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Content

Table of Contents
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Summary

Excerpt

Some schemes require that a health facility requests a pre-authorization of a treatment from the insurer before they administer it to the client in order to have the assurance that the costs will be covered. For eg. expensive treatments like certain type of heart surgeries might require a pre-authorization request to be approved by the insurer (including indication of amount to be blocked from the patients ceiling) before the hospital undertakes the surgery. Request is derived from Service Desk issue reported by users in Egypt captured in OSD - 42

Page Properties

Overview

Process Group

JLN Group - Claims Management

Function

JLN Process - Pre-authorization

Source

Jira Legacy
serverSystem JIRAJira
serverId97d38f4a-4cd9-3563-900d-60c9290b47f4
keyOSD-42

Jira Legacy
serverSystem JIRAJira
serverId97d38f4a-4cd9-3563-900d-60c9290b47f4
keyOSD-50

Impact on costs

(man hours, man days)

 

Impact on schedule

Category of change

  •  Minor
  •  Major
  •  Principal

Related

Page Tree
root@self
startDepth1

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Prioritisation

Score

05

Current Relevance

03

Future Relevance

06

Global Good

06

Local Funding

Discussion

At the moment, this is out of scope of openIMIS as normally benefit packages are pre defined etc. Might become relevant again when looking at formal sector. Page Properties

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Requirement

1.1           Goals/Scope

1.2           Background

Draft specification of pre-determination workflow as special case of a claims workflow:

1.3           Assumptions

1.4           User stories

1.5 Implementation Cases

Technical Specification

2.1     Impact on the general architecture

2.2    Impact on the database structure

Child Pages

Child pages (Children Display)
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