Readiness before submission
Missing member, provider, diagnosis, referral, invoice, or clinical evidence can be identified before a claim reaches the transport queue.
HIB claims workflow Nepal
Prepare hospital claims for future HIB API integration
Xodont currently provides a local claim-readiness record and outbox foundation for member, referral, encounter, diagnosis, invoice, and clinical evidence. It is not a certified live HIB/openIMIS connector. Production requires the current interface contract, schema mapping, official access, UAT, approval, monitoring, and reconciliation.
Designed for
Nepal hospitals and service-provider institutions organising evidence and local workflow before contract mapping, official access, HIB UAT, certification, and any production transport.
Operational value
What changes when the workflow is connected
Stable local submission identity
A local identifier and retained attempt history preserve what was prepared; remote duplicate behaviour must be verified against the approved HIB interface.
Settlement requirements made testable
Acceptance criteria can define the HIB-specific denial, resubmission, remittance, variance, and reconciliation evidence required before go-live.
Capabilities
What hib claims readiness must control
Member and referral context
HIB member identity, referral or authorisation reference, patient, encounter, facility, provider, and claim number.
Clinical evidence package
Diagnosis, clinician, orders, results, procedures, medicines, admission or discharge evidence, and other required supporting documents.
Digitised invoice detail
Source-linked billed services, quantities, tariffs, patient or payer route, corrections, credit notes, and claim amount.
Readiness validation
A draft remains unready until required fields are complete; validation errors stay visible to the responsible team.
Local readiness outbox
Tenant-scoped provider configuration, protected credentials, payload identity, readiness status, and retained attempt history form a foundation for future contract-specific work.
Denial and settlement acceptance model
Define the required denial codes, correction, resubmission, remittance, short-payment, variance, and accounting behaviour for contract-specific UAT.
Workflow
A practical implementation path
- 01
Build the eligible care record
Capture member, referral, provider, diagnosis, services, medicines, results, discharge, and financial route as care happens.
- 02
Prepare and validate
Create a claim readiness record, freeze its identity, and resolve required-field or evidence errors before queueing.
- 03
Enable transport only after acceptance
Map the current contract, complete HIB UAT, verify failure and duplicate behaviour, and obtain written go-live approval before production transport is enabled.
- 04
Test resolution and reconciliation
Use contract fixtures to prove response, denial, correction, resubmission, remittance, variance, and financial posting back to the original claim and invoice.
Acceptance checklist
What to validate before go-live
Turn every broad promise into a test with an owner, expected result, evidence, and sign-off.
- Current HIB contract, endpoint, authentication, certificate, provider, and environment details
- Member, referral, provider, diagnosis, service-code, tariff, invoice, and evidence mappings
- Draft, ready, queued, sent, accepted, rejected, denied, resubmitted, settled, and failed states
- Idempotency, timeout, retry, duplicate, partial acceptance, and error-recovery tests
- Credential storage, rotation, access, audit, incident response, and test-versus-production separation
- Denial, resubmission, settlement, variance, receivable, and accounting reconciliation
Evidence boundary
Xodont currently provides a local claim-readiness and outbox foundation, not a certified live HIB/openIMIS connector. Production still requires current schema mapping, eligibility and package rules, asynchronous operations, remittance and attachment handling where required, official access, UAT, approval, monitoring, and reconciliation.
Frequently asked questions
Questions buyers ask about hib claims readiness
No. Xodont currently provides a local claim-readiness and outbox foundation, not a certified live HIB/openIMIS connector.
Official Nepal context
Context—not product certification
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Plan around your team
Test hib claims readiness with your real workflow
Bring one patient journey, one difficult exception, one report, and one reconciliation requirement. We will map the pilot around evidence your team can accept.