Bahmni-insurance-odoo is an addon developed in Odoo that is responsible to handle claim creation, submission, tracking and account voucher management to handle insurance payment.
Before you start generating claim, you should setup and configure your insurance app settings first.
Insurance Settings
This section includes all the settings related to insurance app. Go to "Menu / Insurance/ Configuration / Settings" and review the settings for:
- Username, password and base-url
This section is used to setup credentials and url for the insurance connect service. Insurance connect service is a middleware for Bahmni and OpenIMIS that handles claims between Bahmni and OpenIMIS.
Username: Username of insurance-integration service
Password: Password of insurance-integration service
Base Url: Base url of insurance-integration service
- Claim id setup
This section is related to claims.
Start Range, End Range, Next Value:
These values are the range of claim code provided to current institution. For eg: for current hospital the range provided may be from 100000-200000. Hence,
Start range = 100000,
End range = 200000
Current value = 100000
Company setup
This section involves, setting up hospital type for insurance processing as OpenIMIS has products based on hospital type. Go to "Settings / Companies/ <Your Company>" and review the settings for:
- Goto Edit mode of your company
- Select Hospital type one of two
- Hospital
- PHC
- Based on this hospital type, all the products are prepared for insurance claims
For eg: OPD service can be of two types and may have two prices based on hospital type.OPD Hospital can have price of Rs 200 and
OPD PHC can be Rs 100
Product Setup
Add product specific to insurance. Some of the products to be added are
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Overview:
Odoo insurance module is a custom module developed in Odoo, integrating insurance services in Bahmni. This module is responsible for consolidating sales order in order to create claim items and sends them to insurance-integration services for processing. It is also responsible for checking and updating the status of the claims in the system.
Architecture:
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ER Diagram
Workflow:
NHIS Number
The patient information is synced from OpenMRS to Odoo. The patient information includes insurance related information like NHIS Number, NHIS primary contact etc. These data are passed to Odoo as additional patient information, which is handled by bahmni_atom_feed. Configurations to sync these is here.
Eligibility Request
Eligibility request is handled by bahmni-insurance-module, during the sales order confirmation. This module checks whether a patient is eligible for the items/services mentioned in the sales order. A call to insurance-integration is made to get the insurance details of the patient, which is then validated by this module.
Print consent
This module is responsible to take consent of patient before processing insurance. A printable pdf format with patient's consent is generated by this module.
Claim Draft Creation
After confirmation of sales order, an invoice for the sales order is generated. Simultaneously, a claim draft is generated is the sales order is of payment type (Insurance/Partial). The claim draft includes items mentioned in sales order and claimable items.
Claim Confirmation
After claim draft is generated, then it needs to be confirmed. After confirmation, additional items can't be added into the claim.
Claim Submission
This module is also responsible for handling the claim submission. Once a claim is confirmed, it is submitted to imis-integration for processing. Before submitting, a claim code is generated by bahmni-insurance-odoo module which is unique to each claim. Later on this code is used to track the claim.
Claim Tracking
Once a claim is submitted then, it can be tracked using bahmni-insurance-odoo module. Claim tracking involves checking the status of the claim. The module makes a call to insurance-integration module, which returns the status of the claim, status of those claimed items, amount approved and rejection reason if any item is rejected.