Content
Welcome to the openIMIS technical documentation repository.
openIMIS is a versatile open source software which supports the administration of health financing and social protection schemes. It is specially designed to manage the complex, high-volume data flows which are required to operate such schemes by seamlessly integrating beneficiary, provider and payer data in a single platform.
This manual is a guide on the use and functionality of the software rather than in-depth technical reference. The Contents section, provide a reference to the page of each major chapter and the sub chapters within. By clicking on the content title (online version), the reader is re-directed to the position of the content title.
1. Web Application
1.1 Users and logins
1.1.1 Login
To access the software, Users must have a valid User Name and Password, provided by the “IMIS Administrator”. In the browser address bar type the URL of the openIMIS instance to request the start page. Login page will appear (Img. 1). Use the provided Login Name and Password, and click on the button Login. If successful, the system will re-direct to the Home Page (Img. 2). The full menu is displayed. Clicking on the menu headers will display a sub-menu providing further navigation options. Only menu accessible to the user are displayed. Below the main menu at the top left-hand corner there is information about the current login user: Login Name, a list of roles acquired by the user and and the region the districts to which the user has access. Logins and roles assignment can be created in the Users Administration page, custom roles can be created and modified in the User roles Administration Page.
1.1.2 Reset Forgotten Password
When a password is forgotten, clicking Enter the Enter the Click on the Check the user’s inbox and click on Once the confirmation is submitted, the new credentials can be used in the Forgot Password? on the login screen (Forgot Password page (Img. 3).
User Name linked to the accountNew Password. In some browsers (i.e. Internet Explorer) it is possible to display the password entered by clicking on the eye in the right part of the password text box (Img. 4).
Submit button. In case the User Name coincides with an user in the register of users, an e-mail will be sent to confirm the password change (Img. 5).
Confirm password link inside the received email with the subject IMIS Password Request then re-enter the data of the steps 1 & 2 (Img. 6).
1.1.3 Password change
Any user can change his/her password by adjustment of his/her profile. Functionality for changing of a password can be done in the menu Clicking on the sub menu Current Password Enter the current password of the logged in user. New Password Enter a new password of the logged in user. The password should have at least 8 alphanumeric characters with at least one digit. Confirm Password Repeat the new password of the logged in user. Once all mandatory data are entered, clicking on the Mandatory data If mandatory data is not entered at the time the user clicks the Cancel By clicking on the Cancel button, the user will be re-directed to the Home Page.Navigation
Profile, sub menu Change Password.
Change Password re-directs the current user to the Change Password Page.Change Password Page
Saving
Save button will save the record. The user will be re-directed back to the Home Page. A message confirming that the new password has been saved will appear at the bottom.Save button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right side of the corresponding field).
1.2 Claims
The functionality under the menu claim entry and submission When it is submitted and it successfully passes at least some automatic checks, the claim goes to the status Checked. If the claim doesn’t pass automatic checking it goes to the status Rejected and its processing ends. The claim in the status Checked may be reviewed from medical point of view and/or a feedback on it can be collected from the patient. claim review: scrutinisation and feedback Medical reviewing and feedback acquiring can be by-passed. Ones such (manual) scrutiny of the claim is at the end, the claim may be pushed to the status Processed. claim valuation In this status the claim is evaluated in nominal prices, taking into account all ceilings, deductibles and other cost sharing rules associated with insurance product or products covering claimed health care. If there is no medical service or medical item price of which a relative one according to the corresponding insurance product, the claim goes automatically to the status Valuated. If there is at least one medical service or medical item with relative pricing, the claim goes to the status Valuated only after a batch for corresponding period is run. The batch for a period (month, quarter, year) finishes evaluation of relative prices on claims on one hand and summarizes all claims in the period for accounting system that is external to openIMIS (it is not a part of it). claims values based on stage Different values (prices) of a claim are associated with each stage of processing of claims. When a claim is entered the value of the claim based on nominal prices of claimed medical services/items is designated as Claimed Value. Claimed Value is associated with the state Entered. The value of the claim after automatic checking of claims during submission of the claim and after manual interventions of medical officers is designated as Approved Value. Approved Value is associated with the state Checked. The value of the claim after corrections based on all cost sharing rules of covering insurance products is designated as Adjusted Value. Adjusted Value is associated with the state Processed. The final value of the claim taking into account actual value of relative prices is designated as Paid Value. Paid Value is associated with the state Valuated.Claims allows complete processing of claims from their entering into IMIS, modification, submission to processing, automatic checking of their correctness, reviewing of them by medical officers, their evaluating and preparation of report to an accounting system for their remuneration to contractual health facilities. Each claim can be consequently in several states. Once it is entered to openIMIS (either by the mobile phone application Claim Management or typed in and saved in IMIS) it goes to the status Entered.
1.2.1 Heath Facility Claims
1.2.2 Review Claims
1.2.3 Batch Run
Administration of batches of claims is restricted to users with the system role of Accountant or with a role including an access to Claims/Claim/Batch. A claim has been already processed (review actions menu). All functionality for use with the administration of processing of batches can be found under the main menu Clicking on the sub menu The Batch Run Control Page is the central point for batch processing administration. Access to the page is restricted to users with the system role of Accountant or with a role including an access to Claims/Claim/Batch. By having access to this page, it is possible to process batches, filter, and filter for accounts. The panel is divided into six sections (Img. 47) Batch Processing Panel The batch processing panel allows a user to process batches based on the following criteria: Region Select the District Select the Year Select the Month Select the The Month at the end of the quarter process the claim for insuree having a product with Quaterly distribution (Product Page): March –> Process the claim for first quatrerJune –> Process the claim for second quatrerSeptember –> Process the claim for Third quatrerDecember –> Process the claim for Fourth quatrer December process the claim for insuree having a product with Yearly distribution (Product Page) Process Once criteria are chosen, clicking on this button (Img. 48), the claims will be processed based on the selected criteria. If the option Filter Panel for the relative price index per product and period The filter panel allows a user to filter the of indexes for relative pricing per period, product and zone (results of running of batches). In case the product doesn’t have any distribution configured then no relative price index are calculated by running the batch meaning no record will be added to the below list. the Relative price indexes can be filtered based on the following criteria: Type Select the Year Select the Period Select the Region Select the District Select the Product Select the Category Select category of health care (In-patient/hospital, Out-patient/Non-hospital, All) from the list of categories of health care by clicking on the arrow on the right of the selector. Filter Once criteria are chosen, clicking on this filter button (Img. 49) will filter based on the selection criteria. Display Panel for the relative price index per product and period The Display Panel is used to display results of running of batches after the filter or processing. Filter for Accounts Panel The Filter for Accounts Panel is used in filtering of batch protocols for an accounting system based on the following criteria: Group By Select either grouping of the report by health facility ( Start Date Type in a date; or use the Date Selector (Tab. 12) to enter date which is equal or less than claim date. Note. To clear the date entry box; use the ``Clear`` button on the date picker popup. End Date Type in a date; or use the Date Selector (Tab. 12) to enter date which is equal or greater than claim date. Note. To clear the date entry box; use the ``Clear`` button on the date picker popup. Show Claims Check this checkbox, if you need to show all claims in detailed way in the protocol. Region Select the District Select the Health facility Select the Product Select the Health facility Level Select a level from the list of levels of health facilities by clicking on the arrow on the right of the selector. Show All Check this checkbox, if you need to show all health facilities in the report although they have no claim included. Preview Once criteria are chosen, clicking on this preview button (Img. 50) will create a protocol of the selected batch. Button Panel This panel contains control button. Back By clicking on the back button (Img. 14), the user will be re-directed to the Home Page. Information Panel The Information Panel is used to display messages back to the user. Messages will occur once a batch has been processed, filtered or if there was an error at any time during the process of these actions.Pre-conditions
Navigation
Claims, sub menu Batch Run (Img. 46).
Batch Run re-directs the current user to the Batch Run Control Page.Batch Run Control Page
Region from the list of regions by clicking on the arrow on the right of the selector to select a region. Note: The list will only be filled with the regions assigned to the current logged in user and the option National. The option National will process all the claim for the period specified in Month and Yeardistrict from the list of districts by clicking on the arrow on the right of the selector to select a district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is the only one then the district will be automatically selected. If no district is selected then the processing is done only for insurance product defined for the selected region.Year from the list of available years by clicking on the arrow on the right of the selector. Only periods for which a batch hasn’t been run yet are offered in both lists.Month from the list of months by clicking on the arrow on the right of the selector.National was used in the field Region, the batch will run only for nationwide insurance products. If a region is selected in the field Region and no district is selected, the batch will run only for regional insurance products for the selected region. If a district is selected in the field District the batch is run only for district insurance products for the selected district.
Type; from the list of time group types (Monthly, Quarterly, Yearly) by clicking on the arrow on the right of the selector.Year; from the list of available years by clicking on the arrow on the right of the selector.Period; from the list of months/quarters by clicking on the arrow on the right of the selector.Region; from the list that appear after typing characters, all region containing the typed text will appear and be selectable underneath the box. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selectedDistrict; from the list that appear after typing characters , all district containing the typed text will appear and be selectable underneath the box. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selectedProduct; from the list that appear after typing characters , all product containing the typed text will appear and be selectable underneath the box.
health facility) or by product (Product).Region; from the list that appear after typing characters, all region containing the typed text will appear and be selectable underneath the box. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selectedDistrict; from the list that appear after typing characters , all district containing the typed text will appear and be selectable underneath the box. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selectedHealth facility; from the list that appear after typing characters, all Health facility containing the typed text will appear and be selectable underneath the box.*Note: The list will only be filled with the Health facility belonging to the selected region and assigned to the current logged in user. If this is only one then the Health facility will be automatically selected*Product; from the list that appear after typing characters , all product containing the typed text will appear and be selectable underneath the box.
1.3 Administration of Registers
Registers of openIMIS serve as a principal tool by which openIMIS is adjusted to needs of health insurance schemes. With exception of the register of Users that can be managed only by users with the system role openIMIS Administrator or with a role including an access to Administration/Users or Locations, all other registers can be managed by users with the role Scheme Administrator.or with a role including an access to Administration/Products or Health Facilities or Pricelists or Medical Services or Medical Items or Enrolment Officers or Claim Administrators or Payer. There is no system role that includes an access to the register of user profiles. Only users having a role including an access to Administration/User Profiles can access the register of User Profiles.
The register of Users defines who can login to openIMIS and under what constraints. The register of Locations defines administrative division of the territory, on which a health insurance scheme is operated. The register of Payers allows specification of institutional payers that can pay contributions on behalf of policyholders (households, groups of persons). The register of Enrolment Agents specifies all persons (either employed or contracted) by the scheme administration that are entitled to distribute/sell policies to population. The register of Claim Administrators specifies all employees of health facilities that are entitled to submit claims to the scheme administration. The register of Health Facilities contains all contractual health facilities that can submit claims to the scheme administration. The register of Medical Items specifies all possible medical items (drugs, prostheses, medical devices etc.) that can be used in definitions of packages of insurance products and in pricelists associated with contractual health facilities. The register of Pricelists that splits into two divisions for Medical Services and for Medical Items contains pricelists valid for individual health facilities or their groups reflecting results of price negotiations between contractual health facilities and the scheme administration. Finally, the register of Products includes definitions of all insurance products that can be distributed/sold within the health insurance scheme.
1.3.1 Insurance Products
The register of insurance products contains all insurance products in the health insurance scheme. There may be several insurance products available for distribution/selling in a territory, e.g. one basic product and one or several supplemental insurance products. The insurance products may at the different levels. For example that basic insurance product may be at the national level whereas the supplemental insurance products may be at the regional level. Administration of the register of insurance products is restricted to users with the system role of Scheme Administrator or with a role including an access to Administratiom/Products. An insurance product may only be added or thereafter edited, after the approval of the management of the scheme administration. All functionality for use with the administration of insurance products can be found under the main menu Clicking on the sub menu The The search panel allows a user to select specific criteria to minimise the search results. In the case of Products the following search options are available, which can be used alone, or in combination with each other. Product Code Type in the beginning of; or the full Product Name Type in the beginning of; or the full Date From Type in a date; or use the Date Selector Button, to search for products with a Date To Type in a date; or use the Date Selector Button, to search for products with a Region Select the The list will only be filled with the regions assigned to the current logged in user and with the option National. All nationwide products and all regional products relating to the selected region will be found. If no district is selected then also all district products for districts belonging to the selected region will be found. District Select the The list will be only filled with the districts belonging to the selected region. All nationwide products, all regional products relating to the selected region and all district products for the selected district will be found. Show Historical Values Click on Search Button Once the criteria have been entered, use the search button to filter the records, the results will appear in the result panel. The result panel displays a list of all products found, matching the selected criteria in the search panel. The currently hovered record is highlighted in grey (Img. 54). The leftmost record contains a hyperlink which if clicked, redirects the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record. The Information Panel is used to display messages back to the user. Messages will occur once a product has been added, updated or deleted or if there was an error at any time during the process of these actions. Product Code Enter the product code for the product. Mandatory, 8 characters. Product Name Enter product name for the product. Mandatory, 100 characters maximum. Region Select the region in which the product will be used, from the list by clicking on the arrow on the right hand side of the lookup. The option National means that the insurance product is nationwide and it is not constraint to a specific region.Note The list will only be filled with the regions assigned to the current logged in user.` Mandatory. District Select the district in which the product will be used, from the list by clicking on the arrow on the right hand side of the lookup.Note The list will only be filled with the districts assigned to the selected region and assigned to the current logged in user. Maximum of Members Enter the maximal number of members of a household/group for the product. Threshold Members Enter the threshold number of members in product for which the lump sum is valid. Insurance Period Enter duration of the period in months, in which a policy with the product will be valid. Mandatory. Administration Period Enter duration of the administration period in months. The administration period is added to the enrolment date/renewal date for determination of the policy start date. Recurrence Enter duration of the period in months after which registration fee/lump sum is applied again for a renewal. The period starts with the expiry date of the policy to be renewed. Date From Type in the date to provide the date for which underwriting for the insurance product can be done from. Date To Type in the date or use the Date Selector Button to provide the date until which underwriting can be done to. Mandatory. Conversion Select from the list of products, a reference to the product which replaces the current product in case of renewal after the Selecting the current product will prevent the record from saving, and cause a message to be displayed in the Information Panel. Account Code Remuneration Enter the account code of the insurance product used in the accounting software for remuneration of the product. 25 characters maximum. Account Code Contribution Enter the account code of the insurance product used in the accounting software for paid contributions. 25 characters maximum. Lump Sum Enter the lump sum contribution (an amount paid irrespective of the number of members up to a threshold) to be paid by a household/group for the product. If the lump sum is zero no lump sum is applied irrespective of the threshold members. Decimal up to two digits. Contribution Adult Enter the contribution to be paid for each adult (on top of the threshold number of members). Decimal up to two digits. Contribution Child Enter the contribution to be paid for each child (on top of the threshold number of members). Decimal up to two digits. Max Instalments Enter maximal number of instalments in which contributions for a policy may be paid. Mandatory. Registration Lump Sum Enter the lump sum (for a household/group) for registration fee to be paid at the first enrolment of the household/group. Registration fee is not paid for renewals of policies. Assembly Lump Sum Enter the lump sum (for a household/group) for additional assembly fee to be paid both at the first enrolment and renewals of policies. Registration Fee Enter the registration fee per member of a household/group. If registration lump sum is non zero, registration fee is not considered. Registration fee is not paid for renewals of policies. Assembly Fee Enter the assembly fee per member of a household/group. If assembly lump sum is non zero, assembly fee is not considered. Assembly fee is paid both at the first enrolment and renewals of policies. Enrolment Discount percentage Enter the enrolment discount percentage for the insurance product. The discount percentage is applied on the total contributions calculated for a policy underwritten earlier than Enrolment Discount Period Enter the enrolment discount period of the insurance product in months. Renewal Discount Percentage Enter the renewal discount percentage for the insurance product. The discount percentage is applied on the total contributions calculated for a policy renewed earlier than Renewal Discount Period Enter the renewal discount period of the insurance product in months. Grace Period Payment Enter duration of the period in months, in which a policy has a grace period (not fully paid up) before it is suspended. Mandatory, although it is by default and can be left at zero. Grace Period Enrolment Enter duration of the period in months after the starting date of a cycle (including this starting date), in which underwriting of a policy will still be associated with this cycle. Grace Period Renewal Enter duration of the period in months after the starting date of a cycle (including this starting date), in which renewing of a policy will still be associated with this cycle. List all items covered in this product. You can add new items by clicking on Actions Using the pen you can edit the row to edit its values, the bin will remove this item from the product and the floppy disk will finish the edition of the row (But the product still need to be saved to apply changes). Code Displays the code for the medical item Name Displays the name of the medical item Type Displays the type of the medical item Package Displays the packaging of the medical item Price Displays the default price of the medical item Limit Indicates the type of limitation of coverage for the medical item. This may be adjusted per medical item, select between Co-Insurance and Fixed amount. Co-insurance means coverage of a specific percentage of the price of the medical item by policies of the insurance product. Fixed amount means coverage up the specified limit. Co-insurance is the default value. Limit O is used for claims having the type of visit Other, Limit R is used for claims having the type of visit Referral and Limit E is used for claims having the type of visit Emergency. Origin Indicates where the price for remuneration of the item comes from. This may be adjusted per item, the options are: Schema Price: It takes the price from price list of a claiming health facility Provider Price: It takes the price from the claim Relative Price taken from a claim and relative price, the nominal value of which is taken from the price list and the actual value of which is determined backwards according to available funds and volume of claimed items and medical items in a period. [R] is the default value. Adult Indicates the limitation for adults. If the type of limitation is a co-insurance then the value is the percentage of the price covered by policies of the insurance product for adults. If the type of limitation is a fixed limit the value is an amount up to which price of the item is covered for adults by policies of the insurance product. Default is 100%. Adult O is for Other, Adult R is for Referral and Adult E is for Emergency claims according to the type of visit (Visit Type). Child Indicates the limitation for children. If the type of limitation is a co-insurance then the value is the percentage of the price covered for children by policies of the insurance product. If the type of limitation is a fixed limit the value is an amount up to which price of the item is covered for children by policies of the insurance product. Default is 100%. Child O is for Other, Child R is for Referral and Child E is for Emergency claims according to the type of visit (Visit Type). No Adult It indicates the maximal number of provisions of the medical item during the insurance period for an adult. No Child It indicates the maximal number of provisions of the medical item during the insurance period for an child. Waiting Period Adult Indicates waiting period in months (after the effective date of a policy) for an adult. Waiting Period Child Indicates waiting period in months (after the effective date of a policy) for a child. Ceiling Adult It indicates whether the medical item is excluded from comparison against ceilings defined in the insurance product for adults. Default is that the medical item is not excluded from comparisons with ceilings. Hospital means exclusion only for provision of in-patient care Non-hospital means exclusion only for out-patient care Both means exclusion both for in-patient and out-patient care Ceiling Child It indicates whether the medical item is excluded from comparison against ceilings defined in the insurance product for children. Default is that the medical item is not excluded from comparisons with ceilings. Hospital means exclusion only for provision of in-patient care Non-hospital means exclusion only for out-patient care Both means exclusion both for in-patient and out-patient care List all services covered in this product. You can add new services by clicking on Code Displays the code of the medical item Name Displays the name of the medical item Type Displays the type of the medical item (Curative or Preventive) Package Displays the packaging of the medical Item Price Displays the default price of the medical item Limit Indicates the type of limitation of coverage for the medical service. This may be adjusted per medical service, select between Co-Insurance and Fixed amount. Co-insurance means coverage of a specific percentage of the price of the medical service by policies of the insurance product. Fixed amount means coverage up the specified limit. Co-insurance is the default value. Limit O is used for claims having the type of visit Other, Limit R is used for claims having the type of visit Referral and Limit E is used for claims having the type of visit Emergency. Origin It indicates where the price for remuneration of the item, comes from: This may be adjusted per medical item, the options are: [P] Price taken from the price list of a claiming health facility, [O] Price taken from a claim and [R] Relative price, the nominal value of which is taken from the price list and the actual value of which is determined backwards according to available funds and the volume of claimed services and medical items in a period. [R] is the default value. Adult It indicates the limitation for adults. If the type of limitation is a co-insurance then the value is the percentage of the price covered for adults by policies of the insurance product. If the type of limitation is a fixed limit the value is an amount up to which price of the item is covered for adults by policies of the insurance product. Default is 100%. Adult O is for Other, Adult R is for Referral and Adult E is for Emergency claims according to the type of visit (Visit Type). Child It indicates the limitation for children. If the type of limitation is a co-insurance then the value is the percentage of the price covered for children by policies of the insurance product. If the type of limitation is a fixed limit the value is an amount up to which price of the service is covered for children by policies of the insurance product. Default is 100%. Child O is for Other, Child R is for Referral and Child E is for Emergency claims according to the type of visit (Visit Type). No Adult It indicates the maximal number of provisions of the medical item during the insurance period for an adult. No Child It indicates the maximal number of provisions of the medical item during the insurance period for a child. Waiting Period Adult It indicates waiting period in months (after the effective date of a policy) for an adult. Waiting Period Child It indicates waiting period in months (after effective date of a policy) for a child. Ceiling Adult It indicates whether the medical service is excluded from comparison against ceilings defined in the insurance product for adults. Default is that the medical service is not excluded from comparisons with ceilings. Hospital means exclusion only for provision of in-patient care Non-hospital means exclusion only for out-patient care Both means exclusion both for in-patient and out-patient care Ceiling Child It indicates whether the medical service is excluded from comparison against ceilings defined in the insurance product for children. Default is that the medical service is not excluded from comparisons with ceilings. Hospital means exclusion only for provision of in-patient care Non-hospital means exclusion only for out-patient care Both means exclusion both for in-patient and out-patient care NoteIt is possible to specify only one of the following ceilings –per Treatment, per Insuree or per Policy. If ceilings per category of claims are specified together with ceilings per Treatment, per Insuree or per Policy than evaluation of claims may be dependent under special circumstances on the order of claimed medical services/items in a claim.` Ceiling Discrimination Specify whether Hospital and Non-Hospital care should be determined according to the type of health facility (select Split Ceilings & Deductibles Wether you would like to split ceilings & deductibles for Hospitals/Non-Hospitals or not. Ceiling Type Specify wether the deductibles and ceilings are per insuree, treatment or policy. Treatment Deductibles and Ceilings for treatments may be entered for general care ( Insuree Deductibles and Ceilings for an insuree may be entered for general care ( Policy Deductibles and Ceilings for a policy may be entered for general care ( Extra Member Ceiling Additional (extra) ceiling for a policy may be entered for general care ( Maximum Ceiling Maximal ceiling for a policy may be entered for general care ( Ceilings Table Maximal amount of coverage can be specified for claims according to the category of a claim. The options are claims of the category Number Maximal number of covered claims per an insuree during the whole insurance period according to the category of a claim. The options are claims of the category Note If at least one service of the category Surgery is given in the claim it is of category Surgery otherwise if at least one service of the category Delivery is given in the claim it is of category Delivery otherwise if at least one service of the category Antenatal care is given in the claim it is of category Antenatal care otherwise if the claim is a hospital one the claim it is of category Hospitalization otherwise if at least one service of the category Consultation is given in the claim it is of category Consultation otherwise the claim is of the category Visit Start Cycles (1 to 4) If one or more starting dates (a day and a month) of a cycle are specified then the insurance product is considered as the insurance product with fixed enrolment dates. In this case, activation of underwritten and renewed policies is accomplished always on fixed dates during a year. Maximum four cycle dates can be specified. Distribution Type Wether the system has to calculate relative prices for general health care (Enabled) or for (non-)hospital care (Split). This system is disabled if the user selects Disabled. Distribution Periods Select from the list of distribution periods (NONE, Monthly, Quarterly, Yearly), the period that is to be used for calculation of the actual value of relative prices for the insurance product. Relative Pricing Table Distribution periods may be entered for general care ( It is not required to enter a value in each period, zero values are accepted. Once all the percentage values have been entered, click on the button OK to submit the values to the respective grid. Clicking on the button Once all mandatory data is entered, clicking on the Mandatory data If mandatory data is not entered at the time the user clicks the Cancel By clicking on the Click on the When the page opens all entry fields are empty. See the Product Page information on the data entry and mandatory fields. Click on the The page will open with the current information loaded into the data entry fields. See the Product Page for information on the data entry and mandatory fields Because of potential problems with synchronization of data between off-line and on-line version, it is not possible delete insurance products currently.Pre-conditions
Navigation
Administration, sub menu Products.
Product Control Page
Products redirects the current user to the Product Control Page.
Product Control Page is the central point for administration of insurance products. By having access to this page, it is possible to add, edit, duplicate and search. The panel is divided into four panels. (Img. 52)Search Panel
Product Code; to search for products with a Product Code, which starts with or matches completely, the typed text.Product Name to search for products with a Product Name, which starts with or matches completely, the typed text.Date From, which is on or is greater than the date typed/selected. Note: To clear the date entry box; use the mouse to highlight the full date and then press the space key.Date To, which is on or is greater than the date typed/selected. Note: To clear the date entry box; use the mouse to highlight the full date and then press the space key.Region from the list of regions by clicking on the arrow on the right of the selector to select products from a specific region.NoteDistrict from the list of districts by clicking on the arrow on the right of the selector to select products from a specific district.NoteShow Historical Values to see historical records matching the selected criteria. Historical records are displayed in the result in grey to clearly define them from current records (Img. 53).
Result Panel
Information Panel
Product Page
Data Entry
General
Date From determines the earliest date from which underwriting can be done. Mandatory.Date to.NoteContribution Plan
Enrolment disc. period months before the start date of the corresponding cycle.renewal disc. period months before the start date of the corresponding cycle.Covered Medical Items
+ Add Items. To edit items, simply click on the pen icon at the start of each row, change the values and click on the floppy disk icon at the start of the row. Changes are only effective once the product is saved using the Save button at the bottom right of the screen.Covered Medical Services
+ Add Items. To edit services, simply click on the pen icon at the start of each row, change the values and click on the floppy disk icon at the start of the row. Changes are only effective once the product is saved using the Save button at the bottom right of the screen.Deductibles and Ceilings
Based on Health Facility Type) that provided health care or according to the type of health care (select Based on Claim Type) acquired from a claim. In the first case all health care provided in hospitals (defined in the field HF Level in the register of Health Facilities) is accounted for Hospital Ceilings/Deductibles and for calculation of relative prices for the Hospital part. It means that if claimed health care was provided out-patient in a hospital, it is considered for calculation of ceilings/deductibles and for calculation of relative prices as hospital care. In the second case only in-patient care (determined from a claim when a patient spent at least one night in a health facility) is accounted for Hospital Ceilings/Deductibles and for calculation of relative prices for hospital part. Other health care including out-patient care provided in hospitals is accounted for Non hospital Ceilings/Deductibles and also such health care is used for calculation of relative prices for non-hospital part. MandatoryHospitals and Non-hospitals) or for hospital care (Hospitals) only and/or for non-hospital care (Non-Hospitals) only. An amount may be set, indicating the value that a patient should cover within his/her own means, before a policy of the insurance product comes into effect (Deductibles) or the ceiling (maximum amount covered) within a policy of the insurance product (Ceilings) for a treatment (the treatment is identified health care claimed in one claim)Hospitals and Non-hospitals) or for hospital care (Hospitals) only and/or for non-hospital care (Non-Hospitals) only. An amount may be set, indicating the value that an insuree should cover within his/her own means, before a policy of the insurance product comes into effect (Deductibles) or the ceiling (maximum amount covered) within a policy of the insurance product (Ceilings) for an insuree for the whole insurance period.Hospitals and Non-hospitals) or for hospital care (Hospitals) only and/or for non-hospital care (Non-Hospitals) only. An amount may be set, indicating the value that policyholders should cover within their own means, before a policy of the insurance product comes into effect (Deductibles) or the ceiling (maximum amount covered) for the policy (all members of a family/group) of the insurance product (Ceilings) for the whole insurance period.Hospitals and Non-hospitals) or for hospital care (Hospitals) only and/or for non-hospital care (Non-Hospital s ) only per a member of a family/group above Threshold Members.Hospitals and Non-hospitals) or for hospital care (Hospitals) only and/or for non-hospital care (Non-Hospitals) only if extra ceilings are applied for members of a family/group above Threshold Members.Consultations, Surgery, Delivery, Antenatal care, Hospitalizations, and Visits. The category of claim is determined according to the procedure described with Number.Consultations, Surgery, Delivery and Antenatal care. Maximal numbers may be also specified for Hospitalizations (in-patient stays) and (out-patient visits) Visits. The claim category is determined as follows:Pooling Management
Hospitals and Non-hospitals), or for hospital care (Hospitals) only and/or for non-hospital care (Non-Hospitals) only. Percentages should be entered to indicate the distribution over the periods as per the product description. Enter to each field an appropriate percentage of paid contributions for policies of the insurance product allocated proportionally to corresponding calendar period. It means, for example, that in case of the distribution Monthly we put in each slot percentage of paid contributions of the insurance product that are allocated to the corresponding month and that is to be used for calculation of relative prices.Cancel will cancel the action closing the popup and cancelling the change in the distribution.Saving
Save button will save the record. The user will be re-directed back to the Product Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the product has been saved will appear on the Information Panel.Save button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel button, the user will be re-directed to the Product Control Page.Adding a Product
Add button to re-direct to the Product Page.Editing a Product
Edit button to re-direct to the Product Page.Deleting a Product
1.3.2 Health Facilities
The register of health facilities contains all health facilities contracted and/or eligible for submitting of claims by/to the health insurance scheme. Health Facility administration is restricted to users with the system role of Scheme Administrator or with a role including an access to Administration/Health Facilities. A health facility may only be added if the management of the scheme administration contracts it or if eligibility of submitting of claims can be derived from the legislation. It may thereafter be edited; however, approval of the management of the scheme administration is required for a change of the pricelists associated with the health facility. Deletion of a health facility normally will occur when a Health Facility stops its activity or the contract with the health facility with the scheme administration is cancelled. All functionality for use with the administration of health facilities can be found under the main menu Clicking on the sub menu The Search Panel The Search Panel allows a user to select specific criteria to minimise the search results. In the case of health facilities the following search options are available which can be used alone or in combination with each other. Code Type in the beginning of; or the full Name Type in the beginning of; or the full Fax Type in the beginning of; or the full Level Select the Phone Number Type in the beginning of; or the full Email Type in the beginning of; or the full Legal Form Select the Region Select the District Select the Care Type Select the Historical Click on 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 Panel The result panel displays a list of all health facilities found, matching the selected Criteria in the search panel. The currently selected record is highlighted with light grey (Img. 62). The rightmost record contains a hyperlink which if clicked, 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 are displayed at one time( can be changed Img. 41), further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Img. 42) Button Panel With exception of the Information Panel The Information Panel is used to display messages back to the user. Messages will occur once a health facility has been added, updated or deleted or if there was an error at any time during the process of these actions. Data Entry Code Enter the code for the health facility. Mandatory, 8 characters. Name Enter the name for the health facility. Mandatory, 100 characters maximum. Legal Form Select the legal form of the health facility from the list (Government, District organization, Private Organisation, Charity), by clicking on the arrow on the right hand side of the lookup. Mandatory. Level Select a level from the list levels (Dispensary, Health Centre, Hospital), by clicking on the arrow on the right hand side of the lookup. Mandatory. Sub Level Select a sub-level from the list sub-levels (No Sublevel, Integrated, Reference), by clicking on the arrow on the right hand side of the lookup. Mandatory. Address Enter the address of the health facility. Mandatory, 100 characters maximum. Region Select the District Select the Phone Number Enter the phone number for the health facility. 50 characters maximum. Fax Enter the fax number for the health facility. 50 characters maximum. Email Enter the email for the health facility. 50 characters maximum. Care Type Select the type of health care provided by the health facility from the list (In-patient, Out-patient, Both), by clicking on the arrow on the right hand side of the lookup. Mandatory. Select the health facilities price lists (for medical services) from the list by clicking on the arrow on the right hand side of the lookup. The pricelist contains the list of medical services and their prices agreed between the health facility (or corresponding group of health facilities) and the scheme administration which can be invoiced by the health facility and remunerated by the scheme administration. Note: The list will only be filled with the pricelists associated with the previously selected district, regional and nationwide pricelists assigned to the current logged in user. Select the health facilities price lists (medical items) from the list by clicking on the arrow on the right hand side of the lookup. The pricelist contains the list of medical items and their prices agreed between the health facility (or corresponding group of health facilities) and the scheme administration which can be invoiced by the health facility and remunerated by the scheme administration. Note: The list will only be filled with the pricelists associated with the previously selected district, regional and nationwide pricelists assigned to the current logged in user. Account Code Enter the account code (Identification for the accounting software), which will be used in reports on remuneration to be received by the health facility. 25 characters maximum. Check the locations that define the catchment area of the health facility. Specify the percentage of the population of a village that belong to the catchment area in the catchment column. Default is 100%. Saving Once all mandatory data is entered, clicking on the Mandatory data If mandatory data is not entered at the time the user clicks the Cancel By clicking on the Click on the When the page opens all entry fields are empty. See the Health Facility Page for information on the data entry and mandatory fields. Double click on the line to be re-directed to the Health Facility Page. The page will open with the current information loaded into the data entry fields. See the Health Facility Page for information on the data entry and mandatory fields Click on the Before deleting a confirmation popup (Img. 64) is displayed, which requires the user to confirm if the action should really be carried out? When a health facility is deleted, all records retaining to the deleted health facility will still be available by selecting historical records.Pre-conditions
Navigation
Administration, sub menu Health Facilities.Health Facilities re-directs the current user to the Health Facilities Control Page.
Health Facilities Control Page
Health Facilities Control Page is the central point for all health facilities administration. By having access to this page, it is possible to add, edit, delete and search. The page is divided into four panels (Img. 63)Code; to search for health facilities with a Code, which starts with or matches completely, the typed text.Name; to search for health facilities with a Name, which starts with or matches completely, the typed text.Fax to search for health facilities with a Fax, which starts with or matches completely, the typed number.Level; from the list of levels of health facilities (Dispensary, Health Centre, Hospital) by clicking on the arrow on the right of the selector, to select health facilities of a specific level of service.Phone Number to search for health facilities with a Phone Number, which starts with or matches completely, the typed number.Email to search for health facilities with an Email which starts with or matches completely, the typed text.Legal Form; from the list of legal forms (Government, District organization, Private Organisation, Charity) by clicking on the arrow on the right of the selector, to select health facilities of a specific legal form.Region; from the list of districts by clicking on the arrow on the right of the selector to select health facilities from a specific region. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then this region will be automatically selected.District; from the list of districts by clicking on the arrow on the right of the selector to select health facilities from a specific district. Note: The list will only be filled with the districts that belong to the selected region and that are assigned to the current logged in user. If this is only one then the district will be automatically selected.Care Type from the list of types (In-patient, Out-patient, Both) of provided health care by clicking on the arrow on the right of the selector, to select health facilities with a specific type.Historical to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Img. 61)
Cancel button, which re-directs to the Home Page, and the Add button which re-directs to the health facility page, the button panel (the buttons Edit and Delete) is used in conjunction with the current selected record (highlighted with blue). The user should select first a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Health Facility Page
Region; from the list of regions by clicking on the arrow on the right of the selector to enter the region in which the health facility is located. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then this region will be automatically selected. Mandatory.district; from the list of districts by clicking on the arrow on the right of the selector to enter the district in which the health facility is located. Note: The list will only be filled with the districts assigned to the selected region and to districts assigned to the currently logged in user. If this is only one then the district will be automatically selected. Mandatory.Price Lists (Medical Services)Price Lists (Medical Items)Region, District, Municipality, Village, Catchment gridSave button will save the record. The user will be re-directed back to the Health Facility Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the health facility has been saved will appear on the Information Panel.Save button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel button, the user will be re-directed to the Health Facilities Control Page.Adding a Health Facility
Add button to re-direct to the Health Facility Page.Editing a Health Facility
Deleting a Health Facility
Delete button to delete the currently selected record.
1.3.3 Medical Services
The register of Medical Services contains all medical services that can be included in packages of benefits of insurance products administered and remunerated by the health insurance scheme. Administration of the register of medical services is restricted to users with the system role of Scheme Administrator or with a role including an access to Administration/Medical Services. A medical service may only be added or thereafter edited or deleted, after the approval of the management of the scheme administration. All functionality for use with the administration of Medical Services can be found under the main menu Clicking on the sub menu The Search Panel The Search Panel allows a user to select specific criteria to minimise the search results. In the case of medical services the following search options are available which can be used alone or in combination with each other. Code Type in the beginning of; or the full Name Type in the beginning of; or the full Type Select the Click on 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 Panel The Result Panel displays a list of all medical services found, matching the selected Criteria in the search panel. Double click 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 are displayed at one time( can be changed Img. 41), further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Img. 42) Button Panel Material UI add button can be used to add medical itemsDouble click on a line open the serviceDelete button at the end of the line delete the service“Open in new tab” button enable the user to open the service in a new tab. Information Panel Page selector- Result Panel Data Entry Code Enter the code for the medical service. Mandatory, 6 characters. Name Enter the name of the medical service. Mandatory, 100 characters maximum. Category Choose the category (Surgery, Consultation, Delivery, Antenatal, Other) which the medical service belongs to. Type Choose one from the options available (Preventive, Curative), the type of the medical service. Mandatory. Select from the list (Simple Service, Visit, Day of Stay, Hospital Case), the level for the medical service. Mandatory. Price Enter the price a general price that can be overloaded in pricelists. Full general price (including potential cost sharing of an insuree) for the medical service. Mandatory. Care Type Choose one from the options available (Out-patient, In-patient, Both), the limitation of provision of the medical service to the specific type of health care. Mandatory. Frequency Enter the limitation of frequency of provision in a number of days within which a medical service can be provided to a patient not more than once. If the frequency is zero, there is no limitation. Note: By default the frequency is 0. Patient Choose one or a combination of the options available, to specify which patient type the medical service is applicable to. Note: By default all patient options are checked (selected). Saving Once all mandatory data is entered, clicking on the Mandatory data If mandatory data is not entered the Click on the When the page opens all entry fields are empty. See the Medical Service Page for information on the data entry and mandatory fields. Double click on the service line to re-direct to the Medical Service Page. The page will open with the current information loaded into the data entry fields. See the Medical Service Page for information on the data entry and mandatory fields. Click on the Before deleting a confirmation popup (Img. 69) is displayed, which requires the user to confirm if the action should really be carried out? When a medical service is deleted, all records retaining to the deleted medical service will still be available by selecting historical records.Pre-conditions
Navigation
Administration, sub menu Medical Services.
Medical Services re-directs the current user to the Medical Services Control Page.
Medical Services Control Page
Medical Services Control Page is the central point for all medical service administration. By having Access to this panel, it is possible to add, edit, delete and search. The panel is divided into four panels (Img. 66)Code; to search for medical services with a Code, which starts with or matches completely, the typed text.Name to search for medical services with a Name, which starts with or matches completely, the typed text.Type; from the list of types (Preventive, Curative) by clicking on the arrow on the right of the selector, to select medical services of a specific type.HistoricalHistorical to see historical records matching the selected criteria. Historical records are displayed in grey and with a Valid date to clearly define them from current records (Img. 67)
Medical Service Page
Service LevelSave button will save the record. The user will be re-directed back to the Medical Services Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the medical service has been saved will appear on the Information Panel.Save button won’t be activeAdding a Medical Service
Add button to re-direct to the Medical Service Page.Editing a Medical Service
Deleting a Medical Service
< button to delete the currently selected record; the user is re-directed the Medical Services Control Page.
1.3.4 Medical Items
The register of Medical Items contains all medical items (drugs, prostheses) that can be included in packages of benefits of insurance products within the health insurance scheme and are remunerated by the scheme administration. Administration of the register of medical items is restricted to users with the system role of Scheme Administrator or with a role including an access to Administration/Medical Items. A medical item may only be added or thereafter edited or deleted, after the approval of the management of the scheme administration. All functionality for use with the administration of medical items can be found under the main menu Clicking on the sub menu The Search Panel The search panel allows a user to select specific criteria to minimise the search results. In the case of medical items the following search options are available which can be used alone or in combination with each other. Code Type in the beginning of; or the full Name Type in the beginning of; or the full Type Select the Package Type in the beginning of; or the full Historical Click on 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 Panel The result panel displays a list of all medical items found, matching the selected criteria in the search panel. The number of rows per page is limited to 10 by default but one can use the “Rows per page” drop-down in the bottom right of the search results. If there are more rows to display, one can use the page navigation. (Img. 73) Data Entry Code Enter the code for the medical item. Mandatory, 6 characters. Name Enter the name of the medical item. Mandatory, 100 characters maximum. Type Choose one from the options available, the type of the medical item. Mandatory. Package Enter the package (Indication of type and volume of package in a suitable coding system) for the medical item. Mandatory, 255 characters maximum. Price Enter the price (a general price that can be overloaded in pricelists). Full general price including potential cost sharing of an insuree) for the medical item. Mandatory. Care Type Choose one from the options available, the limitation of provision of the medical item within the specific type of health care (In-patient, Out-patient or Both). Mandatory. Frequency Enter the limitation of frequency of provision in a number of days within which a medical item cannot be provided to a patient not more than once. If the frequency is zero, there is no limitation. Note: By default the frequency is 0. Patient Choose one or a combination of the options available, to specify which patient type the medical item may be provided to. Note: By default all patients’ options are checked (selected). Saving Once all mandatory data is entered, clicking on the Mandatory data If mandatory data is not entered at the time the user clicks the Cancel By clicking on the Click on the When the page opens all entry fields are empty. See the Medical Item Page for information on the data entry and mandatory fields. Double-click on a row to re-direct to the Medical Item Page. The page will open with the current information loaded into the data entry fields. See the Medical Item Page for information on the data entry and mandatory fields. Click on the Before deleting a confirmation popup (Img. 75) is displayed, which requires the user to confirm if the action should really be carried out? When the medical item is deleted, all records retaining to the deleted medical item will still be available by selecting historical records.Pre-conditions
Navigation
Administration, sub menu Medical Items
Medical Items re-directs the current user to the Medical Items Control Page.
Medical Items Control Page
Medical Items Control Page is the central point for all medical item administration. By having access to this page, it is possible to add, edit, delete and search. The panel is divided into four panels (Img. 71)Code; to search for medical items with a Code, which starts with or matches completely, the typed text.Name to search for medical items with a Name, which starts with or matches completely, the typed text.Type; from the list of types (Drugs, Medical consumable) by clicking on the arrow on the right of the selector, to select medical items of a specific type.Package; to search for medical items with a Package, which starts with or matches completely, the typed text.Historical to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Img. 72).
Medical Item Page
Save button will save the record. The user will be re-directed back to the Medical Items Control Page, with the newly saved record displayed and selected in the Result Panel. A message confirming that the medical item has been saved will appear on the Information Panel.Save button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel button, the user will be re-directed to the Medical Items Control Page.Adding a Medical Item
Add button to re-direct to the Medical Item Page.Editing a Medical Item
Deleting a Medical Item
Delete button to delete the currently selected record
1.3.5 Medical Service Price Lists
Price lists of medical services are tools for specification which medical services and at which prices can be invoiced by contractual health facilities to the scheme administration. Administration of price lists of medical services is restricted to users with the system role of Scheme Administrator or with a role including an access to Administration/Pricelists-Medical Services. A price list of medical services may only be added, after an agreement with a health facility or a group of health facilities on specific prices. Editing of the price list may occur only after an approval of the management of the scheme administration. Deletion of a price list of medical services normally will occur when a price list becomes obsolete. All functionalities related to the administration of price lists medical services can be found under the main menu Clicking on the sub menu The The search panel allows a user to select specific criteria to minimise the search results. In the case of price lists for medical services the following search options are available which can be used alone or in combination with each other. Name Returns price lists which contains the typed text. Date Type in the full Region Select the Note The list will only be filled with the regions assigned to the current logged in user and with the option National. All nationwide pricelists and all regional pricelists relating to the selected region will be found. If no district is selected then also all district pricelists for districts belonging to the selected region and assigned to the currently logged in user will be found. District Select the Show Historical Values Click on Search button Once the criteria have been entered, use the search button to filter the records, the results will appear in the Result Panel. The Result Panel displays a list of all price lists of medical services found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue. The leftmost record contains a hyperlink which if clicked, 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. Further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel. The Information Panel is used to display messages back to the user. Messages will occur once a price list of medical services has been added, updated or deleted or if there was an error at any time during the process of these actions. Name Enter the name for the price list of medical services. Mandatory, 100 characters maximum. Date Enter the creation date for the price list of medical services. Region Select the District Select the Medical Services Select from the list of available medical services the medical services which the price list of medical service should contain by clicking on the Once all mandatory data is entered, clicking on the Mandatory Data If mandatory data is not entered at the time the user clicks the Cancel By clicking on the Click on the When the page opens all entry fields are empty. See the Price List Medical Services Page for information on the data entry and mandatory fields. Click on the The page will open with the current information loaded into the data entry fields. See the Price List Medical Services Page for information on the data entry and mandatory fields. Click on the Before deleting a confirmation popup (Img. 80) is displayed, which requires the user to confirm if the action should really be carried out? When a price list medical service is deleted, all records retaining to the deleted price list medical service will still be available by selecting historical records.Pre-conditions
Navigation
Administration, sub menu Price Lists and sub menu Medical Services Price Lists
Medical Services Price Lists redirects the current user to the Price List Medical Services Control Panel.
Price List Medical Services Control Page
Price List Medical Services Control Page is the central point for administration of all price lists of medical service. By having access to this panel, it is possible to add, edit, delete and search. The panel is divided into four panelsSearch Panel
Date to search for price lists of medical services with a creation Date which matches completely, the typed date.Region from the list of regions by clicking on the arrow on the right of the selector to select price lists of medical services from a specific region. The option National means that the price list is common for all regions.District from the list of districts by clicking on the arrow on the right of the selector to select price lists of medical services from a specific district. Note: The list will be only filled with the districts belonging to the selected region. All nationwide pricelists, all regional pricelists relating to the selected region and all district pricelists for the selected district will be found.Show Historical Values to see historical records matching the selected criteria. Historical records are displayed in the result in grey to clearly define them from current records.Result Panel
Information Panel
Price List Medical Services Page
Data Entry
Region from the list of regions by clicking on the arrow on the right of the selector to enter the region in which the price list of medical services is to be used. The region National means that the price list is common for all regions. The list will only be filled with the regions assigned to the current logged in user and with the option National. Mandatory.District from the list of districts by clicking on the arrow on the right of the selector to enter the district in which the price list of medical services is to be used. Note: The list will be only filled with the districts belonging to the selected region and currently logged in user. It is not mandatory to enter a district, not selecting a district will mean the price list of medical services is used in all districts of the region or nationwide if the region National is selected.check box to the left of a medical service. The list shows the medical services displaying the code, name, type and price for reference. There is also an extra column, Overrule, which can be used to overrule the pre-set price. By clicking once on the row desired item in the overrule column, a new price can be entered for the individual service. This can occur when price agreed between a health facility or group of health facilities and the health insurance administration differs from the common price in the register of medical services.Saving
Save button will save the record. The user will be re-directed back to the Price List Medical Services Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the price list medical service has been saved will appear on the Information Panel.Save button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel button, the user will be re-directed to the Price List Medical Services Control Page.Adding a Price List of Medical Services
Add button to re-direct to the Price List Medical Services Page.Editing a Price List of Medical Services
Edit button to re-direct to the Price List Medical Services Page.Deleting a Price List of Medical Services
Delete button to delete the currently selected record.
1.3.6 Medical Item Price Lists
Pricelists of medical items are tools for specification which medical items and at which prices can be invoiced by contractual health facilities to the scheme administration. Administration of pricelists of medical items is restricted to users with the system role of Scheme Administrator or with a role including an access to Administration/Pricelists-Medical Items. A price list of medical items may only be added, after an agreement with a health facility or a group of health facilities on specific prices. Editing of the price list may occur only after an approval of the management of the scheme administration. Deletion of a price list of medical items normally will occur when a price list becomes obsolete. All functionality for use with the administration of medical items price lists can be found under the main menu Clicking on the sub menu The The search panel allows a user to select specific criteria to minimise the search results. In the case of price lists for medical items the following search options are available which can be used alone or in combination with each other. Name Type in the beginning of; or the full Date Type in the full Region Select the District Select the Show Historical Values Click on Search button Once the criteria have been entered, use the search button to filter the records, the results will appear in the result panel. The Result Panel displays a list of all price lists of medical items found, matching the selected criteria in the search panel. Hovering over records changes the highlight to grey (Img. 84). The leftmost record contains a hyperlink which if clicked, redirects the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record. The Information Panel is used to display messages back to the user. Messages will occur once a price list medical item has been added, updated or deleted or if there was an error at any time during the process of these actions. Name Enter the name for the price list of medical items. Mandatory, 100 characters maximum. Date Enter the creation date for the price list of medical items. Note: You can also use the button next to the date field to select a date to be entered. Region Select the District Select the Medical Items Select from the list of available medical items the medical items which the price list of medical items should contain by clicking on the Once all mandatory data is entered, clicking on the Mandatory data If mandatory data is not entered at the time the user clicks the Cancel By clicking on the Click on the Add button to re-direct to the Price List Medical Item Page. When the page opens all entry fields are empty. See the Price List Medical Item Page for information on the data entry and mandatory fields. Click on the Edit button to re-direct to the Price List Medical Item Page. The page will open with the current information loaded into the data entry fields. See the Price List Medical Item Page for information on the data entry and mandatory fields. Click on the Duplicate button to re-direct to the Price List Medical Item Page. The page will open with all the current information for the selected price list, (except for the price list name which should be unique), loaded into the data entry fields. See the Price List Medical Item Page for information on the data entry and mandatory fields. To save the record, enter a unique code before clicking on Click on the Before deleting a confirmation popup (Img. 86) is displayed, which requires the user to confirm if the action should really be carried out? When a price list of medical items is deleted, all records retaining to the deleted price list of medical items will still be available by selecting historical records.Pre-conditions
Navigation
Administration, sub menu Price Lists, sub menu Medical Items Price Lists.
Medical Items re-directs the current user to the Price List Medical Items Control Page.
Price List Medical Items Control Page
Price List Medical Items Control Page is the central point for all medical item price list administration. By having access to this panel, it is possible to add, edit, delete and search. The panel is divided into four panels (Img. 84).Search Panel
Name; to search for price lists medical items with a Name, which starts with or matches completely, the typed text.Date to search for price lists of medical items with a creation date which matches completely, the typed date.Region from the list of regions by clicking on the arrow on the right of the selector to select price lists of medical items from a specific region. The option National means that the price list is common for all regions. Note: The list will only be filled with the regions assigned to the current logged in user and with the option National. All nationwide pricelists and all regional pricelists relating to the selected region will be found. If no district is selected the also all district pricelists for districts belonging to the selected region will be found.District;from the list of districts by clicking on the arrow on the right of the selector to select price lists medical items from a specific district. Note: The list will be only filled with the districts belonging to the selected region and assigned to the currently logged in user. All nationwide pricelists, all regional pricelists relating to the selected region and all district pricelists for the selected district will be found.Show Historical Values to see historical records matching the selected criteria. Historical records are displayed in the result in grey to clearly define them from current records (Img. 83).
Result Panel
Information Panel
Price List Medical Item Page
Data Entry
Region from the list of regions by clicking on the arrow on the right of the selector to enter the region in which the price list of medical items is to be used. The district National means that the price list is common for all regions. Note: The list will only be filled with the regions assigned to the current logged in user and with the option National. Mandatory.District from the list of districts by clicking on the arrow on the right of the selector to enter the district in which the price list of medical items is to be used. Note: The list will be only filled with the districts belonging to the selected region and currently logged in user. It is not mandatory to enter a district, not selecting a district will mean the price list of medical items is used in all districts of the region or nationwide if the region National is selected .check box to the left of a medical item. The list shows the medical items displaying the code, name, type and price for reference. There is also an extra column, Overrule, which can be used to overrule the pre-set price. By clicking once on the row desired item in the overrule column, a new price can be entered for the individual item. This can occur when price agreed between a health facility or group of health facilities and the health insurance administration differs from the common price in the register of medical items.Saving
Save button will save the record. The user will be re-directed back to the Price List Medical Items Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the price list of medical items has been saved will appear on the Information Panel.Save button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel button, the user will be re-directed to the Price List Medical Items Control Page.Adding a Price List of Medical Items
Editing a Price List of Medical Items
Duplicating a Price List of Medical Items
Save.Deleting a Price List of Medical Items
Delete button to delete the currently selected record; the user is re-directed to the Price List Medical Items Control Page.
1.3.7 Users Administration
User administration is restricted to users with the system role of IMIS Administrator or with a role including an access to Administration/Users. Enrolment officers and Claim administrators are now considered as a user with specific roles. A user may only be added or edited after the approval of the management of the scheme administration. Deletion of a user normally will occur when a user leaves his/her post within the health insurance scheme and/or the scheme administration. A built in user with the user name Admin and the initial password Admin is created automatically in openIMIS with access to all locations of the register of locations (at any time). The Admin user has an implicit role that includes full access rights to the registers of locations, full access to the register of user profiles and an access to downloading/uploading of the register of locations to/from an external file. All functionalities related to users administration can be found under the main menu Clicking on the sub menu It is the central point for the users administration. By having access to this page, it is possible to add, edit, delete and search users. The page is divided into four panels. The following rules apply to the list of found users besides conformance with all search criteria: The user Admin is not included in any search for users with exception of searches done by an Admin user itself.A user having the access right Users/Search (see User Profiles) will only be able to see users that have access to them same set of locations or to a subset of locations of the user making the search only. The search panel allows a user to filter on specific criteria. Last Name Filter on users who have the typed text in their last name. Login Name Filter on users who have the typed text in their login. Phone Number Filter on users who have the typed text in their phone number. Email Filter on users who have the typed text in their email. Other Names Filter on users who have the typed text in their other names. Role Filter users with the selected role Health Facilities Select the Health Facility; from the list of health facilities by clicking on the arrow on the right of the selector, to select users from a specific health facility.Note The list will only contain the health facilities belonging to the districts assigned to the currently logged in user. Region Select the Region from the list of regions by clicking on the arrow on the right of the selector to find users with access to a specific region.Note The list will only contain the health facilities belonging to the regions assigned to the currently logged in user. District Select the District from the list of districts by clicking on the arrow on the right of the selector to find users with access to a specific district.Note The list will only contain the health facilities belonging to the districts assigned to the currently logged in user. Language Select the Language from the list of languages by clicking on the arrow on the right of the selector, to select users with a specific language. Search Button Once the criteria have been entered, use the search button to filter the records, the results will appear in the result panel. The result panel displays a list of all users found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Img. 89). The leftmost record contains a hyperlink which if clicked, redirects 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 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Img. 90) With exception of the The Information Panel is used to display messages back to the user. Messages will occur once a user has been added, updated or deleted or if there was an error at any time during the process of these actions. User name Enter the Login name for the user. This is an alias used for logging into the application; a minimum of 6 and a maximum of 25 characters should be used for the login. Each Login Name should be unique. Mandatory. Given Names Enter other names of the user. Mandatory, 100 characters maximum. Last name Enter the last name (surname) for the user. Mandatory, 100 characters maximum. Email Enter the e-mail address for the user. 50 characters maximum. Phone Number Enter the phone number for the user. 50 characters maximum. Health Facility Select the health facility that the user belongs to, if applicable, from the list of health Facilities from the list by clicking on the arrow on the right hand side of the lookup. Roles Select from the list of available roles the Roles which the user carries out. Mandatory (at least one role must be selected). The list of roles contains all roles (user profiles) that are not blocked. Districts Select from the list of available districts the district(s) which the user will have access to. Mandatory (at least one district must be selected). Language Select the user’s preferred language from the list by clicking on the arrow on the right hand side of the lookup. Mandatory. Password Enter the password for the user. This is used at login to grant access to the application; a minimum of 8 and a maximum of 25 characters should be used for the password. The password should have at least one digit. Mandatory. Confirm Password Re-enter the password. The password must be entered twice, to ensure that there was no mistyping in the first entry. Mandatory. Birth date Birth date of the enrolment officer. Works to End date at which the enrolment officer is replaced by the substitution officer. Substitution Officer Replacement of the user after the Works to date. Address Address of the living place of the enrolment officer. Region & District Select the region & district where the enrolment officer will work. It will be used to select villages managed by the enrolment officer. Villages List of all villages where enrolment officer will work. To add villages, you first need to add a row and select the municipality. Birth date Birth date of the enrolment officer. Once all mandatory data is entered, clicking on the Mandatory fields If mandatory fields are not filled when the user clicks on the Cancel By clicking on the Click on the Add button to redirect to the User Page. When the page opens all entry fields are empty. See the User Page for information on the data entry and mandatory fields. Click on the Edit button to redirect to the User Page. The page will open with the current information loaded into the data entry fields. See the User Page for information on the data entry and mandatory fields Click on the Delete button to delete the currently selected record Before deleting a confirmation popup is displayed, this requires the user to confirm if the action should really be carried out.Pre-conditions
Navigation
Administration, sub menu Users.
Users redirects the current user to the Users List Page.
Users List Page
Search Panel
Results Panel
Buttons Panel
Cancel button, which redirects to the Home Page, the button panel (the buttons Edit and Delete) is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Information Panel
User Page
Fields
Generic Fields
Login Fields
Enrolment Officer Fields
Claim Administrator Fields
Saving
Save button will save the record. The user will be redirected back to the User List Page, with the newly saved record displayed and selected in the result panel. A message confirming that the user has been saved will appear on the Information Panel.Save button, a message will appear in the Information Panel, and the data fields will take the focus (by an asterisk on the right of the corresponding data field).Cancel button, the user will be redirected to the User List Page.Adding a User
Editing a User
Deleting a User
1.3.8 User roles/profiles
MIS uses the concept of user profiles (roles) that can be associated with users. Some roles are predefined and they are designated as system roles. Their purpose is guarantee compatibility with the previous versions of IMIS. User roles/profiles administration is restricted to users with the role of openIMIS Administrator. All functionality for use with the administration of user roles can be found under the main menu Clicking on the sub menu The Administration of users’ profile (roles) is not included in any system role. It can be accomplished by the Admin user or by users to which such administration is delegated (by defining a role including an access to Administration/User Profiles) by the Admin user. Pre-conditions A new user profile may only be added or thereafter edited, after an approval of the management of the scheme administration. It can be accomplished at the beginning only by the Admin user. The Admin user can define a new user profile incorporating also adding, editing or deleting of user profiles and create new users with this profile. In this way, rights to the register of user profiles can be delegated to other users besides the Admin user. Navigation All functionality for use with the administration of user profiles can be found under the main menu ADMINISTRATION, sub menu USER PROFILES Search Panel The search panel allows a user to select specific criteria to minimise the search results. The following search options are available which can be used alone or in combination with each other. Role Name When set the search will display the roles with a name that start with the content of the filter , % can be used as a wildcard meaning a search with %er will display all the result containing er in the name System The system user profiles match the previous roles for compatibility reasons. When set to TRUE the search will display the default roles, when set to FALSE the search will display only the custom roles Blocked The blocked user profiles are temporarily not acting in the sense that their access rights are not available to users to whom blocked user profiles were assigned. When set to TRUE the search will display the roles that were blocked, when set to FALSE the search will display only the unblocked roles Historical Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records Click on Result Panel The Result Panel displays a list of all roles/profiles found, matching the selected criteria in the Search Panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image User roles results panel). The leftmost record contains a hyperlink which if clicked, re-directs the user to the Change user role/profile Page. A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel Blue background: Selected recordYellow background: hovered recordsStrikethrough: historical records A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image User roles/profile control page) Button Panel The Information Panel The Information Panel is used to display messages back to the user. Messages will occur once a user role/profile has been added, updated or deleted or if there was an error at any time during the process of these actions. Data Entry - Role details Role Name Enter the name of the role/profile, this name will be used as reference in the User roles/profiles control page and Users page Alternative language Translation of the role name for the second language of openIMIS System Read-only checkbox indicating whether the user profile is a system one or not. Blocked If checked the user profile is blocked Data Entry - Rights details Insurees and Policies list of the right available for the Insurees and Policies module: CRUD rights (Create, read/search, update/edit and Delete):Family/GroupInsureePolicyContributionBusiness specific rolesRenew policyEnquire insuree Claims list of the right available for the Claims module: CRUD rights (Create, read/search, update/edit and Delete):ClaimsBusiness specific roles:Claims:PrintSubmitReviewFeedbackUpdateProcessClaim Batch:ProcessFilterPreview Administration list of the right available for the Administration module: CRUD rights (Create, read/search, update/edit and Delete):ProductsHealth FacilitiesPricelists – Medical ServicesPricelists – Medical ItemsMedical ServicesMedical ItemsEnrolment OfficersClaim AdministratorsUsersUser roles/profilesPayersLocationsBusiness specific rolesDuplicate ProductsDuplicate Pricelists – Medical ServicesDuplicate Pricelists – Medical ItemsDuplicate User roles/profilesMove Locations Tools list of the business rights available for the Tools module RegisterUpload DiagnosesUpload Health FacilitiesUpload LocationsDownload DiagnosesDownload Health FacilitiesDownload LocationsExtractsDownload Mater-dataCreate Phone ExtractsCreate Offline ExtractUpload ClaimsUpload EnrolmentsUpload FeedbackRun reportPrimary Operational Indicators-policiesPrimary Operational Indicators-claimsDerived Operational IndicatorsContribution CollectionProduct SalesContribution DistributionUser Activity ReportEnrolment Performance IndicatorsStatus of RegistersInsurees without PhotosPayment Category OverviewMatching FundsClaim OverviewPercentage of ReferralsFamilies and insurees OverviewPending InsureesRenewalsCapitation PaymentRejected PhotosUtilities/Email settingBackupRestoreExecute ScriptEmail Setting Buttons Save Once all mandatory data is entered, clicking on the Cancel By clicking on the Mandatory data If mandatory data is not entered at the time the user clicks the Click on the Add button to re-direct to the User role/profile Page. When the page opens all entry fields are empty. See the User role/profile Page. for information on the data entry and mandatory fields. Click on the Edit button to re-direct to the User role/profile Page. The page will open with the current information loaded into the data entry fields. See the User role/profile Page. for information on the data entry and mandatory fields. Click on the Duplicate button to re-direct to the User role/profile Page. The page will open with all the current rights for the selected user role/profile, (except for theuser role/profile name which should be unique), loaded into the data entry fields. See the User role/profile Page for information on the data entry and mandatory fields. To save the record, enter a unique code before clicking on Click on the Delete button to delete the currently selected record. Before deleting a confirmation popup (Image User roles/profile delete confirmation) is displayed, this requires the user to confirm if the action should really be carried out. When a user roles/profile is deleted, the rights that it provide are not available to the users having that role/profile. The table below shows the default roles in openIMIS. Tab. 5 Overview of Scheme administrator & district Staff roles Role Responsibilities Available functionality Enrolment Officer He/she enrols insurees and submits enrolment forms to a health insurance administration; handles policy modifications; collects feedback from scheme patients and submits to the health insurance administration. Capture a photo of an Insuree. Send a photo Inquiry on an Insuree Collect feedback from an Insuree Village Executive Officer (VEO) He/she collects feedbacks and collects changes on insurees during insurance periods Collect feedback from an Insuree Inquiry on an Insuree Manager Oversees operations of the health insurance scheme;runs openIMIS operational reports analyses data generated from the IMIS. Create managerial statistics Authorize issuance of a substitution membership card Accountant Transfers data on collected Contributions to an external accounting system. Calculates claim amounts per health facility, runs openIMIS operational reports and presents claims decision overview to management of a health insurance administrator. Processes approved claims to health facility sub-accounts. Transfer of data on Contributions to accounting system Valuation of a claim Transfer of a batch of claims for payment Clerk Enters and modifies data on families, insurees, policies and contributions. Enters data on claims if the claims are submitted in a paper form. Creation/ Search/ Modification/ Deletion/ Modification of a household/group, an Insuree, a Policy or a Contribution. Renewal of a policy Entry of a claim Medical Officer Provides technical advice on claims verification from a medical standpoint. Checking of a claim for plausibility Review of a claim Authorize a claim for payment Scheme Administrator Administers registers (all except the register of users) Administer registers ( Officers, Payers, Health Facilities, , Medical Services, Medical Items, Medical Item Price Lists, Medical Services Price List, Products) Extract Creation for Off-line Health Facilities openIMIS Administrator Administers operations of the IMIS. Is responsible for backups of data. Administer the register of users, Utilities Manage Backup, Restore and Updates Extract Creation for Off-line Health Facilities Tab. 6 Overview of Health Facilities staff roles Role Responsibilities Available functionality Receptionist Verifies membership and issues to a patient a claim form. Inquiring on a Household/group, Insuree and Policy Claim Administrator Pools claim forms of a health facility, enters and submits claims. Opening of a batch of claims Entry of a claim HF Administrator Off-line HealthFacility administration Off-line extract upload Offline HF Administrator Off-line HealthFacility administration Creation of clerk Creation of offline ExtractNavigation
Administration, sub menu Users Profile.
Users re-directs the current user to the User roles/profiles control page.
User roles/profiles control page
User roles/profile control page is the central point for all user roles/profiles administration. By having access to this page, it is possible to add, edit, delete and search users roles/profiles. The page is divided into four panels (Image User roles/profiles control page).Historical to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image User roles results panel).
Add button will add a new role/profile (not available if Historical was checked)The Edit button will edit a role/profile. not available if Historical was checked)The Duplicate bbutton will duplicate a role/profile (not available if Historical was checked)The Delete button will deleting a role/profile (not available if Historical was checked)The Cancel button re-directs to the Home Page.User role/profile Page
Save button will save the record. The user will be re-directed back to the User Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the user has been saved will appear on the Information Panel.Cancel button, the user will be re-directed to the User roles/profiles control page.Save button, a message will appear in the Information Panel, and the data fields will take the focus (by an asterisk on the right of the corresponding data field).Adding a User role/profile
Editing a User role/profile
Duplicating a User role/profile
Save.Deleting a User role/profile
Default User roles and rights
1.3.9 Payers
The register of payers contains all institutional payers that can pay contributions on behalf of policyholders (e.g. private organizations, local authorities, cooperatives etc.). Payer administration is restricted to users with the role of Scheme Administrator. A payer may only be added or thereafter edited or deleted, after the approval of the management of the scheme administration. All functionality for use with the administration of payers can be found under the main menu Clicking on the sub menu The Payer control Page is the central point for all payer administration. By having access to this page, it is possible to add, edit, delete and search (institutional) payers. The page is divided into four panels (Img. 99). Search Panel The search panel allows a user to select specific criteria to minimise the search results. In the case of payers the following search options are available which can be used alone or in combination with each other. Name Email Region District Phone Number Type Historical Search Button Result Panel The result panel displays a list of all payers found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Img. 101). The leftmost record contains a hyperlink which if clicked, 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 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Img. 102). Button Panel With exception of the Information Panel The Information Panel is used to display messages back to the user. Messages will occur once a payer has been added, updated or deleted or if there was an error at any time during the process of these actions. Data Entry Type Name Address Phone Number Fax Email Region District Saving Once all mandatory data is entered, clicking on the Mandatory data If mandatory data is not entered at the time the user clicks the Cancel By clicking on the Click on the When the page opens all entry fields are empty. See the Payer Page for information on the data entry and mandatory fields. Click on the The page will open with the current information loaded into the data entry fields. See the Payer Page for information on the data entry and mandatory fields. Click on the Delete button to delete the currently selected record. Before deleting a confirmation popup (Img. 104) is displayed, which requires the user to confirm if the action should really be carried out? When a payer is deleted, all records retaining to the deleted payer will still be available by selecting historical records.Pre-conditions
Navigation
Administration, sub menu Payers.
Payers re-directs the current user to the Payer Control Page.Payer Control Page
Type in the beginning of; or the full name; to search for payers with a name, that starts with or matches completely, the typed text.
Type in the beginning of; or the full Email to search for payers with an Email, that starts with or matches completely, the typed text.
Select the Region; from the list of regions by clicking on the arrow on the right of the selector to select payers from a specific region. The option National means that the payer is common for all regions. Note: The list will only be filled with the regions assigned to the current logged in user and with the option National. All nationwide payers and all regional payers relating to the selected region will be found. If no district is selected then also all district payers for districts belonging to the selected region will be found.
Select the district; from the list of districts by clicking on the arrow on the right of the selector to select payers from a specific district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the currently logged in user. If this is only one then the district will be automatically selected
Type in the beginning of; or the full Phone Number to search for payers with a Phone Number, that starts with or matches completely, the typed number.
Select the Type; from the list of types of payers by clicking on the arrow on the right of the selector to select payers of specific type.
Click on Historical to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Img. 100).
Once the criteria have been entered, use the search button to filter the records, the results will appear in the result panel.
Cancel button, which re-directs to the Home Page, the button panel (the buttons Edit and Delete) is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Payer Page
Select the type of the payer from the list by clicking on the arrow on the right hand side of the lookup. Mandatory.
Enter the name for the payer. Mandatory, 100 characters maximum.
Enter address of the payer. Mandatory, 100 characters maximum.
Enter the phone number for the payer. 50 characters maximum.
Enter the fax number for the payer. 50 characters maximum.
Enter the email for the payer. 50 characters maximum.
Select the Region; from the list of regions by clicking on the arrow on the right of the selector to enter the region to which the payer belongs. The region National means that the payer is common for all regions. Note: The list will only be filled with the regions assigned to the current logged in user and with the option National. Mandatory.
Select the district to which the payer belongs, from the list by clicking on the arrow on the right hand side of the lookup. Note: The list will only be filled with the districts assigned to the selected region and currently logged in user. If this is only one then the district will be automatically selected. It is not mandatory to enter a district. Not selecting a district will mean the payer operates in all districts of the region or nationwide if the region National is selected.Save button will save the record. The user will be re-directed back to the Payer Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the payer has been saved will appear on the Information Panel.Save button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel button, the user will be re-directed to the Payer Control Page.Adding a Payer
Add button to re-direct to the Payer Page.Editing a Payer
Edit button to re-direct to the Payer Page.Deleting a Payer
1.4 Group/family, Insurees and Policies
1.5 Tools
1.5.1 Upload / Download selected registers
Access to uploading/downloading of selected registers is restricted to the users with the the system role of IMIS Administrator ( the register of locations) or with a role including an access to Tools/Registers. All functionality for use with the administration of uploading/downloading of selected registers can be found under the main menu Clicking on the sub menu The Registers Page is divided into eight sections: (Img. 198) A - Upload of the list of diagnoses By clicking on the If user agrees the selected file containing diagnoses will be uploaded. A statistics on the number of inserted/updated diagnoses appears: (Statistics on uploaded diagnoses). If there are errors an error protocol appears: (Error protocol on uploaded diagnoses) DTD definition of the XML file for uploading/downloading of diagnoses: B - Upload of the register of locations By clicking on the Upload button, a prompt popup message will appear, require a user to agree or disagree (Upload Locations). If user agrees the selected file containing locations will be uploaded. A statistics on the number of inserted/updated locations appears (Upload Locations statistics) If there are errors an error protocol appears (Upload Locations error) DTD definition of the XML file for uploading/downloading of locations: C - Upload of the register of health facilities By clicking on the Upload button, a prompt popup message will appear, require a user to agree or disagree: (Upload Health Facilities) If user agrees the selected file containing locations will be uploaded. A statistics on the number of inserted/updated health facilities appears. If there are errors an error protocol appears. DTD definition of the XML file for uploading/downloading of health facilities: D - Download of the list diagnoses E - Download of the register of locations F - Download of the register of health facilities G - Buttons H - Information PanelNavigation
Tools, sub menu Registers.
Registers re-directs the current user to the Registers Page: (Img. 197)Registers page
Browse
Select from a file in the XML format serving as a source for uploading of the list of diagnoses. Mandatory.Strategy
Select a desired strategy for uploading of the list of diagnoses. The following options are available:Insert Only
Uploads only diagnoses that are not yet included in the list of diagnosesUpdate Only
Updates only diagnoses that are already included in the list of diagnosesInsert and Update
Uploads diagnoses that are not yet included in the list of diagnoses and updates diagnoses that are already included in the list of diagnosesInsert, Update and Delete
Uploads diagnoses that are not yet included in the list of diagnoses, updates diagnoses that are already included in the list of diagnoses and deletes diagnose that are not included in the source fileDry Run
If checked, only diagnostics is provided without real uploadingUploadUpload button, a prompt popup message will appear, require a user to agree or disagree:(Upload Diagnoses)
<!DOCTYPE Diagnoses> [
<!ELEMENT Diagnoses (Diagnosis)*>
<!ELEMENT Diagnosis (DiagnosisCode, DiagnosisName)>
< !ELEMENT DiagnosisCode (#CDATA)>
< !ELEMENT DiagnosisName (#CDATA)>
]>
Browse
Select from a file in the XML format serving as a source for uploading of the register of locations. Mandatory.Strategy
Select a desired strategy for uploading of the register of locations. The following options are available:Insert Only
Uploads only locations that are not yet included in the register of locationsUpdate Only
Updates only locations that are already included in the register of locationsInsert and Update
Uploads locations that are not yet included in the register of locations and updates locations that are already included in the register of locationsDry Run
If checked only diagnostics is provided without real uploadingUpload
<!DOCTYPE Locations> [
<!ELEMENT Locations (Regions, Districts, Municipalities, Villages)>
<!ELEMENT Regions (Region*)>
<!ELEMENT Region (RegionCode, RegionName)>
< !ELEMENT RegionCode (#CDATA)>
< !ELEMENT RegionName (#CDATA)>
<!ELEMENT Districts (District*)>
<!ELEMENT District (RegionCode,DistrictCode, DistrictName)>
< !ELEMENT RegionCode (#CDATA)>
< !ELEMENT DistrictCode (#CDATA)>
< !ELEMENT DistrictName (#CDATA)>
<!ELEMENT Municipalities (Municipality*)>
<!ELEMENT Municipality (DistrictCode,MunicipalityCode, MunicipalityName)>
< !ELEMENT DistrictCode (#CDATA)>
< !ELEMENT MunicipalityCode (#CDATA)>
< !ELEMENT MunicipalityName (#CDATA)>
<!ELEMENT Villages (Village*)>
<!ELEMENT Village (MunicipalityCode,VillageCode, VillageName,MalePopulation ?,
FemalePopulation ?, OtherPopulation,Families ?)>
< !ELEMENT MunicipalityCode (#CDATA)>
< !ELEMENT VillageCode (#CDATA)>
< !ELEMENT VillageName (#CDATA)>
< !ELEMENT MalePopulation (#CDATA)>
< !ELEMENT FemalePopulation (#CDATA)>
< !ELEMENT OtherPopulation (#CDATA)>
< !ELEMENT Families (#CDATA)>
]>
Browse
Select from a file in the XML format serving as a source for uploading of the register of health facilities. Mandatory.Strategy
Select a desired strategy for uploading of the register of health facilities. The following options are available:Insert Only
Uploads only health facilities that are not yet included in the register of health facilitiesUpdate Only
Updates only health facilities that are already included in the register of health facilitiesInsert and Update
Uploads health facilities that are not yet included in the register of health facilities and updates health facilities that are already included in the register of health facilitiesDry Run
If checked only diagnostics is provided without real uploading.Upload
<!DOCTYPE HealthFacilities> [
<!ELEMENT HealthFacilities (HealthFacilityDetails,CatchmentsDetails)>
<!ELEMENT HealthFacilityDetails (HealthFacility)*>
<!ELEMENT HealthFacility (LegalForm, Level, Sublevel, Code, Name, Address,
DistrictCode, DistrictName, Phone, Fax, Email,
CareType, AccountCode, ItemPriceListName. ServicePricelistName)>
<!ELEMENT LegalForm (D| C|G|P)>
<!ELEMENT Level (D|C|H)>
<!ELEMENT SubLevel (I|N|R)>
<!ELEMENT Code (#CDATA)>
<!ELEMENT Name (#CDATA)>
<!ELEMENT Address (#CDATA)>
<!ELEMENT DistrictCode (#CDATA)>
<!ELEMENT DistrictName (#CDATA)>
<!ELEMENT Phone (#CDATA)>
<!ELEMENT Fax (#CDATA)>
<!ELEMENT Email (#CDATA)>
<!ELEMENT CareType (I|N|B)>
<!ELEMENT AccountCode (#CDATA)>
<!ELEMENT ItemPriceListName (#CDATA)>
<!ELEMENT ServicePriceListName (#CDATA)>
<!ELEMENT CatchmentsDetails(Catchment*)>
<!ELEMENT Catchment (HFCode,VillageCode, VillageName, Percentage)>
<!ELEMENT HFCode (#CDATA)>
<!ELEMENT VillageCode (#CDATA)>
<!ELEMENT VillageName (#CDATA)>
<!ELEMENT Percentage (#CDATA)>
]>
Download
By clicking on the Download button, a prompt popup message will appear, require a user to specify whether the XML file with downloaded list of diagnoses should be opened or saved or canceled: (Download Diagnoses)
Download
By clicking on the Download button, a prompt popup message will appear, require a user to specify whether the XML file with downloaded register of locations should be opened or saved or canceled (Download locations)
Download
By clicking on the Download button, a prompt popup message will appear, require a user to specify whether the XML file with downloaded canceled (Download facilities)
Cancel
By clicking on Cancel button, user will be re-directed to the Home page.
The Information Panel is used to display messages back to the user.
1.5.2 Policy Renewals
Access to management of policy renewals is restricted to the users with the role of Clerk. All functionality for use with the administration of policy renewals can be found under the main menu Clicking on the sub menu By having access to this page, it is possible preview the report on policy renewals, preview the journal on policy renewals and update the status of a policy. The journal will contain information on actual prompts being generated by the system. These prompt could already have been sent to the mobile phones of enrolment officers. The report on policy renewals will contain information on the expiration of policies for any given period. The page is divided into two panels (Img. 210). Select Criteria Panel Button Panel Information Panel After selecting specific criteria; preview the report (Img. 211) by clicking on the preview button. Just like preview of the policy renewals the journal report can also be previewed. The difference between the Policy Renewal report and the Journal is; one forecasts the renewal while the other gives a report on the status of the renewal. Below is an example of a Journal Report. Access to administration of feedback prompts is restricted to the users with the role system role of Medical Officer or with a role including an access to Claims/Claim/Feedback. All functionality for use with the administration of feedback prompt can be found under the main menu Clicking on the sub menu The Feedback Prompt Page is divided into three panels (Img. 214). Select Criteria Panel Buttons Panel Information PanelNavigation
Tools, sub menu Policy Renewals
Policy Renewals re=directs the current user to the Policy Renewal Page.
Policy Renewal Page
The Select Criteria Panel or the filter panel allows a user to select specific criteria to minimise the report on policy renewals.
Two tasks are carried out by this form. 1) Preview the report on policy renewal and 2) Preview the journal on policy renewal. Depending on the selected option, filter will be changed accordingly.
If Preview option is selected then a user has the following filters.Policy Status
Select the policy status from the drop down list by clicking on the right arrow. By selecting any of the options a user can filter the report on particular status of the policy. This filter is not mandatory. User can leave it blank to preview the report on any status.Region
Select the Region; from the list of regions by clicking on the arrow on the right of the selector to select policies from a specific region. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected.District
Select the district; from the list of districts by clicking on the arrow on the right of the selector to select policies from a specific district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selected.Municipality
Select the Municipality; from the list of municipalities by clicking on the arrow on the right of the selector to preview report from a specific district. Note: The list will only be filled with the municipalities that belong to the selected district. If this is only one then the municipality will be automatically selected.Village
Select the village; from the list of villages by clicking on the arrow on the right of the selector to preview report from a specific village. Note: The list will only be filled with the villages that belong to the selected municipality.Enrolment Officer
Select the Enrolment Officer; from the list of enrolment officers by clicking on the arrow on the right of the selector to preview the report for the specific officer. Note: The list will only be filled with the enrolment officers belonging to the districts assigned to the current logged in user. If this is only one then the enrolment officer will be automatically selected.Date From
By clicking on the button next to the Date From data field a calendar will pop up. Click on his desired date and the textbox will be filled with the selected date. This is a mandatory field. Only the policies for renewal date greater than or equal to the Date From will be previewed.Date To
By clicking on the button next to the Date To data field a calendar will pop up. Click on his desired date and the textbox will be filled with the selected date. This is a mandatory field. Only the policies for renewal date less than or equal to the Date To will be previewed.
When previewing the journal; the Policy Status filter will be replaced with SMS Status and there will be one more additional filter, Journal On.SMS Status
Select the SMS status from the drop down list by clicking on the right arrow. By selecting any of the options the user can filter the journal on a particular SMS status. This filter is not mandatory. By leaving it blank all journals will be displayed.Journal On
Select the journal On from the drop down list by clicking on the right arrow, to filter the journal either on prompt or on expiry of the prompt.Cancel: Re-directs to the Home PagePreview: Click on the preview button to display the report based on the filters.Update: Click on this button to manually update the status of the policy on the current day. Although this task is carried out by the IMIS Policy Renewal Service running on the server at specific intervals of time, this button enables the task to be run manually.
The Information Panel is used to display messages back to the user. Messages will occur once a user has updated the policy status or if there was an error at any time during the process of these actions.Preview Report on Renewals
Preview Journal on Renewals
Feedback Prompts
Navigation
Tools, sub menu Feedback Prompts
Feedback Prompts re-directs the current user to the Feedback Prompt Page (Img. 213).
The Select Criteria Panel or the filter panel allows a user to select specific criteria for feedback.SMS Status
Select SMS Status from the listRegion
Select the Region; from the list of regions by clicking on the arrow on the right of the selector to select a specific region for feedbacks. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected.District
Select the district from the list of districts by clicking on the arrow on the right of the selector to select district for feedbacks. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the District will be automatically selected.Municipality
Select the Municipality from the list of municipalities you wish to prompt for feedbacks. Note: The list will only be filled with the municipalities that belong to the selected district. If this is only one then the municipality will be automatically selected.Village
Select the village; from the list of villages you wish to prompt for feedbacks. Note: The list will only be filled with the villages that belong to the selected municipality.Enrolment Officer
Select the Enrolment Officer; from the list of enrolment officers by clicking on the arrow on the right of the selector to preview the report for the specific officer. Note: The list will only be filled with the enrolment officers belonging to the districts assigned to the current logged in user. If this is only one then the enrolment officer will be automatically selected.Start Date
Type in a date; or use the Date Selector Button, to enter the Start Date for feedbacks. Mandatory. *Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.End Date
Type in a date; or use the Date Selector Button, to enter the End Date for feedbacks. Mandatory. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.Send SMS
By Clicking Send SMS button, user actually sends an SMS. When an SMS is sent successfully as message will be given. If failed to be sent, a failure message will appear.Preview
By clicking on the Preview button, a report (journal) of feedbacks prompted will get generated and displayed (Img. 215).Cancel
By clicking on Cancel button, user will be re-directed to Home Page.
The Information Panel is used to display messages back to the user. Messages will occur if there was an error at any time during the processing of the reports.
1.5.3 IMIS Extracts
Access to the openIMIS Extracts page is restricted to users with the system role of Scheme Administrator (IMIS Central online) or HF Administrator (IMIS offline installations) or with a role including an access to Tools/Extracts. This page will contain all functionality for data synchronization between IMIS Central and IMIS offline installations as well as the generation of extract files for the mobile phones (Android). Depending on the type of installation, the interface will enable and disable certain functions. The extract functionality is covering extracts for the mobile phone applications and the openIMIS ‘offline’ installations. Offline extracts are only to be generated in case a district has so called ‘off-line’ installations in areas where no Internet connectivity is available. Extracts are to be downloaded to the local PC that is initiating the creation of the extract. Standard procedures should be formulated to stipulate the time interval between Extract creations and the management of transporting and installing/transferring these extracts into the target environment: mobile phones or offline openIMIS clients. All functionality related to openIMIS extracts can be found under the main menu Clicking on the sub menu This page opens in two different modes depending on the type of openIMIS installation: openIMIS Central (live server) or openIMIS offline (installed on local network in a health facility or an office of the scheme administration). The Extracts Page is divided into eight sections (Image 6.23). A - Download Master Data section The Master Data section is used for generation of the data needed for off-line operation of IMIS (Policies) application run on Android platforms. The following data files can be downloaded: Master data for running IMIS (Policies) application (Download Master Data) Prompts for renewal of policies (Download Renewals) Prompts for acquiring of feedbacks (Download Feedbacks) Enrolment Officers Code: Enter the code of an enrolment officer for whom the master data and prompts should be generated. B - Create Phone Extract section The Phone extract panel is used for the generation of so called SQLite database files for the mobile phone applications. Each district will have its own phone extract file that needs to be distributed to the mobile phones within the district. To generate a phone extract file, the operator has to select a region and a district from the list of available districts. In case the user is having access to its own district only, the district will be automatically selected and shown on the display. By clicking the In case the extract is created in the background, the following dialog box appears: If the extract is not created in background the user is notified about successful creation by the following message as shown below. The extract will be downloaded to your local computer by clicking the The extract file is called IMISDATA.DB3 and needs first to be copied (downloaded) to the local machine. After clicking the The extract is now ready to be transferred/copied to the mobile phones. This process is performed manually by connecting the mobile phone to the computer with the provided USB cable. The user needs to copy, manually, the file from the local machine into the ‘IMIS’ Folder on the mobile phone. C - Offline Extract section The offline extract section is used to generate the openIMIS ‘offline’ extract files for the health facilities or offices of the scheme administration that run openIMIS offline. To generate an offline extract file, the operator has to select a region and a district from the list of available districts. In case the user is having access to its own district only, the district will be automatically selected and shown on the display. When an operator belongs to one specific district, the district box is already selected with the district of the user. To create a new extract, the operator needs to click the Three types of extracts could be generated: Differential Extract Full extract The Full extract will always contain all information in the database. These extracts are only generated in case the By clicking the Empty Extract Empty extracts will only contain the data from registers and no data on insurees and their policies/photos. If a full set of register data should be included in the extract, the checkbox After clicking the The message is only shown to provide some details on how much information is exported to the extract file. Depending on the After clicking OK the statistics of the full extract will be shown: We are now ready to download the extract to our computer. The combo box next to the district selector contains information on all generated extracts with the sequence number and date. (e.g. Sequence 000007 – Date 06-09-2012). If the extract selector does not show any entries (blank) it means that no previous extracts were created. At least one full extract needs to be generated. This is needed to initialise a new offline openIMIS installation. To download the actual extracts, the operator needs to select the desired extract sequence from the list of available extracts. Four different types of extracts could be downloaded by clicking one of the following buttons: After clicking the desired extract download button, the file download dialog box appears to select the destination folder for the extract file as shown below: In case the extract file is not available (anymore) on the server, the following dialog box might appear: The reason for this box to appear could be that the file to be downloaded has been removed from the server or that you have attempted the download a full extract but no full extract was generated (only the differential extracts exist). It is also possible that you have attempted to download a photo extract but no photos were added since the last extract. Checking the checkbox In case the extract is created in the background, the following dialog box appears: D - Upload Claims section Browse Upload E - Upload Enrolment section Browse Upload F - Upload Feedback section Browse Upload G - Button section The H - Information panel The Information Panel is used to display messages back to the user. Messages will occur once an action has completed or if there was an error at any time during the process of these actions. Offline HF A - Import Extract Used to extract photos obtained from online IMIS B - Import Photos Used to upload photos obtained from online IMIS C - Download Claim XMLs Used to download claims made in the offline health facility prior to be sent to online IMIS Offline Insurer A - Import Extract Used to upload extract obtained from online IMIS B - Import Photos Used to upload photos obtained from online IMIS C - Import Extract The Choose file section should be clicked to select an extract file to upload/import. The following file selector appears for Internet explorer (the appearance might differ for different internet browsers): On clicking the With the import/upload of an extract it is important to understand that each extract has its sequence number. This sequence number is found in the filename of the extract. We would in case of differential imports/uploads have to follow the sequence. In the example screen above, it shows in the status bar, that the last import was number 6. Therefore we should select in this case the differential extract number 7 as highlighted in the file selection dialog. Alternatively the operator could select any full extract with a sequence number higher than 6. In case a wrong extract is selected, warning messages will appear as shown below: In case you are missing extract sequences, additional extracts are needed to be uploaded before the extract selected. The extract selected, in this case, does not directly follow the last sequence as indicated in the status bar of the screen. The additional extracts are to be provided by NSHIP district office. In case the extract file selected is valid, the system will import the data. New data will be added and existing data might be modified. After a successful import of an extract (Differential and FULL), a form is displayed with the statistics of the import as shown below: The above statistics are provided to give some quick overview of how many records were inserted or updated during the import process. In case we would for example update the phone number of an enrolment officer, it would result in one update and one insert as we always keep historical records. The photos inserts and updates are related to information on the photos, but are not the actual photographs. The actual photographs (\*.jpg) are uploaded separately. D - Import Photos The import of photos is optional and will have no further checking on sequence numbers. NSHIP should provide (if available) with each extract the photo extract as well. E.g. (for Differential extract) OR (for FULL extract) The photo extract will contain all photographs associated with the actual extract in a zipped format. The Upload procedure will simply unzip the extract and copy the image files to the photo folder of IMIS. After successful upload of the photographs the following message appears: E - Button panel The ‘Cancel’ button brings the operator back to the main page of IMIS. F - Information panel The Information Panel is used to display messages back to the user. Messages will occur once an action has completed or if there was an error at any time during the process of these actions. If the user opens the openIMIS extracts page (in offline mode only), the status bar will show the last sequence number uploaded.Pre-conditions
Navigation
Tools, sub menu IMIS Extracts
IMIS Extracts re-directs the current user to the IMIS Extracts Page.IMIS Extracts (online mode)
Create button in panel the section, a phone extract will be created. This process might take a while. As long as the hour glass (as a cursor) is shown, openIMIS is still processing the file. The file size depends on the amount of photographs included in the extract. The file size could range into hundreds of MBs. To alleviate this problem two options are available:With Insurees
Checking this box means that a complete phone extract (including photos) will be generated. Leaving it unchecked a shortened phone extract without photos will be generated.In background
Checking this box means that the phone extract will be created in background and the user will be notified by e-mail (provided his/her e-mail is entered in the register of users).
Download link that will appear after the creation of the extract, as shown below.
Download button, the operator is able to select the destination folder (locally) for the file to download as shown below.
Create button.(Download D)
Differential extracts will only contain the differences in data compared with the previous extract. The first differential extract (sequence 000001) will contain all data as it will be the first extract. Thereafter, this type of the extract, will only contain any differences after the previous extract. This will result in smaller files sent to the health facilities in off-line mode. When we click the create button, the differential extract is always generated and will be assigned the next sequence number. A separate Photo extract will be created containing only photographs linked to changes compared with the previous extract. Differential extracts with insure and policy data are only generated in case the With Insuree checkbox is checked as shown below.
(Download F)Full extract and the With Insuree checkbox are checked as shown below.
Create button, in case of Full extract is checked, two extracts will be generated, one differential extract and one full extract. Both extracts will have the same sequence number. This implies that full extracts are not always needed/generated. A separate photo extract will be created containing all photographs.(Download E)Full extract has to be checked as shown below.
Create button, the system will create the extract file and will on completion display the following message:
Full extract option, we will be re-directed to the extract page and will see the newly generated extract sequence in the list or will get a new message as shown below:
Download D (Differential extract)
Will download the selected differential extract with the following filename
Filename: OE_D_<DistrictID>_<Sequence>.RAR (e.g. OE_D_1_8.RAR)Download F (Full extract)
Will download the latest full extract with the following filename
Filename: OE_F_<DistrictID>_<Sequence>.RAR (e.g. OE_F_1_8.RAR)Download E (Empty extract)
Will download the latest full extract with the following filename
Filename: OE_E_<DistrictID>_<Sequence>.RAR (e.g. OE_F_1_8.RAR)Download Photos D (Differential Photo extract)
Will download the selected differential photo extract with filename:
Filename: OE_D_<DistrictID>_<Sequence>.RAR (e.g. OE_D_1_8_Photos.RAR)Download Photos F (Full Photo extract)
Will download the latest FULL photo extract with the following filename
Filename: OE_D_<DistrictID>_<Sequence>.RAR (e.g. OE_F_1_8_Photos.RAR)
In background means that the off-line extract will be created in background and the user will be notified by e-mail (provided his/her e-mail is entered in the register of users) as shown below:
Browse for the file from the IMIS-Offline or IMIS (Claims ) application containing claims to be uploaded.
Upload claims contained in the selected file.
Browse for the file from the IMIS-Offline or IMIS (Policies )application containing newly enrolled or renewed policies to be uploaded.
Upload policies contained in the selected file.
Browse for the file from the IMIS-Offline or IMIS (Policies )application containing feedbacks to be uploaded.
Upload feedbacks contained in the selected file.Cancel button brings the operator back to the Home Page.IMIS Extracts (OFFLINE MODE)
Choose File button, the file selector dialog appears as shown below:
1.5.4 Reports
Access to the reports is generally restricted to the users with the role of Manager, Accountant, Scheme Administrator and openIMIS Administrator. By having access to the All functionality for use with the administration of Reports can be found under the main menu Clicking on the sub menu The Reports Page is divided into four panels (Img. 243). Select Criteria At anytime during the use of the pop-up, the user can see the date of today. Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box. Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box. Clicking on the arrow to the left displays the previous month. Clicking on the arrow on the right will displays the following month. Clicking on the month will display all the months for the year. Clicking on the year will display a year selector. Report Type Selector Claim History Report Claim overview Primary operational indicators - claims report Percentage of Referrals report Contribution collection report Overview of Commissions Contribution distribution report Contribution Payment Report Matching funds report Enrolment performance indicator report Families and Insurees Overview report Pending Insurees report Rejected Photos Report Insurees without photos Payment category overview Control Number Assignement report Primary operational indicators - policies report Policies Renewals report Capitation Payment Report Derived operational indicators report Product sales report Status of registers report User activity report Button Panel Information PanelReports Page, it is possible to generate several operational reports. Each report can be generated by users with a specific system role (Manager, Accountant, Scheme Administrator and IMIS Administrator) only or with a role including an access to Tools/Reports.Pre-Conditions
Navigation
Tools, sub menu Reports.
Reports re-directs the current user to the Reports Page (Img. 243).
The Select Criteria panel or the filter panel allows a user to select specific criteria determining the scope of data included in the report. The criteria (Img. 273 – Img. 277) will change depending on the selected type of the report.
The general meaning of selection criteria for creating of a report is as follows:Date From
Type in a date; or use the Date Selector Button, to enter the beginning of a period, in which policies have their enrolment, effective, expire or renewal days, contributions were paid or in claimed health care was provided. If used with a report, it is mandatory. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.Date To
Type in a date; or use the Date Selector Button, to enter the end of a period, in which policies have their enrolment, effective, expire or renewal days or in which claimed health care was provided. If used with a report, it is mandatory. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.Payment Type
Select the Payment Type from the drop down list by clicking on the right arrow. By selecting any of the options a user can filter the report on a particular type of the payment. This filter is not mandatory, leave it blank to preview the report on all the payment modes.Region
Select the Region; from the list of regions by clicking on the arrow on the right of the selector to select a region, data of which should be included for the report. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected.District
Select the District; from the list of districts by clicking on the arrow on the right of the selector to select a district, data of which should be included for the report. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selected.Product
Select the Product; from the list of products by clicking on the arrow on the right of the selector to include in the report data for the specific product. Note: The list will only be filled with the products belong to the districts assigned to the current logged in user. If this is only one then the product will be automatically selected.Month
Select the Month from the list of months by clicking on the arrow on the right of the selector to include in the report data relating to that month selected.Year
Select the year from the list of years by clicking on the arrow on the right of the selector to include in the report data relating to that year selected.Quarter
Select the quarter from the list of quarters by clicking on the arrow on the right of the selector to include in the report data relating to that quarter selected.HF Code
Select the HF Code; from the list of heath facility codes by clicking on the arrow on the right of the selector to create the report for the specific health facility. Note: The list will only be filled with health facility codes of health facilities belonging to the districts assigned to the current logged in user. If this is only one then the health facility code will be automatically selected.Enrolment Officer
Select the enrolment officer; from the list of enrolment officers by clicking on the arrow on the right of the selector to select enrolment officer data of whom should be included in the report. Note: The list will only be filled with the enrolment officers assigned to the current selected district. If this is no district selected the enrolment officers list will be filled by all districts’ enrolment officersPayer
Select the payer from the drop down list by clicking on the right arrow. By selecting any of the options a user can filter the report on a particular payer. This filter is not mandatory; leave it blank to preview the report on all the payers.Claim Status
Select the claim status from the drop down list by clicking on the right arrow. By selecting any of the options a user can filter the report on a particular claim status. This filter is not mandatory, leave it blank to preview the report on all the claim statuses.Sorting
Select the way of sorting of records in the report from the list of available ways of sorting (Renewal Date, Receipt Number, Enrolment Officer).Previous
Select the previous reports from the drop down list by clicking on the right arrow. By selecting any of the options a user can fetch a report which was produced before. Note: This filter is available only for Matching Funds Report.CONTROL NO.
Enter a control number to get a payment corresponding to the entered control number. This filter is not mandatory. Note: This filter is available only for Contribution Payment Report.PAYMENT STATUS
Select either Matched or Unmatched as the payment status. Note: This filter is available only for Contribution Payment Report.POSTING STATUS
Select the status of posting of requests for control numbers. This filter is not mandatory. Note: This filter is available only for Control Number Assignment.ASSIGNMENT STATUS
Select the status of results of requests for control number. This filter is not mandatory. Note: This filter is available only Control Number Assignment Report.INSURANCE NUMBER
Enter the insurance number of an insuree. This filter is not mandatory. Note: This filter is available only Claim History Report.MODE
Select the mode (Prescribed Contributions, Actually Paid Contributions) of calculation of commissions. This filter is mandatory. Note: This filter is available only Overview of Commissions.COMMISSION RATE
Enter a commission rate as % of an assessment base. This filter is mandatory. Note: This filter is available only Overview of CommissionsSCOPE
Select the details level of the report (Claims and All Details, Claims and Rejection Details, Claims Only)Date Selector Button
Clicking on the Date Selector Button will pop-up an easy to use, calendar selector (Tab. 12) by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
This panel contains a list of available report types. A user can select to create a desired report by clicking on the report type list item (Img. 287) and narrow the report using the criteria being shown on the panel above, and then click the preview button to create the report. Available report types are:
Preview button
By clicking on this button, the system will process the selected report type basic on the corresponding criteria submitted and re-direct current user to Report Page, for previewing the processed report. At any time the user clicks on the preview button, the current criteria will be saved in the session and can be reused later in the same session and for other report types where the same criteria are found.Cancel button
By clicking on this button, the current user will be re-directed to the Home Page.
The Information Panel is used to display messages back to the user. Messages will occur if there was an error at any time during the processing of the reports.
1.5.5 Utilities
Access to the The All functionality for use with the administration of utilities can be found under the main menu Clicking on the sub menu Backup utility can be found in the top panel of the Utilities Page. By default the path of the backup folder will be populated from the default table. User can change the path according to the requirement. Next to the textbox user can see one heck box called Restore utility can be found in the second panel of the Utilities Page. User will have to put the path of the backup file to be restored. After the path has been entered user can just click on the Execute script can be found in the third panel of the Utilities Page. User will have to choose the script by clicking on the browse button. User will have to select the file only with the .isf extension. After the file has been chosen, user can just click on the Utilities is restricted to the users with the role of openIMIS Administrator.Utilities is the place for database administration. By having access to this page, it is possible to backup and restore the openIMIS operational database and also to execute SQL Scripts (patches provided for maintenance or update of the database). At the top of the page, the current “Backend” version is displayed for reference.Navigation
Tools, sub menu Utilities
Utilities re-directs the current user to the Utilities Page.
Backup
Save Path. If user wants to update the backup folder in default table then this check box should be in checked state. Otherwise system will take the backup on the folder assigned by the user but it will not be updated in database. So next time when user comes on the Utilities Page, the textbox will be populated with the original path. After the path has been entered user can just click on the Backup button to start the process and a progress bar will be appeared on the screen. Users are requested to be patient while the system performs the task.
Restore
Restore button to start the process and a progress bar will be appeared on the screen. Users are requested to be patient while the system performs the task.Execute scrip
Execute button to run the script. Users are requested to be patient while the system is executing the script. After the script is executed successfully, backed version will be updated to the latest version. If user will try to run the lower or the equal version’s script then system will prompt the user with the appropriate message
1.5.6 Funding
Access to the The The functionality for entering of funds can be found under the main menu Clicking on the sub menu Data Entry Select the region from the list of regions for which the funding is designated by clicking on the arrow on the right of the selector. Note: The list will only be filled with the regions assigned to the current logged in user. Select the district from the list of districts for which the funding is designated. by clicking on the arrow on the right of the selector. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. Select an insurance product from the list of insurance products purchased in the selected district (including national insurance products) for which the funding is designated. Select from the list of institutional payers the funding authority/agency. Enter the date of receiving of the funding. Enter the amount of the funding. Enter an identification of the document accompanying the funding. Saving Once all mandatory data is entered, clicking on the Mandatory data If mandatory data is not entered at the time the user clicks the Cancel By clicking on the Cancel button, the user will be re-directed to the Home Page.Funding is restricted to the users with the system role of Accountant or with a role including an access to Tools/Funding.Funding is the place where funding from external authorities (payers) can be for entered. openIMIS creates internally one fictive family/group (the insurance number of the head of the fictive family/group is 999999999, the name is Funding and the other name is Funding as well) for the district for which a funding is done. Each entering of a fund results in creation of a fictive policy for the corresponding fictive family/group with paid contribution in the amount of the funding. The fictive policy is active since the date of payment of the corresponding fund. These fictive policies are overpaid as these funds are usually much higher than the contribution rate for a single family/member of the group but it doesn’t matter. External funding corresponds to payment of contributions for many families/members of the group in some period. openIMIS can regard funds as standard contributions and its standard functionality can be used for handling of funds. One distinctive feature of payment of funds by means of the fictive policies is that the payments of funds don’t appear in the reports on matching funds generated for funding authorities. So, there is no danger that offices of the scheme administration would acquire new funds based on funding already acquired.Navigation
Tools, sub menu Funding
Funding re-directs the current user to the Funding Page.Funding Page
RegionDistrictProductPayerPayment DateContribution PaidReceipt NumberSave button will save the record. A message confirming that the new password has been saved will appear. The user will be re-directed back to the Home Page.Save button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right side of the corresponding field). The user will be re-directed to the Home Page.
1.5.7 Email Settings
Access to the The The functionality for entering of funds can be found under the main menu Clicking on the sub menu Data Entry SMTP Login to be used on the email server in order to send email SMTP password to be used on the email server in order to send email. SMTP email server address or IP SMTP email server IP port, standard port are 25 when no encryption is used 465 when implicit encryption is used(depreciated) 587 when explicit encryption is used, see Check to box if the SMTP mail server require encryptionEmail Settigns is restricted to the users with the role of Accountant.Email Settigns is the page where the setting of the outbound email server are entered.Navigation
Tools, sub menu Email Settigns
Email Settigns re-directs the current user to the Email settings Page.Email settings page
EmailPasswordSMTP HostPortEnable SSLEnable SSL
1.5.8 Date Picker
Tab. 12 Date Picker | ||
 Img. 296 Day picker |  Img. 297 Month picker |  Img. 298 Year picker |
At anytime during the use of the pop-up, the user can see the date of today. Clicking on a day will close the pop-up and display the date | Clicking on the arrow to the left displays the previous month. Clicking on the arrow on the right will displays the following month. | Clicking on the year will display a year selector. |
1.6 Offline mode
IMIS system can be used in offline mode, which makes it possible for usage by health facilities (HF) and scheme administration offices with low/no internet connectivity.
1.6.1 Offline Facilities
Facilities available while offline and online in IMIS, are similar with some few differences. The following are the feature wise differences found while using openIMIS in offline mode. Login If a user who is logging in is having user role HF Administrator or offline Scheme Administrator and if Heath Facility ID/Scheme Office ID is not set yet, just after clicking login button on the login screen/page, the user will be prompted to enter Health Facility/Scheme Office ID (Img. 299), (Img. 300), only once for that very first time of logging in. Information bar Throughout the application, an information bar at the bottom of each page will have a different background colour to that of online openIMIS and on the its right end, there will be shown heath facility code and health facility name / Scheme Office ID submitted (Img. 301), (Img. 302). Menu Access For all users with roles other than HF Administrator and Offline Scheme Administrator , will have the menus available to them as per normal roles’ rights in online openIMIS version. Menu access in the offline version is different in following scenarios: User with roles HF Administrator and Offline Scheme Administrator can access only Extracts Extracts Menu leads an offline user to Extracts control panel. Using this panel, an offline user with rights to this panel can import data from online openIMIS to the local offline IMIS, and can also download claims and enrolments prior to upload them to the online IMIS. This panel is divided into five sections (Img. 303), (Img. 304) If an offline user is HF Administrator, section C will contain facility to section a - import extract This section has a facility to enable synchronization of online openIMIS data with that offline openIMIS data. When online data in a zipped file is obtained (downloaded extraction) from online openIMIS to user local computer, user will use this section to put that data into offline IMIS. User has to select a file from a local computer by clicking the ‘select file’ button on the left side of the section, and in the popup window which appears (Img. 304) user can navigate to the required file and select the file. After clicking the upload button on the very end of right hand side in this section, data in the file will be imported to the offline openIMIS and confirmation will be given as popup messages (Img. 305), (Img. 306). User cannot import an extract whose sequence number is same as last one imported; if done so, a popup message (Img. 308) will be shown. section b - import photos Just as the section name implies, this is a section with facility to enable a user synchronize insurees’ photos in online IMIS, with insurees’ photos in offline IMIS. When online insurees’ photos in a zipped file is obtained from online openIMIS to user local computer, user will use this section to put those photos into offline IMIS. User has to select a file from a local computer by clicking the ‘select file’ button on the left side of the section, and in the popup window which appears (Img. 309), user can navigate to the required file and select the file. After clicking the upload button on the very end of right hand side in this section, data in the file will be imported to the offline openIMIS and confirmation will be given as popup messages (Img. 309). If importation of photo is not done due to some reason, the above popup message will not be shown, instead system will issue proper popup message to notify a user what went wrong and what is to be done. section c - download claim xmls This section has facility to enable offline HF Administrator download to a zipped file all offline claims. By clicking the download button on the right hand side, the user initiate download process and all offline claims will be downloaded to a default downloads folder in user’s local computer or a prompt of ‘where to save file’ will be displayed by browser’. User can navigate through folder in his/her local computer to find the file downloaded. If no new claims found, a message will be displayed. download enrolment xmls This section has facility to enable Offline Scheme Administrator download to a zipped file all offline enrollments of families, insurees, policies and contributions. By clicking the download button on the right hand side, the user initiate download process. If no enrolment found, a popup message box (Img. 310) will appear, notifying the user. Otherwise enrollments will be downloaded in a zipped file and a confirmation popup message (Img. 312) will appear section d - buttons This section has a cancel button, which when clicked will take the current user to the Home page. section e - information bar Information bar at the bottom will show different notification messages in blue color depending on the actions of the user. Such actions and messages may be: No Previous Extract Found This message is seen at the first time when using the system and no any extract has been imported into the offline IMIS Last Extract Sequence: <Sequence Number> This message is seen, after a single / series of extract importation have been made to the offline openIMIS and that much times will be shown as a sequence number at the end of the message. This enables proper tracking of right extracts to import and use. No claims Found When HF offline openIMIS user is downloading offline claims and no new offline claims is found, this message is displayed. User Users with role HF Administrator, can create only users with roles: Receptionist, Claim Administrator and HF Administrator (Img. 316). User with role ‘offline NSHIP Administrator’, can create only user with role: Clerk (Img. 317). data access Search / Find In all pages in Create / Edit Only families, insurees, policies and contributions created/edited while offline, will be available for further manipulation. An online data is available for viewing purposes. For an offline user with a right to open 
Users, IMIS Extracts and Utilities menus, while all other users with different roles can access menus just as they would do in the online openIMIS version.Download Claims. If an offline user is Offline Scheme Administrator, section C will contain facility to Download Enrolments
Insurees and Policies menus with search / find acility, there will be an extra search criteria (Img. 318) to enable search for offline data only. This feature is available if a user is in Offline IMIS.
Insurees and Policies menus, he/she can access all data but can manipulate only that data which was created offline. The rest of the data will be available in read-only mode
1.7 Group insurance
openIMIS is supporting group insurance since the October 2021 release, this feature allows a “policyholder” to take insurance for other insuree. This feature does not change the insuree registration process, therefore the insuree must be already known by openIMIS before being attached to a policyholder. openIMIS must have those configured: Products Locations Health Facilities Before starting the configuration of openimis the scheme must be defined upfront this features don’t covers the registration of the insuree, insuree must be registered using other openIMIS functions Setting up the contribution plans This feature comes with contribution plans, those items are used to bring flexibility in the pricing models for a product. thanks to contributions plan, the scheme administrator can define different pricing for the same coverage. Before setting up the policyholder the scheme administrator must setup the contribution plans and then make bundle of contribution plan; even if only one contribution plan (product) is wished to be available for group insurance on “bundle” must still be created. Creating the policyholder Once the general information regarding the Policyholder is saved, the eligible contribution plan bundle for that policyholder must be linked in the “contribution plan bundle” tab. add Policyholder users to allow the inputs from the policyHolder, openimis user can be configure to the PH user, so they will have access the data that need to be maintained by the policyholders Adding insuree on the policyholder Insuree can be added via the “policyholder insuree” tab, the clerk will have to find the insuree using the insuree number, then the policyholder contribution bundle plan (PH-CBP) need to be attached to the insuree Once PH-CBP is selected, the calucation params will be pulled (eg. invoice) and new inputs fields might apprears Generating coverage Used to generate coverage the group insurance features used contracts. At creation the contrat will pull the valid PH-Insuree, once created (draft), the contract will have to go through severals steps : submitted (negociable) , approved (executable) , payed (Effective) then the coverage are active for the contract dates (can be modulated by the contribution plans) Generating payment to third parites Once a claim is approved a payment is likely to be due, if order to generate the appropriate payment, payment plans need to be usedGetting started
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