Medical billing, South Africa
Medical billing that a scheme can read
An account a medical aid will accept carries the member, the patient, the scheme, the membership number, the practice number and, for every line, the date, the tariff code and the ICD-10 diagnosis. IndunAI puts them there, holds an account that is missing its diagnosis, and keeps one ledger of what the scheme and the patient each still owe.
Claims through a switching house are not built yet. The account is ready for them; until then the patient claims it back or the desk sends it on.
Made-up patient
Date rendered07 Oct 2026
Tariff0190
ICD-10J06.9
NAPPIon medicine lines
DoctorHPCSA and practice number
Medical aid details frozenHeld without a diagnosis
A made-up line. The codes are display and claim data; the amount is the only figure charged.
The coded account
The codes ride the lines.
Each line of a medical account carries its own codes, beside the amount it charges.
Tariff codes and modifiers
Each service on the practice's list carries its tariff code, so a booked consultation's account line starts with it. Modifiers go on the line too. Medicines and consumables carry their NAPPI code.
ICD-10, checked for shape
The doctor types the diagnosis, up to six codes in their own order, the first being the primary. The code is checked as it is entered: a missing dot is put back (J069 becomes J06.9), an external cause is never first, and an injury code is followed by its cause. Loaded from the Department of Health's ICD-10 list, codes are searchable where they are typed. The shape is checked; whether a scheme accepts a code for a patient is not.
The medical aid half is frozen onto the account
When the account is raised, the patient, the date of birth, the main member, the scheme, the plan and the membership number are copied onto it. A file updated next month does not change an account already sent. Each doctor's HPCSA and practice numbers go on the accounts of the patients they saw.
No diagnosis, no account
An account to a medical aid with no ICD-10 code is held before it goes out, so it is fixed at the practice rather than rejected by the scheme. A private patient's account is not held for one.
Paid in parts
One ledger per account, and nobody edits it.
A medical aid pays some of an account, often weeks later and often less than it was billed. The patient pays the rest. Some of it is written off. Each of those is one row.
Two portions
An account opens on the medical aid's portion where the patient has a scheme, and on the patient's portion where they do not.
Receipts
The scheme's remittance, or the patient's EFT, card, cash or online payment, each taken off its own portion.
Shortfalls and write-offs
What the scheme did not pay moves to the patient in one step; a write-off takes an amount off with no money arriving.
Reversals, not edits
A mistake is undone by a reversing row that names the one it undoes. Every row says who wrote it, so the ledger is its own audit trail.
The patient's own part
The pay link asks for the patient's portion only, and nothing while it is all with the medical aid. Card payments go through PayFast or Yoco.
Settles itself
An account that reaches nothing owing closes on its own, and a reversal that leaves money owing opens it again.
Debtors
Who owes what, and for how long.
The Debtors list shows every account that has gone out and still owes something, aged as current, 30, 60, 90 and 120 days and over, grouped under the account holder, who for a dependant is the main member. Each figure is split between what the medical aid owes and what the patient owes. A statement of account lists a patient's accounts and every payment against them.
A practice moving across brings its opening balances with it: each becomes one account on the day it was owed, marked as sent, so no message goes to the patient and no reminder runs.
Where it stops
What billing does not do yet.
No claims switching
Electronic claims to medical aids through a switching house are not available today. Until they are, the account carries every detail a scheme asks for, so the patient can claim it back, or the desk sends it on the way it does now.
No benefit checks
It does not check benefits, authorisations or a scheme's rules for a code, and remittances are recorded by the desk, not imported.
What it costs
The practice software is priced with you in the demo. The assistant in front of it is from R1 450 a month including VAT for up to 300 conversations, plus a once-off R2 500 setup, or R4 995 a month fully managed. Meta's WhatsApp fees are separate. The plans are on the pricing page.
FAQ
Fair questions.
Does IndunAI do medical billing?
Yes, where the practice switches it on. Accounts carry tariff codes and modifiers, ICD-10 and NAPPI on every line, the scheme details frozen onto the account, and the doctor's HPCSA and practice numbers. Payments, shortfalls and write-offs go on one ledger per account.
Does it submit claims electronically?
Not yet. Until it does, the account carries everything a scheme asks for, and the patient claims it back or the desk sends it on as it does now.
Where do the tariff and NAPPI codes come from?
From the practice's own lists, loaded as CSV, because both are licensed and none ships with the software. ICD-10 loads from the Department of Health's list. A code typed that is not on the list is still accepted.
What happens when the medical aid pays less than billed?
The desk records the scheme's payment against the medical aid's portion and moves the shortfall to the patient's portion in one step. The patient's pay link then asks for their part.
Can we see what each patient owes?
Yes. The Debtors list ages every account in 30-day steps, splits it between medical aid and patient, and groups dependants under their main member. A statement of account lists a patient's accounts and payments.
Can a mistake on an account be fixed?
Yes, by reversing the row that was wrong. Nothing on the ledger is edited or deleted, and every row records who wrote it.
See an account go from the consultation to paid.
A demo raises a made-up patient's account, records a part payment and moves the shortfall, on a fictional practice.
The practice side, one piece at a time, and the assistant that sits in front of it.