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Pre-conditionsAccess to the NavigationAll functionality for use with the administration of health facility claims can be found under the main menu Img. 9 Image - Navigation Health Facility Claims Clicking on the sub menu Claims Control Page Anchor | | ||
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Anchor | claims-control-img | claims-control-img | isMissingRequiredParameters | true
Tab. 1 Materal icons | |||
Img. 12 Add | Img. 13 Save | Img. 14 Back | Img. 15 Print |
Tab. 2 Claims Actions | ||
Img. 16 Select all | Img. 17 Tree dots | Img. 18 Tree dots menu |
Add
By clicking on the add button (Img. 12), the user is directed to the Claim Page, where new entries for new claim can be added. When the page opens all entry fields are empty. See the Claim Page for information on the data entry and mandatory fields.
Submit selected
By clicking on the submit selected manu (Img. 18), claim status of all selected claims with the status Entered will be submitted.
Once the process is done, a popup window ( Img. 19 ) with the result of the process will be shown.
Img. 19 Submitted Claims details – Claims Control Page
Delete selected
By clicking on the delete selected menu, the current selected claim will be deleted.
Before deleting a confirmation popup ( Img. 20 ) is displayed, which requires the user to confirm if the action should really be carried out?
Img. 20 Delete confirmation – Claims Control Page
Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a claim has been added, updated or deleted or if there was an error at any time during the process of these actions.
Claim Page
Main Form
Img. 21 Claim Page
HF Code
Displays the code of the health facility. The field is read only (taken over from the Claims Control Page) and cannot be edited.
HF Name
Displays the name of the health facility. The field is read only (taken over from the Claims Control Page) and cannot be edited.
Insurance Number
Enter the insurance number of the patient. When the field is filled the insuree name will be updated (:refnum:’insuree_picker’). Mandatory.
Img. 22 Search insuree popup
Claim No.
Enter the identification of the claim. Mandatory, up to 8 characters. It should be unique within the claiming health facility.
Main Dg.
Select the code of the main diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box. Mandatory.
Sec Dg 1
Select the code of the first secondary diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box.
Sec Dg 2
Select the code of the second secondary diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box
Sec Dg 3
Select the code of the third secondary diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box
Sec Dg 4
Select the code of the fourth secondary diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box
Claim Administrator
Displays code of the claim administrator. The field is read only (taken over from the Claim Control Page) and cannot be edited.
Visit Date From
Enter the visit date for out-patient care or the admission date for in-patient care. Mandatory.
Visit Date To
Enter the discharge date for in-patient care.
Date Claimed
Enter the date when the claim was prepared by the health facility.
Guarantee No.
Enter identification of a guarantee letter for prior approval of provision of claimed health care.
Visit Type
Select the type of visit/hospital admission from the drop down list (Emergency, Referral, Other)
Services
Service code
When entering the service code, a dropdown suggestion box for the available services with the service code or service name matching your typed text will be shown. Available medical services in the dropdown suggestion box are taken over from the pricelist of medical services associated with the claiming health facility. The desired service can then be selected from the dropdown suggestion box by clicking on it using mouse or selecting it using up and down arrows, then pressing Enter key fill the service code text field, together with quantity and value field in the same row.
Once the selected service has been written on the service data grid row, a new service line will be added and the dropdown suggestion box will close itself. When needed, the dropdown suggestion box can be closed by clicking any place on the page but outside the dropdown suggestion box.
Img. 23 Services dropdown suggestion box – Claim Page
Quantity
This field can be filled manually by entering a number in it or automatically is filled by 1 when the service code above is filled, through dropdown suggestion box. It is this field that receives focus after service code is filled above from the dropdown suggestion box.
Price
This field can be filled manually by entering a number in it or automatically is filled when the service code above is filled, through dropdown suggestion box. Automatically filled prices are taken over from the pricelist of medical services associated with the claiming health facility.
Explanation
Enter extra information about the service for the scheme administration (a medical officer of the scheme administrator).
Items
Item code
When entering the item code, a dropdown suggestion box for the available items with the item code or item name matching your typed text will be shown. Available medical items in the dropdown suggestion box are taken over from the pricelist of medical items associated with the claiming health facility. The desired item can then be selected from the dropdown suggestion box by clicking on it using mouse or selecting it using up and down arrows, then pressing Enter key to fill the item code text field, together with quantity and value field in the same row.
Once the selected item has been written on the item data grid row, a new service line will be added and the dropdown suggestion box will close itself. When needed, the dropdown suggestion box can be closed by clicking any place on the page but outside the dropdown suggestion box.
Img. 24 Items dropdown suggestion box – Claim Page
Quantity
This field can be filled manually by entering a number in it or automatically is filled by 1 when the item code above is filled, through dropdown suggestion box. It is this filled that receives focus after item code is filled above from the dropdown suggestion box.
Price
This field can be filled manually by entering a number in it or automatically is filled when the item code above is filled, through dropdown suggestion box. Automatically filled prices are taken over from the pricelist of medical items associated with the claiming health facility.
Explanation
Enter extra information about the medical item for the scheme administration (a medical officer of the scheme administrator).
Claimed
This field is filled automatically with a new total of quantities multiplied to their corresponding values in both data input grids at any time when there is a change in values in the either quantity fields or value fields anywhere in both data input grids.
Explanation
Enter extra information about the whole claim for the scheme administration (a medical officer of the scheme administrator).
Saving
Once all mandatory data is entered, clicking on the Save
button (Img. 13) will save the claim. The user stay in the Claim Page; a message confirming that the claim has been saved will appear on the right of the Claim Page (Tab. 3).
Tab. 3 Claim Save Confirmation | |||
Img. 25 Create confirmation | Img. 26 Update confirmation | Img. 27 Back | Img. 28 Print |
If mandatory data is not entered at the time the user clicks the Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk).
Printing of a claim
By clicking on the Print
button (Img. 15), the user will be shown a printable version of the claim details page. The printable version of the claim is available in the pdf formats.
Restoring/Duplicating a claim
By clicking on the Restore
button, the Claim Page is cleared filled with a new calim having the same details, at the exeption of the claimID that get a leading “@”
Creating of a new claim
By clicking on the Add
button (Img. 12), the Claim Page is cleared (with exception of HF Code, HF Name and Claim Administrator) and it ready for entering of a new claim for the same health facility and of the same claim administrator as before.
Back
By clicking on the back
(Img. 14) button, the user will be re-directed to the Claims Control Page
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