How to Track HMO Claims at a Dental Clinic (Philippines)

It's the last Saturday of the month and you ask your assistant a simple question: how much do the HMOs owe us right now? Out comes the folder. Claim forms, LOA printouts, a photocopied ID, a sticky note that says "follow up Intellicare" with no date on it. Closing time comes and there's still no number. You did the cleanings and extractions weeks ago. The money sits somewhere between your clinic and the HMO, and nobody is keeping track of where.

Why HMO money goes missing

A cash patient settles up at the counter. An HMO patient doesn't. Your clinic does the work, sends the paperwork to the HMO, and waits for the HMO to approve the claim and pay it. Everything after the visit happens out of sight, and that's where the money slips.

It slips in small, ordinary ways:

• The claim never goes out. The forms wait in the folder because the day got busy, and the HMO can't pay a claim it never received.
• Nobody knows how old a claim is. Without the date it went out, "we filed that a while ago" is the best answer anyone has, and a while ago can mean last week or last quarter.
• Your team stops chasing once the HMO says yes. An approval feels like the finish line, so nobody follows up on the payment. That claim is money the HMO already agreed to pay you.
• Rejected claims quietly disappear. The rejection comes back, the form goes back in the folder, and nobody fixes it, re-files it or decides what happens next.

Nobody's being careless. Your front desk is handling a patient at the counter and a blinking Messenger inbox, and the folder sits in a drawer.

Log every claim the day it goes out

The fix is one habit. When a claim or LOA leaves your clinic, it goes on the list that same day, before it disappears into the folder. Record five things:

• The patient. When the HMO asks about a claim, you find it by name instead of by digging.
• The HMO. Maxicare, Intellicare, Medicard or whichever card the patient carries, so you know who to call about what.
• The LOA number. It's the HMO's own reference for that approval. Quote it when you follow up.
• The procedure and the amount. What you did and what you're claiming for it, so your totals mean something.
• The date it went out. Skip this one and a claim from last week looks exactly like one that's been quiet for months.

In HeyDenta that's one short form on the HMO Claims screen. Pick the patient from your patient list, choose the HMO from a list of Philippine HMOs or type one in, then add the LOA number, the procedure, the amount and the date you sent it. A notes field holds the rest, like where you filed the LOA printout or who you spoke to at the HMO. Every new claim starts as Submitted.

Work the list by status, oldest first

Once every claim is on the list, follow-up stops being a memory test. Each claim sits in one of four places, and each place needs something different from your front desk:

• Awaiting approval. Sent, with no answer yet. Start with the oldest, because a claim that's been quiet for weeks may never have reached the HMO.
• Approved, not yet paid. The HMO said yes and the money hasn't come. Follow these up first. The approval is in, so the call is about the payment date.
• Rejected. Read the reason before anything else. Your team can fix a missing signature or a wrong LOA number on the paperwork and re-file the claim. If the HMO won't cover the procedure at all, check your agreement with that HMO, then let the dentist decide whether the patient pays. If so, tell the patient soon after the rejection comes back.
• Paid. Mark it and move on. Record the money in the patient's payments too, so it shows up in your books.

HeyDenta's HMO Claims screen opens on four peso totals: what's awaiting approval, what's approved but unpaid, what you marked paid this month and what the HMOs rejected. Tap a status to see only those claims. The newest sit at the top, so the oldest, the ones that need a phone call, wait at the bottom of each list. Every claim shows the date you filed it and how many days ago that was.

Moving a claim along takes one tap: Approve or Reject on a submitted claim, Mark paid on an approved one, Re-file on a rejected one. Re-filing restarts the day count, so the age you see is always the age of the current filing.

Give the list one owner and a fixed time each week, say Friday before closing. A short session with a sorted list beats a long afternoon with the folder.

The HMO folder versus a claims list

Here's the same month of HMO work, kept two ways.

Every row on the left depends on somebody's memory on a busy day. On the right, the date, the amount and the status stay on the screen, so nobody has to carry them around in their head.

If your front desk screen faces the waiting area, the Hide money switch blurs the money figures on screen, so a patient at the counter doesn't see what an HMO owes you.

Isn't a spreadsheet enough?

It can be. If one person owns the sheet and updates it the day each claim moves, a spreadsheet tracks HMO claims fine. Keep it.

The trouble starts when the updates fall behind. In a busy week the claims go in as a batch, the statuses go stale, and the file lives on one computer, so the only person who can answer "did Medicard pay?" is whoever keeps it. Someone types every patient name by hand, too.

With HeyDenta, the claims list sits in the same app as your schedule and patient records. The patient comes from your patient list, the screen adds up the totals, and anyone on the team can open it from their own login. If you ever leave, your claims come with you, because the data export includes them as a spreadsheet file.

Whichever you use, log each claim the day it goes out and follow up the oldest first.

What it costs

HMO claim tracking comes with the Clinic plan at ₱3,900/month, and with Multi-branch, from ₱8,900/month. Every plan starts with a 14-day free trial and no card, and the trial includes the HMO Claims screen. Pay yearly and get two months free. It's month to month, and you can cancel anytime.

Clinic covers the rest of the front desk as well: Aria answering patients 24/7 on Messenger, Instagram and web chat, booking them into your schedule and sending appointment reminders, for two to three dentists with a login each.

Before you decide, count the claims in your folder that went out more than a month ago with no payment yet. That pile is what the list is for. Built in the Philippines, for clinics that take HMO patients.

Common questions