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- You can view the enrolment of the Macintyre family (search under Insurees and Policies - Families/Groups with Insurance Number/Household ID: 070707070) of 5 who enrolled on the 20th of March 2018last month. Clicking on the insurance number underneath the headline saying "1 Families/Groups Found" will lead you to the details page of the Macintyre family. They paid 10000 units in cash (see under Contributions) on the 20th to be covered under the product code BCUL0001 that offers coverage for up to 6 members at a cost of 10000 units. To view what is offered in the covered product search for product code BCUL0001 (under Administration -> Products). The family was enrolled by Enrolment Officer (sri sid) and can actively (see under Policies) avail services at all health facilities covered by the insurer for a period of one year starting from the 20th.
- Alternatively, you can practice and enrol a family yourself by following the next steps (refer to the user manual on GitHub for detailed functionalities):
- Create a family: Insurees and Policies → Add a Family/group → enter all the required information and save
- Add family members: Insurees and Policies → Families/Groups → search the family where to add members and click on it → on the next screen click on the green "+" sign in the insuree section → enter the insuree-related information and save.
- Add an insurance policy: Insurees and Policies → Families/Groups → search the family where to add members and click on it → on the next screen click on the green "+" sign in the policy section → enter the policy related-information and save.
- Add a contribution: Insurees and Policies → Families/Groups → search the family where to add members and click on it → on the next screen click on the green "+" sign in the contribution section → enter the contribution-related information and save.
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A claim can be entered in the system by going to the page under Claims called Health Facility Claims. To view an existing claim that was entered by a designated Claims Administrator for his/her respective Health Facility you can view the example of Claim No. CIA00001 CIG00001 by searching for this number under Claims No. field. Claims Status field should be set to Entered as the claim is in this status. Once the search yields the claim you can select the claim by clicking on the Claim No. CIA00001 CIG00001 to view the details of the entered claim. At this point changes can be made to the claim before it is submitted for automatic checking by the system of the claim against the product definition in the system.
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Reviewer check: In order to view a claim in the system which has gone through a manual check by a (medical reviewer) reviewer you can do so in Review page under Claims. Set the Claim Status field to Checked and search for Claim No. UPDH0002UPDH0009. You will find here that based on selection criteria available in the system a claim reviewer had selected this claim for review but not for feedback. If you open this claim by selecting it and clicking on Review you will find details of the claim where it is indicated that the reviewer found that even though the system approved (Status set to Passed) the service M14, the diagnosis did not match with the service that was provided and hence the reviewer decided to reject this claim by indicating 0 in the App. Qty (Applied Quantity) field. The Approved amount is hence 10 instead of the claimed 21010 units. The claim is currently saved allowing the opportunity for the reviewer to get further clarification to reconsider his/her decision before processing this claim.
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