Diagram
Fields
Name | Type | Mandatory | Default | Explanation | |
---|---|---|---|---|---|
ClaimID | int (PK) | YES | Unique database identifier | ||
InsureeID | int (FK tblInsuree) | YES | The Insuree receiving the medical services and items | ||
ClaimCode | nvarchar (max 8 chars) | YES | Unique code given by Health Facility | ||
DateFrom | smalldatetime | YES | Start date of the visit to Health Facility | ||
DateTo | smalldatetime | NO | End date of the visit to Health Facility. | ||
ICDID | int ( | YES | The Main Diagnosis | YES | |
ClaimStatus | tinyint | YES | 2 | The Claim Status changing by the adjudication process. | |
Adjuster | int | NO | |||
Adjustment | ntext | NO | |||
Claimed | decimal (18, 2) | NO | Total amount claimed by Health Facility: sum of price*quantity for all items and services | ||
Approved | decimal (18, 2) | NO | |||
Reinsured | decimal (18, 2) | NO | |||
Valuated | decimal (18, 2) | NO | |||
DateClaimed | date | YES | Current date | The date when the Claim has been entered into openIMIS. | |
DateProcessed | smalldatetime | NO | |||
Feedback | bit | YES | 0 | ||
FeedbackID | int (FK tblFeedback) | NO | 0 | The Feedback form linked to this Claim | |
Explanation | ntext | NO | Health Facility’s general explanation for the Claim | ||
FeedbackStatus | tinyint | NO | 1 | ||
ReviewStatus | tinyint | NO | 1 | The status of the Medical Officer review. | |
ApprovalStatus | tinyint | NO | 1 | ||
RejectionReason | tinyint | NO | 0 | ||
ValidityFrom | datetime | YES | Current date | ||
ValidityTo | datetime | NO |
Name | Type | Mandatory | Default | Explanation | |
---|---|---|---|---|---|
LegacyID | int | NO | |||
AuditUserID | int | YES | |||
ValidityFromReview | datetime | NO | |||
ValidityToReview | datetime | NO | |||
AuditUserIDReview | int | NO | |||
RowID | timestamp | NO | |||
HFID | int ( | YES | FK tblHF)YES | ||
RunID | int ( | NO | FK tblBatchRun) | NO | |
AuditUserIDSubmit | int | NO | |||
AuditUserIDProcess | int | NO | |||
SubmitStamp | datetime | NO | |||
ProcessStamp | datetime | NO | |||
Remunerated | decimal (18, 2) | NO | |||
GuaranteeId | nvarchar (max 50 chars) | NO | |||
ClaimAdminId | int ( | NO | FK tblClaimAdmin)NO | ||
ICDID1 | int | NO | |||
ICDID2 | int | NO | |||
ICDID3 | int | NO | |||
ICDID4 | int | NO | |||
VisitType | char (1) | NO | Emergency, Referral, Other | ||
ClaimCategory | char (1) | NO | Automatically defined in checking process: Surgery, Delivery, Antenatal, Hospitalisation, Consultation, Visit | ||
ClaimUUID | uniqueidentifier | YES | New UUID |
Forms
The following forms/pages are displaying or edit Claim related data: