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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 Clicking on the sub menu Claims Control PageThe Claims Control Page is the central point for all health facility claim administration. By having access to this panel, it is possible to add, edit and search claims. Claims can be edited only in the state Entered. The panel is divided into four panels (Img. 10). Search PanelThe search panel allows a user to select specific criteria to minimise the search results. In the case of claims the following search options are available which can be used alone or in combination with each other. Region Select the District Select the HF Code Select the HF Name Type in the beginning of; or the full Claim Administrator Select the Visit Type Select the Insurance Number Type in the beginning of; or the full Claim No. Type in the beginning of; or the full Review Status Select the Feedback Status Select the Claim Status Select the Main Dg. Select the Main diagnosis from the list of diagnoses status by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box, to select claims with main diagnosis. Batch Run Select the Visit Date From Type in a date; or use the Date Selector (Date Picker), to search for claims with a Visit Date To Type in a date; or use the Date Selector (Date Picker), to search for claims with a Claim Date From Type in a date; or use the Date Selector (Date Picker), to search for claims with a Claim Date To Type in a date; or use the Date Selector (Date Picker), to search for claims with a Search Button Once the criteria have been entered, use the search button to filter the records, the results will appear in the Result Panel. Result PanelThe Result Panel displays a list of all claims found, matching the selected criteria in the search panel. The currently selected record is highlighted with light grey. (Img. 11). Double click on the line re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record. A maximum of 10 records can be displayed per default but it can be changed by configuration (gitHub), in a scroll panel. Further records can be viewed by either changing the page or deleting/submitting the current loaded claims and search claims again. ActionsModular openIMIS comes with Material UI this means that there is a single button (Tab. 1) which function will change depending on the context (Icon change), for less used functions a tree dots menu is available (Tab. 2) only when claim(s) are selected. By double-clicking on the claim line, the user is directed to the Claim Page, where the current selected claim can be edited (provided it in the state Entered), this page will open with the current information loaded into the data entry fields. See the Claim Page for information on the data entry and mandatory fields.
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. 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? Information PanelThe 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 PageMain FormHF 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. 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 Claims 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) ServicesService 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. 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). ItemsItem 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. 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). SavingOnce all mandatory data is entered, clicking on the
If mandatory data is not entered at the time the user clicks the Printing of a claim By clicking on the Restoring/Duplicating a claim By clicking on the Creating of a new claim By clicking on the Back By clicking on the |
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