WEBHOOK_URL.

Settings

Insurers, cover rules and connection health. Credentials live in .env, never here.

Insurers

Which gateway each insurer is billed through, and the scheme sent on claims.

Code	Name	Gateway	Scheme code	Scheme name

Cover rules

* is the default for any insurer without its own row. Fixed = patient pays a fixed copay; Percentage = insurer covers that share.

Insurer	Category	Type	Value	Discount %

Connections

Demo members (mock mode)

JUB-1001	Jubilee · EDI channel · 80 % cover, 5 % discount
JUB-1002	Jubilee · low balance (KES 1 800)
AAR-2002	AAR · EDI channel · KES 200 fixed copay
BRT-3003	Britam · inactive cover (rejected)
CIC-4004	CIC · Terminal-channel · pending session, 10 % discount
MAD-5005	Madison · Terminal-channel · pending session
SHA-6006	SHA · Terminal-channel · KES 2 000 balance

OTP in mock mode is 123456. Add a line with code FAIL-INVOICE to see a partial failure.