Glossary:

Account receivable : JLN term JLN Process - Accounts receivable

Account payable: JLN term Accounts payable 

outbound invoice, aka invoice: invoice that openIMIS send to some other third parties

inbound invoice, aka bill: invoice that openIMIS recieves from some other third parties

outbound payment, aka bill payment: payment that openIMIS send to some other third parties Payment to providers

inbound payment aka invoice payment: payment that openIMIS recieves from some other third parties like Premium collection and Funding

Models

The concept is to use a widely use format as base. inspiration can form FHIR invoice and SAGE API Invoices. openIMIS is not an accounting system therefore generating book and ledger is not in the project scope but invoice are a good representation for the payable mentioned above. To bring flexibility, a JSON fields was added to the invoice line in case a structured details is required.

The link with the Source and actor won’t be in a form a database foreign keys because those could be from different table.

bills

referenceSource{
  "label":"",
  "code":"",
  "type": "batchRun/commissionOverview/capitationReport",
  "id":"UUID",
  "address":{"text":"",...}
}

referenceActor{
  "label":"",
  "code":"",
  "type": "HF/Insuree/PH/payer/user",
  "id":"UUID",
  "address":{"text":"",...}
}

tax details {
  "lines": [
    {"label":"", "rate":"", "base":"", "amount":""}]
    …
  ],
  "total":""
}

billLineItems

to document the content for the bill

tax details {
  "lines": [
    {"label":"", "rate":"", "base":"", "amount":""}]
    …
  ],
  "total":""
}

Note: Do we need unit of measurement ? or should it be in the description.

billPayments

To document the payment done on the invoice. out of scope: a payment done for 2 invoice, to support such scenario an “generalPayment“ table need to be created, this table will have sub table with relationships to billPayments, once the reconciliation between the different invoice will be done.

billEvents

this table will log the event relating to the invoice

[out of scope]billdocuments

This should be managed by a document management module

Integration points:

Services

o billPaymentSent

o billPaymentRejected

o billPaymentRefunded

o billCreate (called on save)

o billUpdate (called on save)

o billDelete

o billItemCreate

o billItemUpdate

o billItemDelete

o billAmend

o billValidateItems

o billMatchItems

bill Payment specific modules (Calculation rules)

those calculation rules modules structure

• models: none

• services: 1 per signal listened

• static values

  • type: operation fee, supplier payment, reimbursment

• converters: one converter from another openIMIS object to invoice

• parameters: on for the “recipient” and “subject“ on the invoice

  • change might be required in the calculation module to save it in dedicated fields instead of json_ext OR we move those in the json ext fields

  • support search on those parameters

Listening to other modules signal are strikethrough because during the migration not all update will happens through modular therefore such trigger will complexity the invoice creation processes

• Page:
  Contribution plan calculation rule: legacy contribution (openIMIS)

  • payment-layer-project
• Page:
  Payment plan calculation rule: fees (openIMIS)

  • payment-layer-project
• Page:
  Payment plan calculation rule: Commission (openIMIS)

  • payment-layer-project
• Page:
  Payment plan calculation rule: Capitation (openIMIS)

  • payment-layer-project
• Page:
  Payment plan calculation rule: Fee-for-service (openIMIS)

  • payment-layer-project

[OUT OF SCOPE]Insuree cash transfet

converter

1. one accountPayable per insuree (for all dependant), one line per cash payment (level of Item and service)

2. one accountPayable per period, one line per cash payment claim

[out of scope]new signals are use to trigger action in another module:

o [one signal per service]

o billValidated (all billItemMatched and billItemAmountValidated)

o billFullyPaid

Create a FHIR interface for the accounting systems

Here the FHIR ressource to be used:

https://www.hl7.org/fhir/invoice.html

Acceptance criteria

1. Insurance clerk generates claim bill per health facility for a given time period

2. Insurance clerk generates commission bill per EO for a given time period

3. Insurance clerk generates capitation bill per HF for a given time period

4. Insurance clerk display the bill with details

5. Insurance clerk add a payment on the bill

6. Insurance clerk print the bill

7. Insurance clerk delete a bill (this won’t delete the generating Item)

Front end

Search page

search criteria

search result

card page

general information

detials

• Either drop down as current screen

  • General Account Payable section

    • Select “Account payable”

    • Payment plan picker in the future data model

      • can be a static drop down list for the old model: Valuation / Capitation / Commission fees / payment fees + Product picker

      • Or calculation for payment plan using the product configuration could be created, then payment plan could be created for each products

    • two datetime entries: DateFrom/DateTo

    • Location picker

  • Export Account Payable section

    • Payment plan picker in the future data model

      • can be a static drop down list for the old model: Valuation / Capitation / Commission fees / payment fees + Product picker

      • Or calculation for payment plan using the product configuration could be created, then payment plan could be created for each products

    • two datetime entries: DateFrom/DateTo

    • Location picker

    • group by: Product or third party

    • third party: user(EnrolmentOffice)/HF/”insuree”

  • section “payment plan calculated” that will display all “Account Payable generated” with there input detail in 1 column, working var in a second and the result in the third (relative index)