Payers and tariffs

Set insurer and scheme rates per service, record patients' insurance policies, and understand what tariffs affect today.

A payer is an insurer, TPA or government scheme that pays for some patients' care. A tariff is the rate a payer has agreed for one service. LeapHealthOS lets you keep these rates and record which patients hold which policies. This page is for administrators who manage payer rates and front-desk staff who record a patient's insurance.

Tariffs price estimates only

Today, tariffs are used only when a cost estimate is produced. Bills and bookings still use your normal prices, and there is no split of a bill between the payer and the patient. The screen says so: "Rates here price estimates. Bills price at the empanelled rate once insurance billing is enabled." Estimates themselves have no screen yet; see Registration fees and estimates.

When an insurer pays at the counter, staff record it as a payment with the Insurance method and a claim number. See Creating a payment and collecting money.

Before you begin

The list of payers comes from your tenant's payer schemes. Payers cannot be added from the Payers & tariffs screen or the Tenant Registry yet. If the screen shows "No payers set up yet — they are added in tenant types", ask your implementation team to add your payers.

Opening the screen

Open SettingsPlatform ConfigurationPayers & tariffs. The menu is visible only to administrators. The screen has two tabs: Tariffs and Patient policies.

The Tariffs tab

The table lists one row per tariff:

Column	What it shows
Payer	The payer the rate belongs to.
Service	The service, shown as a number (for example #42) rather than its name.
Rate	The agreed rate in rupees.
Active	A switch. Inactive tariffs are kept but not used.
Actions	Edit rate and Delete.

Use the Payer filter to show one payer, or All payers.

Finding the service behind a number

Because the Service column shows a number, note which service you picked when you add a tariff. One payer can have only one tariff per service, so the payer filter plus the rate usually identifies the row.

Adding a tariff

Start a new tariff

Administrator

Settings > Platform Configuration > Payers & tariffs

On the Tariffs tab, select Add tariff.

Choose the payer and service

Pick the Payer and the Service. Only active services are listed.

Enter the rate

Type the Rate (₹) in rupees, for example 850 or 850.50.

Save

Select Save.

Expected result: The tariff appears in the table as active.

If a tariff already exists for that payer and service, you see "A tariff for this payer and service already exists". Edit the existing row instead.

Changing, pausing and removing a tariff

Edit rate changes the amount. Payer and service cannot be changed; delete the tariff and add a new one instead.
The Active switch pauses or resumes a tariff without losing it.
Delete asks "Delete this tariff?" and warns "Estimates stop using this rate immediately." The tariff is not erased: it stays in the table with its Active switch off, and you can switch it back on later.

Recording a patient's insurance policy

A patient's policy tells LeapHealthOS which payer's tariff applies to them. Policies are recorded on the patient's profile, not on this screen. The Patient policies tab only points you there with Open Patients.

Open the patient

Front desk or administrator

All Patients

Find the patient and open their profile. See The patient profile.

Add the policy

In the Insurance section, select Add policy.

Enter the policy details

Choose the Payer, enter the Policy number, and set Valid from and Valid to.

Save

Select Save.

Expected result: The policy is listed in the Insurance section with its validity dates.

A patient can have more than one policy. The one that counts is the newest active policy whose dates cover today. Policies stay in the list after their dates have passed. A policy marked Inactive is never used.

Policies cannot be edited

There is no way to edit or deactivate a policy once saved. If a policy number is wrong, add a corrected policy; the newest active one is used. Ask your implementation team if an incorrect policy must be removed.

How a tariff is applied

For an estimate, each service is priced in this order: the patient's payer tariff, then the centre price, then the service price. The full order is on How a price is resolved.

Who can do what

Task	Permission
View tariffs	Read permission on Billing
Add, edit, pause or delete tariffs	Configure permission on Billing
Add a patient policy	Create permission on Billing

See Roles and permissions.

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