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For the pregnancy complication services, we would need fee-for-service bundles with ceilings. The individual services and items provided to the patient need to be entered into the system to get the total amount of the claim. Of course, these services and items need to be part of the bundle list in order to be reimbursed. If this is the case, the total amount of the claim is reimbursed, given that it is below the ceiling, otherwise only bundle maximum price is reimbursed.
Specification
Health Facility form
add comments textfield in the HF edit form to allow the note taking (Reginal Found for Health Promotion) in case of authorization of missing product, which will be displayed during claim review
Service creation
new dropdown named Type is added
options: simple/atomic, flat fee bundle and fee-for-service bundle
Step 1: simple service only shows current service creation form (current form)
first step is to add all atomic services and items (part of the CS scheme)
Step 2: for both flat fee bundle and fee-for-service bundle
a checkbox Manual is displayed close to the price to allow manual change if the price
if unchecked then the bundle price is readonly and the price is calculated with above formula
if checked the price can be manually edited and any change in services and items lists will not impact the price
when unchecked (if it was checked) the formula is automatically applied and the price is updated
if this service type selected then the list of of atomic services and items (added in step 1) will be displayed as it is displayed in the Claim creation form
service name with search
quantity
price readonly
delete button (to be removed from the bundle)
flat fee bundle only
will be second step because dependent on atomic services and items
bundle price is calculated based on individual services and items added with the formula SUM(service.quantity*service.price)+SUM(item.quantity*item.price)
frequency will be limited to 365 days through configuration add comments textfield in the HF edit form to allow the note taking (Reginal Found for Health Promotion) in case of authorization of missing product, which will be displayed during claim review
fee-for-service bundle only
bundle ceiling (price) is calculated based on individual services and items added with the formula SUM(service.quantity*service.price)+SUM(item.quantity*item.price)
the label for the service price will be changed to Ceiling instead of Price as for a fee-for-service bundle, this is the maximum amount that can be reimbursed, not the total price of the bundle
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The same view with the additions of the claim creation. readonly field???
display comments from HF during claim review
if authorization then MO can increase quantity to reimburse the specific service/product from bundle