# Vetra for Providers
### Hospitals, clinics, pharmacies and labs — get paid faster on Vetra

> **Vetra** connects your facility to every HMO that uses the platform. Submit claims in one place, follow pre-auth requests in real time, and see remittances the moment payment is made.

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## 1. What the provider portal gives you

| Module | Purpose |
| --- | --- |
| **Dashboard** | Today's claims, PA status, settlements, disputes — all live. |
| **HMO Network** | The HMOs you're linked to, plus a directory of HMOs you can request to join. |
| **Claims** | Three-step submission, queue with statuses, query replies, attachments. |
| **Authorizations (PA)** | Pre-auth requests, codes, SLAs, appeals. |
| **Payments** | Remittances received, payment proofs, statements. |
| **Disputes** | Raise and track disputes against an HMO's remittance. |
| **Roles & Users** | Invite your billing team with scoped access. |
| **Settings** | Facility details, banking, tax, departments. |

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## 2. Joining a network

You have one account on Vetra and it connects you to multiple HMOs at once.

1. Sign up at `app.vetrainsure.com/provider/signup` with your facility name and licence details.
2. Verify your facility (upload licence + tax cert).
3. Open **Network**. Search the HMO directory and send a "Link to network" request.
4. Once the HMO approves the link, their plans, fee schedules and PA rules become visible to you for that HMO only.

> The same facility account can be linked to as many HMOs as you sign agreements with.

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## 3. Submitting a claim — the 3-step flow

### Step 1 — Patient & encounter
- Enter the **Vetra Member ID** (`<HMO>-<CLIENT>-<NNNNN>-<TYPE>`) — eligibility is verified instantly.
- Pick the encounter type (out-patient, in-patient, pharmacy, diagnostics, dental, optical).
- Capture provisional / final diagnosis (ICD-10).

### Step 2 — Line items
- Add each procedure / drug / lab / consumable with the appropriate code, quantity and unit price.
- The platform shows the **plan benefit limit** for each line. Lines over benefit are highlighted.

### Step 3 — Attachments & review
- Attach prescription, lab requests, diagnostic reports.
- Add encounter notes / discharge summary if applicable.
- Review the totals, then **Submit**.

The claim enters the HMO's queue and you can track it in real time.

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## 4. Claim statuses you'll see

| Status | What it means |
| --- | --- |
| **SUBMITTED** | Sent — waiting for HMO to receive. |
| **RECEIVED** | HMO has accepted into their queue. |
| **IN_REVIEW** | Adjudicator is working on it. |
| **QUERIED** | HMO asked a question — open the claim to reply. |
| **RESUBMITTED** | You've answered the query — back in queue. |
| **APPROVED** | Approved in full or part. |
| **REJECTED** | Declined — see the coded reason. |
| **SETTLED** | Paid — see the remittance in **Payments**. |

The notifications bell lets you know the moment a status changes.

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## 5. Pre-authorizations

- Request a PA from the same screen you'd submit a claim from.
- Pick the urgency:
  - **ROUTINE** — standard SLA.
  - **URGENT** — shorter SLA, prioritized in the HMO's queue.
  - **EMERGENCY** — fastest SLA. (Note: emergency PAs also notify the enrollee directly to prevent fraud.)
- If an HMO has an **auto-approval rule** that matches, you receive an instant auth code.
- A rejected PA can be **appealed** with extra context.

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## 6. Payments — how you get paid

- Each HMO runs **settlement runs** at their configured cadence.
- A run produces a **remittance** addressed to your facility: which claims, what amount, fees, net payable.
- Once the HMO uploads the **payment proof**, your **Payments** tab shows it instantly.
- **Disputes** let you challenge a remittance line. Track it through to resolution in **Disputes**.

> **Cash flow tip:** approved claims are the predictable revenue. Use the Payments tab as your real-time AR ledger.

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## 7. Notifications

A real-time bell tells you when:
- A claim is queried, approved, rejected or settled.
- A PA is decisioned or auto-approved.
- A remittance is generated or payment proof is uploaded.
- A dispute is responded to.

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## 8. Roles inside your facility

Invite your billing team with scoped access:
- **Facility Admin** — everything.
- **Billing** — submit claims and PAs, view payments.
- **Read-only** — view-only across the portal.

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## 9. API / EHR integration (optional)

If you run an EHR/HIS, you can integrate:
- `POST /v1/claims` — submit a claim.
- `POST /v1/authorizations` — request a PA.
- Webhooks — get status changes pushed to your system.
- See `vetrainsure.com/developers` for details.

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## 10. Security & privacy

- TLS 1.2+ everywhere, AES-256 at rest, managed key rotation.
- Tenant isolation — your data is scoped to your facility and to the HMO you're sharing it with.
- Full audit log of every action in your portal.

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## 11. Day-in-the-life — Billing Officer

| Time | Action |
| --- | --- |
| 08:30 | Open Dashboard → see overnight notifications. |
| 09:00 | Submit yesterday's discharge claims (3-step flow). |
| 11:00 | Reply to two QUERIED claims; resubmit. |
| 13:00 | Request an EMERGENCY PA for an in-coming admission. |
| 15:00 | Check **Payments** — yesterday's remittance landed; reconcile. |
| 16:00 | Raise a dispute on a partially-paid claim. |

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## 12. Where to get help

- **In-app:** Ask Vetra widget (bottom-right).
- **Docs:** `vetrainsure.com/documentation`
- **Email:** providers@vetrainsure.com
- **Status:** `status.vetrainsure.com`

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*Vetra Health, Inc. — Get paid faster, with less friction.*