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Table of Contents
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Summary

Excerpt

The product OpenIMIS should apply to different target groups. It is necessary to separate the target groups. Primarily because of the necessity that different target groups can receive different service packages.
This is not only about the allocation of molecular services in terms of male/female or adult/child but also about whole groups of people like e.g.

  • formal sector workers

  • informal sector workers

  • pensioners

  • civil servants

  • prisoners

    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

    Related

    Process Group

    JLN Group - Claims Management

    Function

    JLN Process - Pre-authorization

    Source

    https://openimis.atlassian.net/browse/OSD-42

    https://openimis.atlassian.net/browse/OSD-50

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

    Jira Legacy
    serverSystem JIRA
    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

    Page Properties

    Prioritisation

    Score

    05

    Current Relevance

    4

    03

    Future Relevance

    6

    06

    Global Good

    6

    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.

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    Info

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    Requirement

    1.1           Goals/Scope

    1.2           Background

    1.

    Involved Entities

    Process Description

    Additional Reading

    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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