Medical aid details in the Healthcare pack

How the Healthcare pack captures a patient's medical aid details at registration, why a person checks membership, and why claims stay outside it.

By Achekam · 11 October 2026 · 5 min read · For Healthcare businesses in South Africa, Nigeria, Kenya

Launching soon. The Industry CRM add-on described in this article is launching soon. This article describes it as it will work at launch.

"Is my medical aid going to cover this?" For many patients, that is the first question, and the front desk is expected to know. Behind it sit three separate jobs that practices often blur together: capturing the patient's scheme, HMO or insurer details, checking that the membership is real and active, and getting paid by the scheme once the patient has been seen.

The Healthcare pack in Achekam's Industry CRM handles the first job, leaves the second to a person on purpose, and does not attempt the third. This article explains that split, why it is drawn where it is, and how to organise the work around it.

What registration captures

The Healthcare pack calls customers Patients and keeps two kinds of record: a Patient file and an Appointment. A new patient starts with intake. The registration form goes to the patient as a request, and the intake captures their medical aid and account details, has consent and the practice's terms signed electronically by the patient, parent or guardian, and books the first visit.

Two kinds of detail come in at that stage, and it helps to keep them apart in your head:

• Cover details: the scheme, HMO or insurer, the plan or option, the membership number and the main member.
• Account details: who is responsible for paying whatever the cover does not.

For a working adult those are often the same person. For a child, a student or a dependant, the main member and the person responsible for the account are usually a parent or partner, and the front desk needs both names right.

The pack is for the front desk only. It keeps no clinical notes, diagnoses, test results or prescriptions, so these are administrative details, not part of a medical record.

A person checks membership

In the Healthcare pack, medical aid membership is checked by a person. Nothing connects to a medical scheme or sends a claim.

So the check happens the way your practice already does it: a receptionist logs into the scheme's or administrator's portal, phones the scheme, or uses your existing switching or claims provider. What changes is that the check becomes part of the patient's intake rather than a scrap of paper.

Organise it so it is never forgotten:

1. Decide who checks. One named role, usually reception or the billing clerk.
2. Decide when. Before the first visit, not at the desk with the patient waiting. For returning patients, at the first visit of each new year, when many people change plans.
3. Record the outcome. Note on the patient's file that cover was confirmed, by whom and on what date, or that it could not be confirmed.
4. Tell the patient early. Where cover cannot be confirmed, tell the patient before they arrive that the visit may be billed to them directly.

A worked example in words: a new patient registers online on a Monday for a Thursday appointment. On Tuesday the billing clerk sees the returned registration, checks the membership on the scheme's portal, and notes it as confirmed with the date. Had the portal shown the membership as suspended, she would have phoned the patient that afternoon, and the patient would have come in knowing they would pay on the day.

No connection to schemes, and no claims sent

This is deliberate. The pack does not talk to medical schemes, HMOs or insurers, and it does not submit claims. Keep your existing claims route, whether that is a switching house, a scheme portal or a practice-management system you already use, and keep doing it the same way.

That boundary keeps the pack honest about what it is: a front-desk tool that knows who your patients are and what they have agreed to, not a claims engine. More on what sits inside and outside the pack is in what the Healthcare pack covers at the front desk.

Keeping account details current

Cover details go stale quietly. Patients change employers, schemes, plans and addresses, and a membership number that was right last year produces a rejected claim this year.

A light routine keeps them current:

• Ask every returning patient at check-in whether their cover or address has changed.
• Re-check membership at the first visit of each year.
• When a claim is rejected for a membership reason, update the file the same day and tell the patient.
• Keep the account holder's e-mail address correct, because that is where invoices and statements go.

How this sits beside the practice's billing

The pack's appointment workflow records attendance and either invoices the visit or records that it was paid at the till. When a visit is invoiced, the invoice is a normal customer invoice: issuing it takes the next number in your sequence and posts it to the ledger as debtors, sales and output VAT. Default terms are 30 days.

The scheme's payment, when it arrives through your existing claims route, is recorded against that invoice. Achekam records customer payments against one invoice or spread across a customer's invoices, and a part payment leaves the invoice part-paid. Whatever the scheme does not pay stays on the account for the patient or account holder to settle.

So the division of labour is simple:

The registration steps themselves, including consent, are covered in registering a patient with signed consent. South African practices can find rulings on medical schemes and the complaints process against schemes on the Council for Medical Schemes website, the statutory regulator of South African medical schemes.

Capturing details is easy; trusting them is the work. Let the pack collect the information, give the membership check to a named person with a fixed moment in the intake, and keep claims on the route your practice already knows.

General guidance only, not advice on your own circumstances. Tax and payroll rules change: check the current position with the authority or your adviser.