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 Forgot Password? on the login screen (Login) results in the opening of the Forgot Password page (Img. 3).

• Enter the User Name linked to the account

• Enter the New 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).

  

• Click on the 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).

• Check the user’s inbox and click on 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).

• Once the confirmation is submitted, the new credentials can be used in the Login page.

1.1.3 Password change

Any user can change his/her password by adjustment of his/her profile.

Navigation

Functionality for changing of a password can be done in the menu Profile, sub menu Change Password.

Clicking on the sub menu Change Password re-directs the current user to the Change Password Page.

Change Password Page

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.

Saving

Once all mandatory data are entered, clicking on the 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.

Mandatory data

If mandatory data is not entered at the time the user clicks the 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).

Cancel

By clicking on the Cancel button, the user will be re-directed to the Home Page.

1.2 Claims

The functionality under the menu 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. 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.

2. 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.

3. 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).

4. 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.

1.2.1 Heath Facility Claims

Pre-conditions

Access to the Health Facility Claims Page is restricted to users with the role of Claim Administrator.

Navigation

All functionality for use with the administration of health facility claims can be found under the main menu Claims, sub menu Health Facility Claims.

Clicking on the sub menu Health Facility Claims re-directs the current user to the Claims Control Page.

Claims Control Page

The Claims Control Page is the central point for all health facility claim administration. By having access to this panel, it is possible to add, edit and search claims. Claims can be edited only in the state Entered. The panel is divided into four panels (Img. 10).

Search Panel

The search panel allows a user to select specific criteria to minimise the search results. In the case of claims the following search options are available which can be used alone or in combination with each other.

Region

Select the Region where claiming or searched for health facility is located from the list of regions by clicking on the arrow on the right of the selector to select claims 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 where claiming or searched for health facility is located from the list of districts by clicking on the arrow on the right of the selector to select claims 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.

HF Code

Select the HF Code (Health Facility Code) from the list of codes of health facilities by clicking on the arrow on the right of the selector, to select claims from a specific health facility. Note: The list will only be filled with the health facilities belonging to the selected district and assigned to the current logged in user.

HF Name

Type in the beginning of; or the full HF Name (Health Facility Name) to search for claims belonging to the health facility whose name start with or match completely the typed text.

Claim Administrator

Select the Claim Administrator from the list of claim administrators by clicking on the arrow on the right of the selector, to select claims submitted by a specific claim administrator. Note: The list will only be filled with the claim administrators belonging to the health facility selected.

Visit Type

Select the Visit Type from the list of visit types (or hospital stays) by clicking on the arrow on the right of the selector, to select claims with specified visit type.

Insurance Number

Type in the beginning of; or the full Insurance Number, to search for claims, on behalf of insurees with the insurance number which starts with or match completely the typed text.

Claim No.

Type in the beginning of; or the full Claim No., to search for claims with the specific claim identification which starts with or match completely the typed text.

Review Status

Select the Review Status from the list of options for review status by clicking on the arrow on the right of the selector, to select claims with specific review status.

Feedback Status

Select the Feedback Status from the list of options for feedback status by clicking on the arrow on the right of the selector, to select claims with specific feedback status.

Claim Status

Select the Claim Status from the list of options for claim status by clicking on the arrow on the right of the selector, to select claims with specific claim status.

Main Dg.

Select the Main diagnosis from the list of diagnoses status by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box, to select claims with main diagnosis.

Batch Run

Select the batch run from the list of batch runs by clicking on the arrow on the right of the selector, to select claims from specific batch run

Visit Date From

Type in a date; or use the Date Selector (Date Picker), to search for claims with a Visit Date From date which is on or is greater than the date typed/selected. Note. To clear the date entry box; use the ``Clear`` button on the date picker popup. Visit Date From should be the day of admission for in-patient care or the visit date in case of out-patient care.

Visit Date To

Type in a date; or use the Date Selector (Date Picker), to search for claims with a Visit Date From date which is on or is less than the date typed/selected. Note. To clear the date entry box; use the ``Clear`` button on the date picker popup. Visit Date To should be the day of discharge for in-patient care or the visit date in case of out-patient care.

Claim Date From

Type in a date; or use the Date Selector (Date Picker), to search for claims with a Claim Date date which is on or is greater than the date typed/selected. Note. To clear the date entry box; use the ``Clear`` button on the date picker popup*

Claim Date To

Type in a date; or use the Date Selector (Date Picker), to search for claims with a Claim Date date which is on or is less 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.

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 claims found, matching the selected criteria in the search panel. The currently selected record is highlighted with light grey. (Img. 11). Double click on the line 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 can be displayed per default but it can be changed by configuration (gitHub), in a scroll panel. Further records can be viewed by either changing the page or deleting/submitting the current loaded claims and search claims again.

Actions

Modular openIMIS comes with Material UI this means that there is a single button (Tab. 1) which function will change depending on the context (Icon change), for less used functions a tree dots menu is available (Tab. 2) only when claim(s) are selected. By double-clicking on the claim line, the user is directed to the Claim Page, where the current selected claim can be edited (provided it in the state Entered), this page will open with the current information loaded into the data entry fields. See the Claim Page for information on the data entry and mandatory fields.

Tab. 1 Material icons
Img. 12 Add	Img. 13 Save	Img. 14 Back	Img. 15 Print

Tab. 2 Claims Actions
	Img. 17 Tree dots	Img. 18 Tree dots menu

Add

By clicking on the add button (Img. 12), the user is directed to the Claim Page, where new entries for new claim can be added. When the page opens all entry fields are empty. See the Claim Page for information on the data entry and mandatory fields.

Submit selected

By clicking on the submit selected manu (Img. 18), claim status of all selected claims with the status Entered will be submitted.

Once the process is done, a popup window ( Img. 19 ) with the result of the process will be shown.

Delete selected

By clicking on the delete selected menu, the current selected claim will be deleted.

Before deleting a confirmation popup ( Img. 20 ) is displayed, which requires the user to confirm if the action should really be carried out?

Information Panel

The Information Panel is used to display messages back to the user. Messages will occur once a claim has been added, updated or deleted or if there was an error at any time during the process of these actions.

Claim Page

Main Form

HF Code

Displays the code of the health facility. The field is read only (taken over from the Claims Control Page) and cannot be edited.

HF Name

Displays the name of the health facility. The field is read only (taken over from the Claims Control Page) and cannot be edited.

Insurance Number

Enter the insurance number of the patient. When the field is filled the insuree name will be updated (:refnum:’insuree_picker’). Mandatory.

Claim No.

Enter the identification of the claim. Mandatory, up to 8 characters. It should be unique within the claiming health facility.

Main Dg.

Select the code of the main diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box. Mandatory.

Sec Dg 1

Select the code of the first secondary diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box.

Sec Dg 2

Select the code of the second secondary diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box

Sec Dg 3

Select the code of the third secondary diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box

Sec Dg 4

Select the code of the fourth secondary diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box

Claim Administrator

Displays code of the claim administrator. The field is read only (taken over from the Claims Control Page) and cannot be edited.

Visit Date From

Enter the visit date for out-patient care or the admission date for in-patient care. Mandatory.

Visit Date To

Enter the discharge date for in-patient care.

Date Claimed

Enter the date when the claim was prepared by the health facility.

Guarantee No.

Enter identification of a guarantee letter for prior approval of provision of claimed health care.

Visit Type

Select the type of visit/hospital admission from the drop down list (Emergency, Referral, Other)

Services

Service code

When entering the service code, a dropdown suggestion box for the available services with the service code or service name matching your typed text will be shown. Available medical services in the dropdown suggestion box are taken over from the pricelist of medical services associated with the claiming health facility. The desired service can then be selected from the dropdown suggestion box by clicking on it using mouse or selecting it using up and down arrows, then pressing Enter key fill the service code text field, together with quantity and value field in the same row.

Once the selected service has been written on the service data grid row, a new service line will be added and the dropdown suggestion box will close itself. When needed, the dropdown suggestion box can be closed by clicking any place on the page but outside the dropdown suggestion box.

Quantity

This field can be filled manually by entering a number in it or automatically is filled by 1 when the service code above is filled, through dropdown suggestion box. It is this field that receives focus after service code is filled above from the dropdown suggestion box.

Price

This field can be filled manually by entering a number in it or automatically is filled when the service code above is filled, through dropdown suggestion box. Automatically filled prices are taken over from the pricelist of medical services associated with the claiming health facility.

Explanation

Enter extra information about the service for the scheme administration (a medical officer of the scheme administrator).

Items

Item code

When entering the item code, a dropdown suggestion box for the available items with the item code or item name matching your typed text will be shown. Available medical items in the dropdown suggestion box are taken over from the pricelist of medical items associated with the claiming health facility. The desired item can then be selected from the dropdown suggestion box by clicking on it using mouse or selecting it using up and down arrows, then pressing Enter key to fill the item code text field, together with quantity and value field in the same row.

Once the selected item has been written on the item data grid row, a new service line will be added and the dropdown suggestion box will close itself. When needed, the dropdown suggestion box can be closed by clicking any place on the page but outside the dropdown suggestion box.

Quantity

This field can be filled manually by entering a number in it or automatically is filled by 1 when the item code above is filled, through dropdown suggestion box. It is this filled that receives focus after item code is filled above from the dropdown suggestion box.

Price

This field can be filled manually by entering a number in it or automatically is filled when the item code above is filled, through dropdown suggestion box. Automatically filled prices are taken over from the pricelist of medical items associated with the claiming health facility.

Explanation

Enter extra information about the medical item for the scheme administration (a medical officer of the scheme administrator).

Claimed

This field is filled automatically with a new total of quantities multiplied to their corresponding values in both data input grids at any time when there is a change in values in the either quantity fields or value fields anywhere in both data input grids.

Explanation

Enter extra information about the whole claim for the scheme administration (a medical officer of the scheme administrator).

Saving

Once all mandatory data is entered, clicking on the Save button (Img. 13) will save the claim. The user stay in the Claim Page; a message confirming that the claim has been saved will appear on the right of the Claim Page (Tab. 3).

Tab. 3 Claim Save Confirmation
Img. 25 Create confirmation	Img. 26 Update confirmation	Img. 27 Back	Img. 28 Print

If mandatory data is not entered at the time the user clicks the Save button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk).

Printing of a claim

By clicking on the Print button (Img. 15), the user will be shown a printable version of the claim details page. The printable version of the claim is available in the pdf formats.

Restoring/Duplicating a claim

By clicking on the Restore button, the Claim Page is cleared filled with a new calim having the same details, at the exeption of the claimID that get a leading “@”

Creating of a new claim

By clicking on the Add button (Img. 12), the Claim Page is cleared (with exception of HF Code, HF Name and Claim Administrator) and it ready for entering of a new claim for the same health facility and of the same claim administrator as before.

Back

By clicking on the back (Img. 14) button, the user will be re-directed to the Claims Control Page.

1.2.2 Review Claims

The functionality allows reviewing and adjustments of claims from medical point of view. Reviewing of claims is restricted to users with the system role of Medical Officer or with a role including an access to Claims/Claim/Review.

Pre-conditions

A claim has been already submitted.

Navigation

All functionality for use with the administration of claim overview can be found under the main menu Claims, sub menu Reviews.

Clicking on the sub menu Review re-directs the current user to the Claims Overview Page.

Claims Overview Page

The Claims Overview Page is the central point for all claim review administration. By having access to this panel, it is possible to review, feedback, amend and process claims. The panel is divided into five sections (Img. 30).

Search Panel

The search panel allows a user to select specific criteria to minimise the search results. In the case of claims the following search options are available, which can be used alone, or in combination with each other.

Region

Select the 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 selected

District

Select the District; 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 selected

HF Code

Select the HF Code; from the list that appear after typing characters, all HF code containing the typed text will appear and be selectable underneath the box. Note: The list will only be filled with the health facilities belonging to the selected district and assigned to the current logged in user.

HF Name

Type in the beginning of; or the full HF Name, to search for claims belonging to the health facility whose name start with or match completely the typed text

Claim Administrator

Select the claim administrator from the list that appear after typing characters , all claim administrator containing the typed text will appear and be selectable underneath the box. Note: The list will only be filled with the claim administrators belonging to the health facility selected.

Insurance Number

Enter the insurance number of the patient. When the field is selected, the search insuree popup(:refnum:’insuree_picker’) will be display and will allow the claim administrator to search the insuree based on its insurance number, or/and last name, or/and other(first) name

Claim No

Type in the beginning of; or the full Claim No, to search for claims with claim identification which start with or match completely the typed text.

Review Status

Select the Review Status from the list of the options for review status by clicking on the arrow on the right of the selector to select claims with a specific review status

Feedback Status

Select the Feedback Status from the list of the options for feedback status by clicking on the arrow on the right of the selector to select claims with a specific feedback status

Claim Status

Select the Claim Status from the list of the options for claim status by clicking on the arrow on the right of the selector to select claims with a specific claim status.

Main Dg

Select the Main Dg. from the list of diagnoses by typing characters, all diagnoses containing the typed text will appear and be selectable underneath the box, to select claims with main diagnosis.

Batch Run

Select the Batch Run from the list of batch runs by clicking on the arrow on the right of the selector to select claims included in a specific batch run.

Visit Date From

Type in a date; or use the Date Selector (Tab. 12), to search for claims with a Visit Date From which is on or is greater than the date typed/selected. Note. To clear the date entry box; use the ``Clear`` button on the date picker popup.

Visit Date To

Type in a date; or use the Date Selector (Tab. 12), to search for claims with a Visit Date To which is on or is less than the date typed/selected. Note. To clear the date entry box; use the ``Clear`` button on the date picker popup.

Claim Date From

Type in a date; or use the Date Selector (Tab. 12), to search for claims with a Claim Date From which is on or is greater than the date typed/selected. Note. To clear the date entry box; use the ``Clear`` button on the date picker popup.

Claim Date To

Type in a date; or use the Date Selector (Tab. 12), to search for claims with a Claim Date To which is on or is less than the date typed/selected. Note. To clear the date entry box; use the ``Clear`` button on the date picker popup.

Visit Type

Select type of out-patient visit or in-patient admission from the list of types of visit to search for claims made on specific visit/admission type.

Claim Selection Update Panel

This panel is basically for functionality of updating multiple claims which are currently loaded in the Result Panel at once basing on the claim filter criteria available on this panel. The update on the claims is basically changing Feedback Status and Review Status of a claim from Idle to Selected for Feedback or Selected for Review respectively. The filters in this panel work on the claims which are currently loaded on the result panel. The combination of filters is either Select and either Random or Value combination of Value and Variance.

Select

A selection dropdown box to select between Review Select and Feedback Select to filter only claims whose review status is Idle or feedback status is Idle respectively from among claims currently in the Result Panel.

Random

Accept a number which is considered to be a percentage of the claims in the Result Panel. Check the random checkbox and enter a number on the text field next to checkbox. The default is 5%.

Value

Accept a number which is considered to be claimed value. This will filter claims from the Result Panel by taking claims whose claimed value is equal or greater than the entered number in the Value text field. Check the value checkbox and enter a number on the text field next to checkbox.

Variance

Enable to set a variance arround the Value specified Percentage Variance = [(Claim Value Filter Value) – 1] * 100

Filter button

Once desired criteria have been set and after clicking this button (Img. 36), then the claims currently displayed in the result panel which satisfy the criteria, a reduced number of claim will be dispalyed in the result panel

Bulk updates

One can select them all (Img. 35) then by clicking on the 3 dots (Img. 37) more advanced actions (Img. 38) will be displayed.

A notification will be displayed to confirm display the action result (Img. 32)

Result Panel

The Result Panel displays a list of all claims 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. 33).

Per default 10 records can be displayed at one time in a scroll panel but this number can be changed (Img. 42, the default value can also be changed in front end configuration), Further records can be viewed by changing pages (Img. 41).

The Feedback and Review Status Columns in each row contain a drop down list with options for claim feedback status and claim review status. A user can change the claim feedback and review status to Idle to Not Selected or Selected or Bypass. the change will take effect directly in an asynchronous mode, a notification will indicate the result of the update (Img. 34)

Deliver Review

Clicking on this button (Img. 40) re-directs a user to the Claim Review Page, where a claim with review status Selected for Review can be reviewed and its current review status changed to Reviewed. If the claim is not in the status Selected for Review then the claim can be only loaded and shown to the user without any subsequent action.

Deliver feedback

Clicking on this button (Img. 39) re-directs a user to the Claim Feedback Page, where a claim with feedback status Selected for Feedback can be feed backed and its current feedback status changed to Delivered.

Actions Menu

The Action menu is used in conjunction with the current selected record (highlighted with light grey). The user should first select a record by clicking on any position of the record or by clicking on Select All (Img. 35)

Tab. 4 claims review actions

Clear Selection

Unselect the selected claims

Select For Feedback

set the feedback status of the selected claims to Selected

Skip feedback

set the feedback status of the selected claims to Not Selected

Select For Review

set the review status of the selected claims to Selected

Skip Review

set the review status of the selected claims to Not Selected

Process selected

Process the selected claim with the status Checked, once processed the claims will have the status

Processed

this means that the valutation will be done against the cieling and deductible configure on the product page

Information Panel

The Information Panel is used to display messages back to the user. Messages will occur once a claim has been reviewed, updated, feedback added on claim or if there was an error at any time during the process of these actions.

Claim Review Page

Data Entry

Claim Review Page will show read-only information of the current claim selected for review, on the top section of the page, on some of the grid columns of the claim services grid and claim items grid and on the bottom of all the grids. As well, the page has input boxes where a user with the system role Medical Officer or with a role including an access to Claims/Claim/Review can enter new relevant values for review of the current claim.

Read-only information of the current claim:

• HF
  The health facility code and name which the claim belongs to.

• Main Dg.

  The code of the main diagnosis.

• Sec Dg1

  The code of the first secondary diagnosis.

• Sec Dg2

  The code of the second secondary diagnosis.

• Sec Dg3

  The code of the third secondary diagnosis.

• Sec Dg4

  The code of the fourth secondary diagnosis.

• Visit type

  The type of the visit or of the hospital stay (Emergency, Referral, Other)

• Date Processed

  The date on which the claim was processed (sent to the state Processed).

• Claim Administrator

  The administrator’s code, who was responsible for submission of the current claim.

• Insurance Number

  The insurance number of the patient

• Claim No.

  The unique identification of the claim within the claiming health facility.

• Patient Name

  The full name of the patient on whom the claim is made

• Date Claimed

  The date on which the claim was prepared by the claiming health facility

• Visits Date From

  The date on which the patient visited (or was admitted by) the health facility for treatment on which the claim is basing on

• Visit Date To

  The date on which the patient was discharged from the health facility for treatment on which the claim is basing on

• Guarantee No.

  Identification of a guarantee letter.

• Claimed

  The sum of prices of all claimed services and items at the moment of submission of the claim.

• approved

  The value of the claim after automatic checking during its submission and after the corrections of the claim done by a medical officer.

• Adjusted

  The value of the claim after automatic adjustments done according to the conditions of coverage by the patient’s policy.

• Explanation

  Explanation to the claim provided by the claiming health facility.

• claim status

  Claim status is shown on the very bottom right end side after the two grids. This is status which claim gets after submission.

Editable information of the current claim:

• Adjustment

  Enter a text summarizing adjustments in claim done by a medical officer.

Services and Items data entry grids.

1. Approved Quantity (app.qty)

   Enter a number of approved provisions of the corresponding medical service or item.

2. Approved Price (app. price)

   Enter an approved price of the corresponding medical service or item.

3. Justification

   Enter justification for the entered corrections of the price and quantity of the medical service or item.

4. Status

   Select either the status in the claim Passed or Rejected for the corresponding medical service or item respectively.

5. Rejection reason

   The last column of each of the two grids, headed with character ‘R’, gives rejection reason number for each of the claimed services or claimed items in the claim services grid or the claim items grid respectively. Rejection reasons are as follows:

   The rejection description is displayed on the screen when the mouse pointer is above the given line (Img. 44)

Saving / Reviewing

Once appropriate data is entered, clicking on the Save button (Img. 13) will save the claim review and set the reivew status to deliver; a message confirming that the claim has been saved will appear on the Information Panel.

data entry validation

If inappropriate data is entered at the time the user clicks the Save button, an error message will appear in the Information Panel, and the data field will take the focus

Back

By clicking on the back button (Img. 14), the user will be re-directed to the Claims Overview Page.

Claim Feedback Page

The Claim Feedback page will show -only information of the current claim selected for feedback, on the top section of the page it has input boxes where a user with the system role Medical Officer or with a role including an access to Claims/Claim/Feedback can enter feedback on the current claim or where the user can read a feedback delivered by enrolment officers.

Data Entry

Read-only data of the feedback includes in the section **Claim the following:**

Health Facility

The health facility code and name which the claim belongs to.

Insuree

Patient/beneficiary names and insurance number

Date Claimed

The date on which the claim was prepared by the claiming health facility

Visits Date From

The date on which the patient visited (or was admitted by) the health facility for treatment on which the claim is basing on

Visit Date To

The date on which the patient was discharged from the health facility for treatment on which the claim is basing on

Visit Type

Type of visit covered by the claim (emergency, referal, other)

Claim No.

The unique identification of the claim within the claiming health facility.

Guarantee No.

Identification of a guarantee letter for prior approval of provision of claimed health care.

Claim Status

The status of the claim.

Review Status

The status of the claim with respect to reviewing.

Feedback Status

The status of the claim with respect to feed backing.

Claim Administrator

The administrator’s code and name, who was responsible for submission of the current claim.

• Modifiable data of the feedback included in the section Feedback the following
  Feedback Date

  Type in a date of collection of the feedback; Clicking on the field 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.

  Enrolment Officer

  Select an enrolment officer from the list of enrolment officers, by clicking the arrow on the right side of selection field. The enrolment officer collects feedback from the patient.

  Care Rendered

  Select ‘Yes’ or ‘No’ from the slider

  Payment Asked

  Select ‘Yes’ or ‘No’ from the slider

  Drugs Prescribed

  Select ‘Yes’ or ‘No’ from the slider

  Drugs Received

  Select ‘Yes’ or ‘No’ from the slider

  Overall Assessment

  Choose one level among the six levels available from the slider

Saving

Once all mandatory data is entered, clicking on the Save button (Img. 13) will save the feedback on current claim. The user will be re-directed back to the Claims Overview Page; a message confirming that the feedback has been saved will appear on the Information Panel. If inappropriate data is entered or mandatory data is not entered at the time the user clicks the Save button, an error message will appear in the Information Panel, and the data field will take the focus.

Back

By clicking on the back button (Img. 14), the user will be re-directed to the Claims Overview Page.

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.

Pre-conditions

A claim has been already processed (review actions menu).

Navigation

All functionality for use with the administration of processing of batches can be found under the main menu Claims, sub menu Batch Run (Img. 46).

Clicking on the sub menu Batch Run re-directs the current user to the Batch Run Control Page.

Batch Run Control Page

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)

1. Batch Processing Panel

The batch processing panel allows a user to process batches based on the following criteria:

Region

Select the 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 Year

District

Select the district 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

Select the 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

Select the Month from the list of months by clicking on the arrow on the right of the selector.

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 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.

2. 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 Type; from the list of time group types (Monthly, Quarterly, Yearly) by clicking on the arrow on the right of the selector.

Year

Select the Year; from the list of available years by clicking on the arrow on the right of the selector.

Period

Select the Period; from the list of months/quarters by clicking on the arrow on the right of the selector.

Region

Select the 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 selected

District

Select the District; 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 selected

Product

Select the Product; from the list that appear after typing characters , all product containing the typed text will appear and be selectable underneath the box.

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.

3. 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.

4. 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 (health facility) or by product (Product).

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 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 selected

District

Select the District; 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 selected

Health facility

Select the Health 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

Select the Product; from the list that appear after typing characters , all product containing the typed text will appear and be selectable underneath the box.

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.

5. 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.

6. 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.

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.

Pre-conditions

An insurance product may only be added or thereafter edited, after the approval of the management of the scheme administration.

Navigation

All functionality for use with the administration of insurance products can be found under the main menu Administration, sub menu Products.

Product Control Page

Clicking on the sub menu Products redirects the current user to the Product Control Page.

The 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

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 Code; to search for products with a Product Code, which starts with or matches completely, the typed text.

Product Name

Type in the beginning of; or the full Product Name to search for products with a Product Name, which starts with or matches completely, the typed text.

Date From

Type in a date; or use the Date Selector Button, to search for products with a 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

Type in a date; or use the Date Selector Button, to search for products with a 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

Select the Region from the list of regions by clicking on the arrow on the right of the selector to select products from a specific region.Note

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 District from the list of districts by clicking on the arrow on the right of the selector to select products from a specific district.Note

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 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. 53).

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 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.

Information Panel

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 Page

Data Entry

General

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 From determines the earliest date from which underwriting can be done. Mandatory.

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 Date to.Note

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.

Contribution Plan

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 disc. period months before the start date of the corresponding cycle.

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 disc. period months before the start date of the corresponding cycle.

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.

Covered Medical Items

List all items covered in this product. You can add new items by clicking on + 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.

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

Covered Medical Services

List all services covered in this product. You can add new services by clicking on + 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.

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

Deductibles and Ceilings

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 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. Mandatory

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 (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 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)

Insuree

Deductibles and Ceilings for an insuree may be entered for general care (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.

Policy

Deductibles and Ceilings for a policy may be entered for general care (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.

Extra Member Ceiling

Additional (extra) ceiling for a policy may be entered for general care (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.

Maximum Ceiling

Maximal ceiling for a policy may be entered for general care (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.

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 Consultations, Surgery, Delivery, Antenatal care, Hospitalizations, and Visits. The category of claim is determined according to the procedure described with Number.

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 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:

Note

Pooling Management

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 (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.

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 Cancel will cancel the action closing the popup and cancelling the change in the distribution.

Saving

Once all mandatory data is entered, clicking on the 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.

Mandatory data

If mandatory data is not entered at the time the user clicks the 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

By clicking on the Cancel button, the user will be re-directed to the Product Control Page.

Adding a Product

Click on the Add button to re-direct to the Product Page.

When the page opens all entry fields are empty. See the Product Page information on the data entry and mandatory fields.

Editing a Product

Click on the Edit button to re-direct to the Product Page.

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

Deleting a Product

Because of potential problems with synchronization of data between off-line and on-line version, it is not possible delete insurance products currently.

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.

Pre-conditions

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.

Navigation

All functionality for use with the administration of health facilities can be found under the main menu Administration, sub menu Health Facilities.

Clicking on the sub menu Health Facilities re-directs the current user to the Health Facilities Control Page.

Health Facilities Control Page

The 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)

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 Code; to search for health facilities with a Code, which starts with or matches completely, the typed text.

Name

Type in the beginning of; or the full Name; to search for health facilities with a Name, which starts with or matches completely, the typed text.

Fax

Type in the beginning of; or the full Fax to search for health facilities with a Fax, which starts with or matches completely, the typed number.

Level

Select the 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

Type in the beginning of; or the full Phone Number to search for health facilities with a Phone Number, which starts with or matches completely, the typed number.

Email

Type in the beginning of; or the full Email to search for health facilities with an Email which starts with or matches completely, the typed text.

Legal Form

Select the 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

Select the 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

Select the 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

Select the 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

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. 61)

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 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.

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.

Health Facility Page

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 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

Select the 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.

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.

Price Lists (Medical Services)

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.

Price Lists (Medical Items)

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.

Region, District, Municipality, Village, Catchment grid

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 Save 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.

Mandatory data

If mandatory data is not entered at the time the user clicks the 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

By clicking on the Cancel button, the user will be re-directed to the Health Facilities Control Page.

Adding a Health Facility

Click on the Add button to re-direct to the Health Facility Page.

When the page opens all entry fields are empty. See the Health Facility Page for information on the data entry and mandatory fields.

Editing a Health Facility

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

Deleting a Health Facility

Click on the Delete button to delete the currently selected record.

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.

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.

Pre-conditions

A medical service may only be added or thereafter edited or deleted, after the approval of the management of the scheme administration.

Navigation

All functionality for use with the administration of Medical Services can be found under the main menu Administration, sub menu Medical Services.

Clicking on the sub menu Medical Services re-directs the current user to the Medical Services Control Page.

Medical Services Control Page

The 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)

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 Code; to search for medical services with a Code, which starts with or matches completely, the typed text.

Name

Type in the beginning of; or the full Name to search for medical services with a Name, which starts with or matches completely, the typed text.

Type

Select the 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.

Historical

Click on Historical 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)

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

Medical Service Page

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.

Service Level

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 Save 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.

Mandatory data

If mandatory data is not entered the Save button won’t be active

Adding a Medical Service

Click on the Add button to re-direct to the Medical Service Page.

When the page opens all entry fields are empty. See the Medical Service Page for information on the data entry and mandatory fields.

Editing a Medical Service

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.

Deleting a Medical Service

Click on the < button to delete the currently selected record; the user is re-directed the Medical Services Control Page.

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.

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.

Pre-conditions

A medical item may only be added or thereafter edited or deleted, after the approval of the management of the scheme administration.

Navigation

All functionality for use with the administration of medical items can be found under the main menu Administration, sub menu Medical Items

Clicking on the sub menu Medical Items re-directs the current user to the Medical Items Control Page.

Medical Items Control Page

The 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)

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 Code; to search for medical items with a Code, which starts with or matches completely, the typed text.

Name

Type in the beginning of; or the full Name to search for medical items with a Name, which starts with or matches completely, the typed text.

Type

Select the 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

Type in the beginning of; or the full Package; to search for medical items with a Package, which starts with or matches completely, the typed text.

Historical

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. 72).

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)

Medical Item Page

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 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.

Mandatory data

If mandatory data is not entered at the time the user clicks the 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

By clicking on the Cancel button, the user will be re-directed to the Medical Items Control Page.

Adding a Medical Item

Click on the Add button to re-direct to the Medical Item Page.

When the page opens all entry fields are empty. See the Medical Item Page for information on the data entry and mandatory fields.

Editing a Medical Item

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.

Deleting a Medical Item

Click on the Delete button to delete the currently selected record

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.

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.

Pre-conditions

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.

Navigation

All functionalities related to the administration of price lists medical services can be found under the main menu Administration, sub menu Price Lists and sub menu Medical Services Price Lists

Clicking on the sub menu Medical Services Price Lists redirects the current user to the Price List Medical Services Control Panel.

Price List Medical Services Control Page

The 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 panels

Search Panel

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 Date to search for price lists of medical services with a creation Date which matches completely, the typed date.

Region

Select the 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.

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 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

Click on 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.

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 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.

Information 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.

Price List Medical Services Page

Data Entry

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 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

Select the 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.

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 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

Once all mandatory data is entered, clicking on the 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.

Mandatory Data

If mandatory data is not entered at the time the user clicks the 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

By clicking on the Cancel button, the user will be re-directed to the Price List Medical Services Control Page.

Adding a Price List of Medical Services

Click on the Add button to re-direct to the Price List Medical Services Page.

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.

Editing a Price List of Medical Services

Click on the Edit button to re-direct to the Price List Medical Services Page.

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.

Deleting a Price List of Medical Services

Click on the Delete button to delete the currently selected record.

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.

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.

Pre-conditions

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.

Navigation

All functionality for use with the administration of medical items price lists can be found under the main menu Administration, sub menu Price Lists, sub menu Medical Items Price Lists.

Clicking on the sub menu Medical Items re-directs the current user to the Price List Medical Items Control Page.

Price List Medical Items Control Page

The 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

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 Name; to search for price lists medical items with a Name, which starts with or matches completely, the typed text.

Date

Type in the full Date to search for price lists of medical items with a creation date which matches completely, the typed date.

Region

Select the 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

Select the 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

Click on 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).

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 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.

Information Panel

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.

Price List Medical Item Page

Data Entry

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 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

Select the 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 .

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 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

Once all mandatory data is entered, clicking on the 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.

Mandatory data

If mandatory data is not entered at the time the user clicks the 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

By clicking on the Cancel button, the user will be re-directed to the Price List Medical Items Control Page.

Adding a Price List of Medical Items

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.

Editing a Price List of Medical Items

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.

Duplicating a Price List of Medical Items

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 Save.

Deleting a Price List of Medical Items

Click on the Delete button to delete the currently selected record; the user is re-directed to the Price List Medical Items Control Page.

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.

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.

Pre-conditions

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.

Navigation

All functionalities related to users administration can be found under the main menu Administration, sub menu Users.

Clicking on the sub menu Users redirects the current user to the Users List Page.

Users List Page

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.

Search Panel

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.

Results 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)

Buttons Panel

With exception of the 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

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 Page

Fields

Generic Fields

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).

Login Fields

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.

Enrolment Officer Fields

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.

Claim Administrator Fields

Birth date

Birth date of the enrolment officer.

Saving

Once all mandatory data is entered, clicking on the 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.

Mandatory fields

If mandatory fields are not filled when the user clicks on the 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

By clicking on the Cancel button, the user will be redirected to the User List Page.

Adding a User

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.

Editing a User

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

Deleting a User

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.

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.

Navigation

All functionality for use with the administration of user roles can be found under the main menu Administration, sub menu Users Profile.

Clicking on the sub menu Users re-directs the current user to the User roles/profiles control page.

User roles/profiles control page

The 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).

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 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).

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 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.

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.

User role/profile Page

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 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

By clicking on the Cancel button, the user will be re-directed to the User roles/profiles control page.

Mandatory data

If mandatory data is not entered at the time the user clicks the 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

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.

Editing a User role/profile

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.

Duplicating a User role/profile

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 Save.

Deleting a User role/profile

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.

Default User roles and rights

The table below shows the default roles in openIMIS.

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.

Pre-conditions

A payer may only be added or thereafter edited or deleted, after the approval of the management of the scheme administration.

Navigation

All functionality for use with the administration of payers can be found under the main menu Administration, sub menu Payers.

Clicking on the sub menu Payers re-directs the current user to the Payer Control Page.

Payer Control Page

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
  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.

• Email
  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.

• Region
  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.

• District
  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

• Phone Number
  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.

• Type
  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.

• Historical
  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).

• 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 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 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.

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.

Payer Page

Data Entry

• Type
  Select the type of the payer from the list by clicking on the arrow on the right hand side of the lookup. Mandatory.

• Name
  Enter the name for the payer. Mandatory, 100 characters maximum.

• Address
  Enter address of the payer. Mandatory, 100 characters maximum.

• Phone Number
  Enter the phone number for the payer. 50 characters maximum.

• Fax
  Enter the fax number for the payer. 50 characters maximum.

• Email
  Enter the email for the payer. 50 characters maximum.

• Region
  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.

• District
  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.

Saving

Once all mandatory data is entered, clicking on the 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.

Mandatory data

If mandatory data is not entered at the time the user clicks the 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

By clicking on the Cancel button, the user will be re-directed to the Payer Control Page.

Adding a Payer

Click on the Add button to re-direct to the Payer Page.

When the page opens all entry fields are empty. See the Payer Page for information on the data entry and mandatory fields.

Editing a Payer

Click on the Edit button to re-direct to the Payer Page.

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.

Deleting a Payer

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.

1.3.10 Locations

Administration of locations is restricted to users with the the system role of IMIS Administrator or with a role including an access to Administration/Locations. The user can see only locations he/she has access to.

Pre-conditions

A region, district, municipality or village may only be added or thereafter edited, after the approval of the management of the scheme administration.

Navigation

All functionality for use with the administration of locations can be found under the main menu Administration, sub menu Locations.

Clicking on the sub menu Locations redirects the current user to the Locations Page.

Locations Page

The Locations page is the central point for all locations administration. By having access to this page, it is possible to add, edit, delete and move regions, districts, municipalities and villages. The page is divided into three panels (Img. 106). Note. Only regions and districts with associated municipalities and villages, belonging to the logged in user will be available to edit or delete. On adding a new region or district, the user will automatically become associated with this region or district.

1. Locations Panel
   This is the working panel and is divided into four vertical panels of Regions, Districts, Municipalities and Villages.

2. Button Panel
   It has three buttons, Add (Img. 12), Delete (Img. 109) and Move (Img. 107) for actions on the locations, double click on a location will open the edit modal box.

Tab. 7 Material design button

3. Information Panel
   The Information Panel is used to display messages back to the user. Messages will occur once a region, district or municipality or village has been added, updated, moved or deleted or if there was an error at any time during the process of these actions.

Adding a Region, District, Municipality, Village

Focusing on the appropriate level of locations by clicking on the Add button will open up a modal entry box. Here one could enter the new code (Code) and name (Name) of a region, district, municipality or village. For villages, the number of male inhabitants (M), female inhabitants (F), inhabitants with the unspecified gender (O) and the number of families (Fam.) can be specified. On clicking the Save button the new record will be saved.

Editing a Region, District, Municipality, Village

Selecting the location to edit and clicking on the Edit button will open up in the top of the screen an entry box with the name of the location. Here one could change the name. On clicking the Save button, the record will be saved.

Deleting a Region, District, Municipality, Village

Select first the location to delete and click the Delete button. Note. It is not possible to delete a region, district or municipality with associated districts, municipalities or villages respectively.

Before deleting a confirmation popup (Img. 110) is displayed, which requires the user to confirm if the action should really be carried out?

When a region, district, municipality or village is deleted, all records retaining to the deleted region, district, municipality or village will still be available by selecting historical records.

Moving a District, Municipality, Village

Moving of a location is needed when the administrative division of the territory, on which a health insurance scheme is active, changes. Clicking on the Move button will open the move location box (Img. 111).

Move Location box

The move location box is composed of three sections, the first display the name of the location to be moved. The second display the name of the current parent when the third enable the selection of the future parents.

For moving a location, select the new parents (village, municipality, district), the fields will appear when needed, for example the municipality drop-down list will be displayed only if the district is selected. The level of the location can be changed by choosing the lower (resp. higher) parent having a different level from the current parent; be aware that the lowest location is the village, therefore if a municipality is moved to village level then the villages under the moved municipality will remain villages but will be moved under the municipality chosen the new parent of the to-be moved municipality.

The Move will be effective once the Move button is clicked.

1.3.11 Policyholder User

The policyholder user is used to link user to policyholders, in addition to the access right policyholder portal that allows the user to have access to only some policyholder.

Pre-conditions

User and Policyholder must be created before

Navigation

All functionality for use with the administration of policyholder users can be found under the main menu Administration, sub menu Policyholder Users.

Clicking on the sub menu Policyholder Users re-directs the current user to the Find contract Page.

Search Page

1. Search criteria

   • User: opeimin user

   • PolicyHolder

   • Date valid from/to

   • Show deleted

2. Results

   The columns name definiction matches with the search criteria definitions

   The rows are the search results

   • Edit policyholder

     as doubleclick on the line, clicking on that button will open the edit popup

     

   • Delete policyhodler

     Confirmation pop up is displayed.

   • duplicate

     A creation popup will be displayed.

3. Create policyholder user button

   A creation popup will be displayed

1.3.12 Contribution Plan

The goal of the contribution plans is the bring flexibity in the enrollment and princing models.

A contribution plan will attach a pricing strategy (calcRule) to given product, it can add up parameters in other pages when its stragegy requires information attached to other object: for example, a CP can ask the monthly income of an inuree to use it in the contribution value calculation

For one given product, multiple contribution plans could be created.

Pre-conditions

Product must be created

Navigation

All functionality for use with the administration of contribution plan can be found under the main menu Administration, sub menu Contribution plan.

Clicking on the sub menu Contribution plan re-directs the current user to the Find contract Page.

Search Page

1. Search criteria

   • Code: code of Contribution plan

   • Name: name of Contribution plan

   • Date valid from/to: period on which the Contribution plan is valid

   • Periodicity: periodicity of the Contribution plan plan in months

   • Show deleted

2. results

   the columns name definiction matches with the search criteria definitions plus:

   • calucation rule: rule used to calculate the policy value but also all related logic (person to be covered, additionnal condition, grace periods …. )

   • insurance product: product to be used when creating policy/coverage

   the rows are the search results

   • Edit Contribution plan

     doubleclick on the line or clicking on the edit button will open the edit page

     

     Img. 117 EditContribution plan

   • Delete

     Confirmation pop up is displayed

   • duplicate

     a creation popup will be displayed

3. create Contribution plan button

   a creation popup will be displayed

1.3.13 Contribution Plan Bundle

The goal of the contribution plans bundle (CPB) is the group several contribution plan to build a standard offering for a bundle of product.

The goal is to ease enrollement of conplex offerings where it would be easy otherwise for the user to mkae a misstake.

The Contribution plan bundle is linked to Contribution plans.

Pre-conditions

Product must be created

Navigation

All functionality for use with the administration of Contribution plan bundle can be found under the main menu Administration, sub menu Contribution plan bundle.

Clicking on the sub menu Contribution plan bundle re-directs the current user to the Find contract Page.

Search Page

1. Search criteria

   • Code: code of Contribution plan bundle

   • Name: name of Contribution plan bundle

   • Calculation rule: rule part of a contribution plan

   • Insurance product: insurance product of a contribution plan

   • Date valid from/to: period on which the Contribution plan bundle is valid

   • Periodicity: periodicity of the Contribution plan bundle plan in months

   • Show deleted

2. results

   the columns name definiction matches with the search criteria definitions:

   the rows are the search results

   • Edit Contribution plan bundle

     Doubleclick on the line or clicking on the edit button will open the edit page

     

     “Create New Contribution Plan” button can add a new link between the bundle and a contribution plan

     create popup will be displayed

     Edit button

     edit popup will be displayed

     delete button

     confirmation popup will be displayed

     replace button

     replace popup will be displayed, the old link will have the validity to updated to the validiy from of the new link
     

   • Delete

     Confirmation pop up is displayed

   • duplicate

     a creation popup will be displayed

3. create Contribution plan bundle button

   a creation popup will be displayed

1.4 Group/family, Insurees and Policies

In openIMIS the policies are assigned to group only, if a policy need to be assigned to an individual then a group of one must be created.

Because of this approach, the Family Overview Page is the starting point to manage, insuree (add, edit), policies(add, edit, renew …) and contribution

1.4.1 Insuree Enquiry

This functionality is available to all system roles or with a role including an access to Insurees and Families/Insuree/Enquiry. The function Insuree Enquiry can be accessed at any time, after login. On the top right hand of the main menu, there is a search feature, allowing the user to enter an Insurance Number for a “quick enquiry”.

By typing in a valid insurance­­­­­­­ number and pressing the enter key or clicking on the green search button, a pop-up will appear (Img. 121), providing a photo of the insuree and information about the current policy or policies covering of the insuree.

The Information includes the following:

• The photo of the insuree

• The name, date of birth and gender of the insuree

• The (insurance) product code, product name and expiry date of a policy

• The status (I for Idle, A for Active, S for Suspended and E for Expired) of the policy at the time of inquiring

• The deductible amount remaining for the insuree to pay before the policy is claimable, for hospitals and non-hospitals

• The ceiling amount claimable by a health facility on behalf of the insuree for both hospitals and non-hospitals.

• Age of the insuree

• First Service Point (FSP) of the insuree

  • Region of FSP

  • District of FSP

  • Level of FSP

1.4.2 Family/Group

Find Family

Access to the Find Family Page is restricted to users with the system roles of Accountant, Clerk and Health Facility Receptionist or with a role including an access to Insurees and Families/Family/Enquiry.

Pre-conditions

Need to enquire on, or edit a family and/or insurees, policies and contributions associated.

Navigation

Find Family can be found under the main menu Insurees and Policies sub menu Families/Groups

Clicking on the sub menu Families/Groups re-directs the current user to the Find Family Page.

The Find Family Page is the first step in the process of finding of a family and thereafter accessing the Family Overview Page of insurees, policies and contributions. This initial page can be used to search for specific families or groups based on specific criteria. The page is divided into two panels (Img. 124):

1. Search Criteria 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.

   • Region

     Select the Region; from the list of regions by clicking on the arrow on the right of the selector to select families/groups 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 families/groups 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 select families/groups from a specific municipality. Note: The list will only be filled with the municipalities in the selected district above.

     Select the Village; from the list of villages by clicking on the arrow on the right of the selector to select families/groups from a specific village. Note: The list will only be filled with the villages in the selected municipality above.

   • Head (/Member) Insuree Insurance Number

     Type in the beginning of; or the full Insurance Number to search for families/groups, who’s family/group head (/member) Insurance Number, starts with or matches completely, the typed text.

   • Head/Member Insuree Last Name

     Type in the beginning of; or the full Last name; to search for families/groups, who’s family/group head (/member) Last name, starts with or matches completely, the typed text.

   • Head/Member Insuree Other Names

     Type in the beginning of; or the full Other Names to search for families/groups, who’s family/group head(/member) Other Names starts with or matches completely, the typed text.

   • Head/Member Insuree Gender

     Select the Gender; from the list of gender by clicking on the arrow on the right of the selector, to select families/groups, who’s family/group head(/member) is of the specific gender.

   • Head/Member Phone Number

     Type in the beginning of; or the full Phone Number to search for families/groups, who’s family/group head(/member) Phone Number, starts with or matches completely, the typed number.

   • Head/Member Email

     Type in the beginning of; or the full Email to search for families/groups, who’s family/group head(/member) Email, starts with or matches completely, the typed number.

   • Head/Member Birth Date From

     Type in a date; or use the Date Selector Button, to enter the Birth Date From to search for families/groups, who’s family/group head(/member), has the same or later birth date than Birth Date From. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.

   • Head/Member Birth Date To

     Type in a date; or use the Date Selector Button, to enter the Birth Date To to search for families/groups, who’s family/group head(/member), has the same or earlier birth date than Birth Date To. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.

   • Poverty Status

     Select the Poverty Status; from the list of has poverty status by clicking on the arrow on the right of the selector, to select families/groups that have a specific poverty status.

   • Confirmation No.

     Type in the beginning of; or the full Confirmation No. to search for families/groups, who’s Confirmation No. starts with or matches completely the typed text.

   • Historical

     Click on Historical to see historical records matching the selected criteria. Historical records are greyed to clearly define them from current records and no delete action is possible (Img. 125).
     

     

   • Reset Filter Button

     To clear the current criteria.

   • Search Button

     To launch the search and filter the records, the results will appear in the Result Panel.

2. Result Panel
   The Result Panel displays a list of all families/groups found, matching the selected criteria in the Search Panel.

   Double clicking on a record re-directs the user to the Family Overview Page for the Family selected or if it is an historical record then the Change Family Page, for detailed viewing.

   Clicking on the trash icon allows user to delete a family (see below).

   The result table is paginated, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Img. 126)
   

   

Family/Group Overview

Access to the Family Overview Page is restricted to users with the system role of Accountant or Clerk or with a role including an access to Insurees and Families.

Pre-conditions

Need to enquire on, or edit a family/group or manage the insurees, policies and contributions associated with it.

Navigation

Family Overview Page cannot be navigated directly to; the first step is to find the family/group by means of using Find Family Page, Find Insuree Page, Find Policy Page or Find Contribution Page. Once a specific family, insuree, policy or contribution is selected by means of selecting the hyperlink in the Result Panel of the respective Find Page, the user is re-directed to the Family Overview Page.

Family Overview Page

The Family Overview Page is the central point for all operations with regards to the families/groups, Insurees, policies and contributions associated with it. The page is divided into 5 panels (Image Family overview)

1. Family/Group Panel
   The Family/Group Panel provides information about the family including the District, Municipality, Village, the Insurance Number and the Last Name and Other Names of the head of family and Poverty status of the family.

2. Insurees Panel
   The Insurees Panel displays a list of the insurees within the family/group. Double clicking on a record re-directs the user to the insuree record for editing or detailed viewing.

   When selecting an insuree in the list, the Policy Panel, will refresh with the policies covering the selected insuree.

   In the Insurees Panel, action buttons allow to add (new or existing - non head- insuree) On insuree, one can set it as family head, remove (‘detach’) insuree from the family/group or delete the insuree.

   When an insuree is removed from the family or deleted, the confirmation dialog gives two options(Remove insuree dialog):

   • Remove/Delete and Cancel Policies: to remove the insuree from any active policy coverage

   • Remove/Delete and Cancel Policies: to keep any existing policy active for that insuree (untill policy renewal)
     

     

3. Policies Panel
   The Policies Pane displays a list of the policies held by the family/group.

   By default only the (last)actives policies are shown. Unchecking Show only last active or last expired displays the previous policies.

   The Add action allows to create a new Policy for edited Family.

   Double clicking on a record re-directs the user to the policy for editing or detailed viewing.

   Each row also contains Delete and Renew actions.

   When selecting a policy in the list, the Contribution Panel, will refresh with the contributions linked to the newly selected policy.

4. Contributions Panel
   The Contribution sPanel displays a list of contributions of the policy currently selected in the Policies Panel.

   Double clicking on a record re-directs the user to the contribution for editing or detailed viewing.

   Each row also contains a Delete action.

   The Add action allows to create a new Contribution for edited Family.

   When selecting a contibution in the list, the Payment Panel, will refresh with the payments linked to the newly selected contribution.

5. Payments Panel
   The Payments Panel displays a list of payments of the contribution currently selected in the Contributions Panel.

   Double clicking on a record re-directs the user to the payment for editing or detailed viewing.

   Each row also contains a Delete action.

   The Add action allows to create a new Payment for edited Family.

Family/Group Page

The Family/Group Page is made of two major section: one for the family/group data itslef, on the the family/group head insuree.

1. The Family/Group data section
   The Family/Group section is dedicated to show/provide the family/group specific data:

   • Region

     Select from the list of available regions the region, in which the head of family/group permanently stays. 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. Mandatory.

   • District

     Select from the list of available districts the district, in which the head of family/group permanently stays. 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. Mandatory.

   • Municipality

     Select from the list of available municipalities the municipality, in which the head of family/group permanently stays. Note: The list will only be filled with the municipalities belonging to the selected district. Mandatory.

   • Village

     Select from the list of available villages the village, in which the head of family/group permanently stays. Note: The list will only be filled with the villages belonging to the selected municipality. Mandatory.

   • Confirmation Type

     Select the type of a confirmation of the social status of the family/group.

   • Confirmation No.

     Enter alphanumeric identification of the confirmation of the social status of the family/group.

   • Group Type

     Select the type of the group/family.

   • Address Details.

     Enter details of the permanent address of the family/group.

   • Poverty Status

     Select whether the family/group has the poverty status.

2. The Head Insuree Details section
   The Head Insuree Details section is dedicated to show/provide the family/group head data.

   The select existing allows to import (use) an existing (non head) insuree as family/group head.

   • Insurance Number

     Enter the insurance number for the head of family/group. Mandatory.

   • Last name

     Enter the last name (surname) for the head of family/group. Mandatory.

   • Other Names

     Enter other names of the head of family/group. Mandatory.

   • Birth Date

     Enter the date of birth for the head of family/group. Note: You can also use the button next to the birth date field to select a date to be entered.

   • Gender

     Select from the list of available genders the gender of the head of family/group. Mandatory.

   • Marital Status

     Select from the list of available marital statuses the marital status of the head of family/group.

   • Beneficiary Card

     Select from the list of card whether or not an insurance identification card was issued to the head of family/group.

   • Location (Region, District, Municipality, Village)

     The checkbox indicates wherever or not the insuree has the same location as the Family.

     When unchecked, user has the ability to provide a distinct Region/District/Municipality/Village for the insuree.
     

     

   • Current Address Details

     The checkbox indicates wherever or not the insuree has the same address as the Family. When unchecked, user has the ability to provide a distinct Region/District/Municipality/Village for the insuree.

   • Phone Number

     Enter the phone number for the head of family/group.

   • Email

     Enter the e-mail address of the head of family/group.

   • Profession

     Select the profession of the head of family/group.

   • Education

     Select the education of the head of family/group.

   • Identification Type

     Select the type of the identification document of the head of family/group.

   • Identification No.

     Enter alphanumeric identification of the document of head of family/group.

   • Photo date

     The date of the photo for the head of family/group related to his/her insurance number.

   • Officer

     The officer who provided the photo of the head of family/group related to his/her insurance number.

   • Avatar

     Browse to get the photo for the head of family/group related to his/her insurance number.

   • Region of FSP

     Select from the list of available regions the region, in which the chosen primary health facility (First Service Point) of the head of family/group is located.

   • District of FSP

     Select from the list of available districts the district, in which the chosen primary health facility (First Service Point) of the head of family/group is located. Note: The list will only be filled with the districts belonging to the selected region.

   • Level of FSP

     Select the level of the chosen primary health facility (First Service Point) of the head of family/group.

   • First Service Point

     Select from the list of available health facilities the chosen primary health facility (First Service Point) of the head of family/group. Note: The list will only be filled with the health facilities belonging to the selected district which are of the selected level.

Adding a Family

A new family can be added using the Add Family/Group main menu entry or via the “+” fab button in the Find Families page.

When the page opens all entry fields are empty. See the Family/Group Pagefor information on the data entry and mandatory fields.

Editing a Family/Group

To edit a Family/Group, double click on the corresponding Find Families result table record.

Changing a Head of Family/Group

The head of the Family/Group is the main contact associated with a policy. For various reasons it may be necessary to change the head of a family/group.

You can change the Family/Group head from the Family Overview Page, in the family insurees section:

Moving an Insuree

Insurees may be moved from one family/group into the edited family. The new insuree must not be a head of family/group in another family/group.

Use the Add existing action in the insurees section of the Family Overview Page page to do so.

A Insuree Search dialog (automatically filtering on non-head insuree) allows the user to find the insuree

When selecting an Insuree, the user has two options:

• Move and Cancel Policies, to cancel the insuree’s policy in the family it is issued from

• Move and Keep Policies, to let current policies active (until policy renewal)

Deleting a Family/Group

To delete a Family/Group, click Delete action in the corresponding Find Families result table record.

Before deleting a confirmation popup is displayed, which requires the user to confirm if the action should really be carried out.

The confirmation dialog gives two options:

• Delete Family and Members: dedicated to also delete any member from that family

• Delete Family Only: family members are ‘detached’ (and remain without family), but not deleted

When a family is deleted, all records retaining to the deleted family will still be available by selecting historical records.

1.4.3 Insuree

Find Insuree

Access to the Find Insuree Page is restricted to users with the system roles of Accountant, Clerk and Health Facility Receptionist or with a role including an access to Insurees and Families/Insuree/Search.

Pre-conditions

Need to enquire on, or edit an insuree, and the family/group, policies and contributions associated.

Navigation

All functionality for use with the administration of insurees can be found under the main menu Insurees and Policies, sub menu Insurees.

Clicking on the sub menu Insurees re-directs the current user to the Find Insuree Page.

Page

The Find Insuree Page is the first step in the process of finding an insuree and thereafter accessing the family/group overview of insurees, policies and contributions. This initial page can be used to search for specific Insurees or groups of insurees based on specific criteria. The panel is divided into three panels (Img. 135)

A. Search Panel

The Search Panel allows a user to select specific criteria to reduce the search results. In the case of insurees the following search options are available, which can be used alone or in combination with each other.

Region

Select the Region; from the list of regions by clicking on the arrow on the right of the selector to select insurees 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 insurees 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 wards either by typing at least two characters or by clicking on the arrow on the right of the selector to select insurees from a specific municipality. Note: The list will only be filled with the wards in the selected district above.

Village

Select the Village; from the list of villages either by typing at least two characters or by clicking on the arrow on the right of the selector to select insurees from a specific village. Note: The list will only be filled with the villages in the selected municipality above.

Insurance Number

Type in the beginning of; or the full Insurance Number to search for insurees with the Insurance Number, which starts with or matches completely, the typed text.

Last Name

Type in the beginning of; or the full Last name; to search for insurees with a Last name, which starts with or matches completely, the typed text.

Given Names

Type in the beginning of; or the full Given Names to search for insurees with Other Names which starts with or matches completely, the typed text.

Gender

Select the Gender; from the list of genders by clicking on the arrow on the right of the selector, to select insurees of a specific gender.

Marital Status

Select the Marital Status; from the list of marital status by clicking on the arrow on the right of the selector, to select insurees of a specific marital status.

Email

Type in the beginning of; or the full Email address to search for insurees with a Email, which contains or matches completely, the typed email.

Phone Number

Type in the beginning of; or the full Phone Number to search for insurees with a Phone Number, which contains or matches completely, the typed number.

Birth Date From

Type in a date; or use the Date Selector Button, to enter the Birth Date From to search for insurees who have the same or later birth date. Note. To clear the date entry box; click on the date and use the ``Clear`` button on the bottom left.

Birth Date To

Type in a date; or use the Date Selector Button, to enter the Birth Date To to search for insurees who have the same or earlier birth date. Note. To clear the date entry box; click on the date and use the ``Clear`` button on the bottom left.

Photo status

Select whether all insurees are searched [Any] or only insurees [With] a photo assigned or only insurees [Without] photo assigned.

Show historical values

Click on Show historical values to see historical records matching the selected criteria. Historical records are displayed in the result as grayed out. (Img. 136)

Search Buttons

When criteria are defined and potentially after a small delay, the search will be automatically executed. There are however two buttons on the top right:

	Reset search criteria
	Search (again)

B. Result Panel

The result panel displays a list of all Insurees found, matching the selected criteria in the search panel. The leftmost column contains a search icon which if clicked, opens a dialog with further details and eligibility check. On the right, the family icon directs the user to the Family Overview Page of the insuree’s family, and a button to delete the insuree.

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. 139)

C. Information/Button Panel

The Information Panel is used to display messages back to the user. Messages will occur once a insuree has been added, updated or deleted or if there was an error at any time during the process of these actions.

The + button will create a new insuree.

Insuree Page

1. Family Details

   The first section contains the family information. Refer to the Family section for details about the displayed fields.

2. Insuree Data

   Relationship

   Shown in the insuree section header only if the insuree is not the head of the family. Select from the list of available relationships of the insuree to the head of family/group.

   Insurance Number

   Enter the insurance number for the insuree. Mandatory.

   Last name

   Enter the last name (surname) for the insuree. Mandatory, 100 characters maximum.

   Given Names

   Enter given names of the insuree. Mandatory, 100 characters maximum.

   Birth Date

   Enter the date of birth for the insuree.

   Gender

   Select from the list of available genders the gender of the insuree. Mandatory.

   Marital Status

   Select from the list of available options for the marital status of the insuree.

   Beneficiary Card

   Select from the list of options whether or not the card was issued to the insuree.

   Photo Date

   Select the date at which the picture was taken.

   Photo

   Click on the person icon to upload a photo for the insuree related to his/her insurance number.

   Note: There is an automated service in the openIMIS Server which will run on configured time basis repeatedly and assign related photos to insurees without photos if any exist in the openIMIS database. So after a user has input insuree’s insurance number and no photo is displayed, there is no need to browse for the photo as that process will be done automatically by the service if the service is configured.

   Officer

   Select the officer handling the insuree. Mandatory.

   Same Village as Family

   If selected, the village of the family is used for this insuree too. Otherwise, fields will appear with Region, District, Ward and Village selection.

   Same Address as Family

   If selected, the address of the family is used for this insuree too. Otherwise, an address field will appear to provide the actual address.

   Phone Number

   Enter the phone number for the insuree.

   Email

   Enter the e-mail address of the insuree.

   Profession

   Select from the list of available professions the profession of the insuree.

   Education

   Select from the list of available educations the education of the insuree.

   Identification Type

   Select the type of the identification document of the insuree.

   Identification No.

   Enter alphanumeric identification of the document of the insuree.

   First Service Point

   Region of FSP

   Select from the list of available regions the region, in which the chosen primary health facility (First Service Point) of the insuree is located.

   District of FSP

   Select from the list of available districts the district, in which the chosen primary health facility (First Service Point) of the insuree is located. Note: The list will only be filled with the districts belonging to the selected region.

   Level of FSP

   Select the level of the chosen primary health facility (First Service Point) of the insuree.

   First Service Point

   Select from the list of available health facilities the chosen primary health facility (First Service Point) of the insuree. Note: The list will only be filled with the health facilities belonging to the selected district which are of the selected level.

3. Saving

   

   Once all mandatory data is entered, clicking on the Save button will save the record. The user will be re-directed back to the Family Overview Page, with the newly saved record displayed and selected in the result panel. A message confirming that the insuree has been saved will appear on the Information Panel.

   Mandatory data

   The Save button is disabled until all mandatory data fields (with an asterisk) are filled.

   Cancel

   By clicking on the Cancel button, the user will be re-directed to the Family Overview Page.

Adding an Insuree

Click on the Green Plus Sign to re-direct to the Insuree Page.

When the page opens all entry fields are empty. See the Insuree Page for information on the data entry and mandatory fields.

Editing an Insuree

Double-click in the insuree search results to edit in the Insuree Page.

The page will open with the current information loaded into the data entry fields. See the Insuree Page for information on the data entry and mandatory fields.

Deleting an Insuree

Click on trashcan icon on the right of an insuree search result to delete it.

Before deleting a confirmation popup (Img. 141) is displayed, which requires the user to confirm if the action should really be carried out?

When an insuree is deleted, all records retaining to the deleted insuree will still be available by selecting historical records.

1.4.4 Policy

Find Policy

Access to the Find Policy Page is restricted to users with the role system roles of Accountant, Clerk or Health Facility Receptionist or with a role including an access to Insurees and Families/Policy/Search.

Pre-conditions

Need to enquire on, or edit a policy, and the family/group, insurees and contributions associated.

Navigation

Find Policy Page can be found under the main menu Insurees and Policies, sub menu Policies.

Clicking on the sub menu Policies re-directs the current user to the find policy page.

Page

The Find Policy Page is the first step in the process of finding a policy and thereafter accessing the Family Overview Page of insurees, policies and contributions. This initial page can be used to search for specific policies or groups of policies based on specific criteria. The panel is divided into two main panels (Img. 143)

Search Panel

The Search Panel allows a user to select specific criteria to minimise the search results. In the case of policies the following search options are available which can be used alone or in combination with each other.

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 for families/groups residing in 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.

Product

Select the Product; from the list of products by clicking on the arrow on the right of the selector, to select policies for a specific product.

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 policies related to a specific enrolment officer.

Enrolment Date From

Use the date selector to enter the Enrolment Date From to search for policies with an Enrolment Date equal or later than the specified date.

Enrolment Date To

Use the date selector to enter the Enrolment Date to to search for policies with an Enrolment Date equal or earlier than the specified date.

Start Date From

Use the date selector to enter the Start Date From to search for policies with a Start Date equal or later than the specified date.

Start Date To

Use the date selector to enter the Start Date to to search for policies with a Start Date equal or earlier than the specified date.

Effective Date From

Use the date selector to enter the Effective Date From to search for policies with an Effective Date equal or later than the specified date.

Effective Date To

Use the date selector to enter the Effective Date To to search for policies with an Effective Date To equal or earlier than the specified date.

Expiry Date From

Use the date selector to enter the Expiry Date From to search for policies with an Expiry Date equal or later then the specified date.

Expiry Date To

Use the date selector to enter the Expiry Date To to search for policies with an Expiry Date equal or earlier then the specified date.

Policy Type

Select whether new policies [New Policy] or renewed policies [Renewal] should be searched for.

Policy Status

Select the Policy Status; from the list of policy statuses by clicking on the arrow on the right of the selector, to select policies for a specific policy status.

A policy can have the following statuses:

• Idle (Policy data entered but policy not yet activated)

• Active (Policy partially or fully paid and made active)

• Suspended (Policy was not fully paid for within the grace period)

• Expired (Policy is not active anymore as the insurance period elapsed)

Balance

Types in a positive Balance to search for policies with a balance equal or greater than the typed amount. For example if 0 (zero) is entered, all policies with a balance, will be displayed. If 1,000 is entered, then only policies with a balance equal to or greater than 1,000 will be displayed.

The balance is the difference between the policy value and total of contributions paid. For the policy

Only with inactive insurees

Check the box to select only policies for families/groups with insurees which are non-active (not covered) despite the policy of their family/group is active. The reason may be addition of a new insuree (member) to the family/group with an active policy without adequate payment of additional contributions or because the maximum number of members in the family/group exceeds the maximum number determined by the insurance product of the policy.

Show historical

Click on Historical to see historical records matching the selected criteria. Historical records are displayed in grey to define them from current records (Img. 144) and do not have action buttons.

Result Panel

The Result Panel displays a list of all policies found, matching the selected criteria in the search panel. The currently selected record is highlighted (Img. 145). On the right are the available action buttons. One can also double-click on the row to view the policy details.

Policy Page

Family Details

Summary of the family concerned by this policy.

Policy Details

Enrolment Date

Enter the enrolment date for the policy. Mandatory. Note: You can also use the button next to the enrolment date field to select a date to be entered.

Effective Date

The effective date for the policy is calculated automatically later on. The effective date is the maximum of the start date and the date when the last contribution was paid or when the user enforced activation of the policy.

Start Date

The start date for the policy is calculated automatically. Either it is the enrolment date plus the administration period of the insurance product associated with the policy for free enrolment (without cycles) or it is a cycle start date determined according to enrolment date and the administration period for enrolment in fixed cycles. The start date may be modified by the user.

Expiry Date

The expiry date for the policy is calculated automatically. When entering a new policy, the expiry date is the start date plus the insurance period of the insurance product associated with the policy for free enrolment or the cycle start date plus the insurance period for enrolment in fixed cycles.

Product

Select from the list of available products the product of the policy. Mandatory.

Enrolment Officer

Select from the list of available enrolment officers the enrolment officer related to the policy. Mandatory

Policy Values

Value

Value

Contributions paid

Amount of contribution paid

Balance

Balance

Deductible

Deductible amounts for the categories: General, In-Patient and Out-Patient

Remunerated Health Care

Remunerated amounts for the categories: General, In-Patient and Out-Patient

Saving

Once all mandatory data is entered, clicking on the Save button will save the record. The user will be re-directed back to the Family Overview Page, with the newly saved record displayed and selected in the result panel.

Adding a Policy

To create a new policy for a family that doesn’t have any yet, head over to the Family Page and in the policies section, use the plus sign on the top right.

Renewing a Policy

Click on the renewal arrows to go to the Policy Page.

The page will open with the current information loaded into the data entry fields. See the Policy Page for information on the data entry and mandatory fields.

Pausing a Policy

Click on the pause symbol to get a confirmation dialog and pause the corresponding policy.

Deleting a Policy

Click on the trashcan icon to delete the currently selected policy.

Before deleting of a policy, all contributions of the policy should be deleted. Before deleting a confirmation popup (Img. 149) is displayed, which requires the user to confirm if the action should really be carried out.

When a policy is deleted, all records retaining to the deleted policy will still be available by selecting historical records.

1.4.5 Contribution

The goal of the contribution plans bundle (CPB) is the group several contribution plan to build a standard offering for a bundle of product.

The goal is to ease enrollement of conplex offerings where it would be easy otherwise for the user to mkae a misstake.

The Contribution plan bundle is linked to Contribution plans.

Pre-conditions

Product must be created

Navigation

All functionality for use with the administration of Contribution plan bundle can be found under the main menu Administration, sub menu Contribution plan bundle.

Clicking on the sub menu Contribution plan bundle re-directs the current user to the Find contract Page.

Search Page

1. Search criteria

   • Code: code of Contribution plan bundle

   • Name: name of Contribution plan bundle

   • Calculation rule: rule part of a contribution plan

   • Insurance product: insurance product of a contribution plan

   • Date valid from/to: period on which the Contribution plan bundle is valid

   • Periodicity: periodicity of the Contribution plan bundle plan in months

   • Show deleted

2. results

   the columns name definiction matches with the search criteria definitions:

   the rows are the search results

   • Edit Contribution plan bundle

     Doubleclick on the line or clicking on the edit button will open the edit page

     

     “Create New Contribution Plan” button can add a new link between the bundle and a contribution plan

     create popup will be displayed

     Edit button

     edit popup will be displayed

     delete button

     confirmation popup will be displayed

     replace button

     replace popup will be displayed, the old link will have the validity to updated to the validiy from of the new link
     

   • Delete

     Confirmation pop up is displayed

   • duplicate

     a creation popup will be displayed

3. create Contribution plan bundle button

   a creation popup will be displayed

1.4.6 Policyholder

Pre-conditions

Before configuring the policyholder, and the to-be-covered insuree; the insurees must be known in openIMIS and at least a product, a contribution plan and a contribution plan bundle must be configured.

Navigation

All functionality for use with the administration of Policyholder can be found under the main menu Insurees and Policies, sub menu Policyholder.

Clicking on the sub menu Policyholder re-directs the current user to the Find Policyholder Page.

Search Page

1. Search criteria
   Code
   Code of the policyholder, often given during the registration process
   Trade name

   Name of the policyholder

   Region/District/Municipality/Village

   Location of the policyholder

   Legal Form

   Legal form of the policyholder

   Activity code

   Code of the policyholder activity

   Date Valid from/to

   Period on which the policyholder is considered as valid for the scheme (eg. creation date / liquidation date)

   Show deleted

   Show deleted policyhodler

2. Reset search criteria

3. Apply the search criteria

4. Result pane
   
   The columns name definitions match with the search criteria definitions. The rows are the serach results.
   

5. Delete policyholder
   
   Confirmation pop up is displayed
   

6. Edit policyholder
   
   As doubleclick on the line, clicking on that button will open the policyholder Page
   

7. standard notification panel for async message (deletion / creation / updates … )

Form

General Information

• Code
  Code of the policyholder, often given during the registration process

• Trade name
  Name of the policyholder

• Region/District/Municipality/Village
  Location of the policyholder

• Legal Form
  Legal form of the policyholder

• Activity code
  Code of the policyholder activity

• Validity date from/to
  Period on which the policyholder is considered as valid for the scheme (eg. creation date / liquidation date)

• Address
  Address of the policyholder

• Phone
  Phone of the policyholder

• Fax
  Fax of the policyholder

• Email
  Email of the policyholder

• Contact Name
  Name of the contact

• Accountancy code

• Bank Account

• Payment reference

Policyholder insuree tab

This tab shows the insuree linked to the policyholder

Search

• Insuree number

• Contribution bundle plan

• Date Valid from/to: Period on which the insuree is attached to the policyholder

• Show deleted: show deleted link between policyholder and insuree

Reset and aply search button are using the same icon as the policyholder.

“Create new policyholder Insuree” button will open a creation pop up.

Results

See search part of the columns descriptions.

In addition to the standard column, the calcualtion column shows default parameters that are pulled from the calcuation rules, in the picture the income is display in that column. Once a contract is created, the data is duplicated on the contract details and might be modified for a specific contract.

Edit button will open a edit popup

Delete button will open a confirmation popup

Duplicate will open a creation popup

Contribution plan tab

This tab is used to link Contribution plan to policyholder in order to reduce the possible Contribution plan choice for the policyholders.

See contribution plan page for more details on contribution plan.

Payement tab

This tab shows the payments linked to policyholder contract.

See payment page for more details on payment.

Policyholder user

This tab is used to see User that that dedicated rights for this policyholder (that user might not be able to see other policyholder).

See policyholder page.

Contract

This tabs show the policyholder contract.

See contract page for more details on contract.

1.4.7 Contract

The contract define the wished coverage for a given list of isuree for a defined period

Pre-conditions

Contract works only with group insurance so far but this might evolve in the future.

Navigation

All functionality for use with the administration of contract can be found under the main menu Insurees and Policies, sub menu Contract.

Clicking on the sub menu contract re-directs the current user to the Find contract Page.

Search Page

1. Search criteria

   • Code: code of the policyholder, often given during the registration process

   • Policyholder: contract for a given policyholder

   • Amount from/to: serach contract by amount

   • Payment due date

   • Payment reference

   • Amendement: search for amendement (0 is none)

   • Date Valid from/to: Period covered by the contract

   • State: status of the contract

   • show deleted: show deleted policyhodler

2. reset search criteria

3. apply the search criteria

4. Result pane
   the columns name definiction matches with the search criteria definitions

   the rows are the search results

5. Edit policyholder
   as doubleclick on the line, clicking on that button will open the policyholder Page

6. Delete policyhodler
   Confirmation pop up is displayed

7. standard notification panel for async message (deletion / creation / updates … )

Card

General information

• Code: code of the contract

• Policyholder: contract for the given policyholder

• amounts

  • notified : the amount when the contract was created, based on insuree default calculation parameters

  • rectified: the amount after modification of the contract (add/remove insuree, change of the calculation params .. )

  • Due: amount after validation of the schem admin

• Date approved: date when the scheme admin approaved the contract

• Payment due date

• State: status of the contract

• Payment reference

• Amendement: amendement number (0 is none)

• Date Valid from/to: Period covered by the contract

Button

The button in 10 is reject a contract, required the approve rights and the contract to be in “negociable” state

The button in 11 is approve a contract, required the approve rights and the contract to be in “negociable” state

The button submit a contract, required the submit rights and the contract to be in “draft” or “Counter” state

The button submit a contract, required the amend rights and the contract to be in “effective” state

contract details tab

This tab shows the insuree linked to the contract

Search

• Insuree number

• Contribution bundle plan

Reset and aply search button are using the same icon as the PH

“Create new policyholder Insuree” button will open a creation pop up

Results

see search part of the columns descriptions

in addition to the standard column, the calcualtion column shows parameters that are pulled from the calcuation rules, in the picture the income is display in that column

edit button will open a edit popup

delete button will open a confirmation popup

duplicate will open a creation popup

Contribution plan tab

this tab is used to link Contribution plan to policyholder in order to reduce the possible Contribution plan choice for the policyholders

See contribution plan page for more details on contribution plan

payement tab

This tab shows the payments linked to policyholder contract

See payment page for more details on payment

person covered user

this tab shows the persons covered by the contract it can the the insuree but also the dependant if the contribution plan foresee it

see policyholder page

1.4.8 Bills

Pre-conditions

In order to generate bills make sure beneficieries have been added with active policies and at least one claim has been processed. Run the batch for the desired period. In order to know how to run a batch head over to Batch Run.

Navigation

Navigate to Bills under Legal and Finance menu

1.4.9 Invoices

Pre-conditions

In order to create an invoice a family must be enrolled. Navigate to the Families/Groups under Insurees and Policies menu and find the family you wish to create an invoice for.

Ones the family is located create a new policy. In order to know how to create a new policy head over to the Policy page.

Navigation

Ones the policy is created navigate to the Invoices under Legal and Finance menu

Newly created invoices can be found here.

The Invoices is the first step in the process of finding an invoice and thereafter accessing an invoice. This initial page can be used to search for specific invoices based on specific criteria. The panel is divided into two main panels.

An invoice can be deleted by clicking on the trash icon from the right side of the list. Ones the user click on the trash icon, they will be prompted with a confirmation dialog. The payment will be either deleted or the operation will be cancelled depending on the action selected from the confirmation dialog.

Search Panel

The Search Panel allows a user to select specific criteria to minimise the search result. In the case of invoices the following search options are available which can be used alone or in combination with eath other.

Subject

Select the Subject; from the list of subjects by clicking on the arrow on the right of the sector to select invoices from a specific subject.

Invoices can be filtered by the following subjects

• Contract (Invoices created for contracts)

• Family (Invoices created for families by creating policies)

Recipient

Select the Recipient; from the list of recipients by clicking on the arrow on the right of the sector to select invoices from a specific recipient.

Invoices can be filtered by the following recipients

• Insuree (Invoice for a specific insuree)

• Policy Holder (Invoice for a specific organization)

Code

Enter the Code of the either Insuree or Policy Holder depending on the Recipient to select invoices for a specific code.

Date Invoice

Use the date selector to enter the Date Invoice to search for invoices with an Invoice Date equal or earlier than the specified date.

Status

Select the Status; from the list of statuses by clicking on the arrow on the right of the sector to select invoices from a specific subject.

An invoice can have the following statuses

• Draft

• Validated (When the invoice is generated)

• Paid (When the invoice is fully paid)

• Canceled (When the invoice is canceled)

• Deleted (When the invoice is deleted from the system)

• Suspended

Amount Total

Type in a positive Invoice Amount to search for invoices with a total amount equal or greater than the typed amount. For example if 1000 is entered, then only invoices with an amount equal or greater than 1,000 will be displayed.

Result Panel

The result panel displays a list of all invoices found matching the selected criteria in the search panel. The current selected record is highlighted. On the right side of the row you can find all the actions available. You can also double click on an invoice to view the invoice deatils.

Invoice Page

General information

General information about the selected invoice

Line Items

Search criteria

List of the items in an invoice can be filtered by search criteria panel. Here are the possible search parameters. The result of the search can be seen in the panel below.

Code

Enter the item code to filter the items by code

Description

Enter the full description or a part of the description to filter the item list

Ledge Account

Enter the full or part of the ledger account to filter the item list

Quantity

Enter the quantity to filter the item list by quantity

Unit Price

Enter the unit price to filter the item list by unit price

Discount

Enter the discount amount to filter the item list by discount

Deduction

Enter the deduction amount to filter the item list by deduction amount

Amount Total

Enter the total amount to filter the item list by amount

Amount next

Enter the net amount to filter the list by net amount

Payments

Search criteria

List of the payments for the selected invoice can be filtered by search criteria panel. Here are the possible search parameters. The result of the search can be seen in the panel below.

Reconciliation Status

Select the reconciliation status of the payments to filter the payment. Following are the possible statuses.

• Not reconciliated (The payment has not been reconciliated yet)

• Reconciliated (The payment has been reconciliated in the system)

• Refunded (The payment has beed refunded)

• Cancelled (The payment has been cancelled)

Code

Enter the payment code to filter the payment list

Label

Enter the label to filter the payment list by label text

Code Thirdparty

Enter the Code thirdparty to filter the payment list by third party code text

Receipt number

Enter the receipt number to filer the payment list by the receipt number

Fees

Enter the fees amount to filter the payment list by fees amount

Amount Receieved

Enter the amount receieved to filter the payment liset by received amount

Payment Date

Use the date selector to enter the Payment Date to search for payments with a Payment Date equal or earlier than the specified date.

Payment origin

Enter the payment origin to filter the payment list by the origin of the payment

Payer Reference

Enter the payer reference to filter the payment list by payer

Create new Payment

To enter a new payment for the selected invoice. Click on the Add (+) icon

This will open up the following form to enter the payment detail

Reconciliation Status

Select the reconciliation status of the payment. Mandatory. Different types of statuses can be found Img. 174

Status:

Select the status of the payment. Mandatory. Following are the possible status of the payment

• Rejected (The payment is rejected)

• Accepted (The payment is accepted)

• Refunded (This is the refund)

• Cancelled (The payment has been cancelled)

Payer Reference

Enter the payment reference. Mandatory

Payer Name

Enter the name of the payer. Mandatory

Code

Enter the unique payment code. Mandatory

Label

Enter the label text for the payment. Mandatory

Code Thirdparty

Enter the third party code for the payment. Mandatory

Receipt number

Enter the unique receipt number for the payment. Mandatory

Fees

Enter the fees amount for the payment. Mandatory

Amount received

Enter the amount received. Mandatory

Payment Date

Use the date selector to enter the Payment Date. Mandatory

Payment origin

Enter the origin of the payment. Mandatory

Ones all the details are filled out, click on the CREATE button to create a new payment for the selected invoice. User can click on the CANCEL button to cancel the operation.

Ones a new payment is created successfully, it can be found under the Payments tab.

The payment can be deleted by clicking on the trash icon from the right side of the list. Ones the user click on the trash icon, they will be prompted by a confirmation dialog. The payment will be either deleted or the operation will be cancelled depending on the action selected from the confirmation dialog.

Events

Events tab conitans all the events happened during the payment process. The entry in this tab can come in two different ways. First is generated automatically by the backend and second is manually added by a user.

Search criteria

List of the events for the selected invoice can be filtered by search criteria panel. Here are the possible search parameters. The result of the search can be seen in the panel below.

Type

Select the Type of the event. Following are the possible Types of the events

• Message (Indicates the information message generated either manually or by the backend)

• Status (Indicates the status change in payment by the backend)

• Warning (Indicates any warning during the payment processing)

• Payment (Indicates the payment has been processed)

• Payment Error (Indicates the error during processing the payment)

Message

Enter the keyword in message to filter the event list.

Create new Comment

To enter a new message for the selected invoice. Click on the Add (+) icon

This will open up the following form to enter a new comment/message

Message

Enter the message. Mandatory

Ones the message is entered click on the CREATE button to create a new comment for the selected invoice. User can click on the CANCEL button to cancel the operation.

Ones a new comment is added successfully, it can be found under the EVENTS tab.

1.4.10 Payment Plans

Payment plans is responsible for generating bills.

Pre-conditions

In order to create a payment plan there must be at least one product needs to be created.

Navigation

Ones a product is available navigate to the Payment Plans under Legal and Finance menu

All the existing payment plans can be found here.

Search Panel

Code

Enter a code to filter the payment plans

Name

Enter the full name or the part of the name to filter the payment plans

Calculation resultpanel

Select a calculation rule by clicking on the righ arrow in the dropdown. Here are the possible choices.

• Payment: Fee for Service (Payment plans for fee for service)

• Payment: Capitation (Payment plans for capitation)

• Payment: Commission (Payment plans for commission)

• Payment: Fees (Payment plans for fees)

• Payment: Unconditional Cash Payment (Payment plans for unconditional cash payment)

Benefit product

Select a product from the dropdown list by clikcing on the right arrow.

Periodicity

This field represents a number of months a payment plan needs to be executed.

Valid from

Use the date selector to enter the Valid from to search for payment plans with a Valid from date equal or later than the specified date.

Valid to

Use the date selector to enter the Valid to to search for payment plans with a Valid to date equal or earlier than the specified date.

Show Deleted

By clicking this checkbox a user can list all the deleted payment plans along with the valid ones.

Create new Payment Plan

To create a new payment plan click on the Add (+) icon in the bottom right of the page.

This will open up the following form to enter the payment plan deatils

Code

Enter a unique code for the payment plan. Mandatory

Name

Enter a name for the payment plan. Mandatory

Calculation Rule

Select a calculation rule from the dropdown list by clicking on the arrow on the right hand side. Here are the possible choices. Mandatory

• Payment: Fee for Service (Payment plans for fee for service)

• Payment: Capitation (Payment plans for capitation)

• Payment: Commission (Payment plans for commission)

• Payment: Fees (Payment plans for fees)

• Payment: Unconditional Cash Payment (Payment plans for unconditional cash payment)

Benefit Product

Select a product from the dropdown list by clicking on the arrow on the right hand side. Mandatory

Periodicity

Enter the periodicity in terms of months. This means how often do you want to generate bills for the payment plans. For instance, entering 1 will generate a bill every month. Mandatory

Valid from

Use the date selector to enter the Valid from. This indicates from which date this payment plan comes in effect. Mandatory

Valid to

Use the date selector to enter the Valid to. This indicates until which date this payment plan is valid.

Additional parameters

Additional parameters change based on the calculation rule selected.

• Payment: Fee for Service

Claim Type
Here you can select for which claims this payment plan is valid. The options are All, Hospital/In-patient and None-hospital/Out-patient

Level 1
Here a user can define the first level. Options are Hospital, Dispensary and Health center.

Sublevel 1
Here a user can define the first sublevel. Options are District and Region

Level 2
Here a user can define the second level. Options are Hospital, Dispensary and Health center.

Sublevel 2
Here a user can define the second sublevel. Options are District and Region

Level 3
Here a user can define the third level. Options are Hospital, Dispensary and Health center.

Sublevel 3
Here a user can define the third sublevel. Options are District and Region

Level 4
Here a user can define the fourth level. Options are Hospital, Dispensary and Health center.

Sublevel 4
Here a user can define the fourth sublevel. Options are District and Region

• Payment: Capitation
  

  

  Claim Type
  Here you can select for which claims this payment plan is valid. The options are All, Hospital/In-patient and None-hospital/Out-patient
  Level 1
  Here a user can define the first level. Options are Hospital, Dispensary and Health center.
  Sublevel 1
  Here a user can define the first sublevel. Options are District and Region
  Level 2
  Here a user can define the second level. Options are Hospital, Dispensary and Health center.
  Sublevel 2
  Here a user can define the second sublevel. Options are payment_newDistrict and Region
  Level 3
  Here a user can define the third level. Options are Hospital, Dispensary and Health center.
  Sublevel 3
  Here a user can define the third sublevel. Options are District and Region
  Level 4
  Here a user can define the fourth level. Options are Hospital, Dispensary and Health center.
  Sublevel 4
  Here a user can define the fourth sublevel. Options are District and Region
  Share Contribution
  Enter the valid integer from 0 to 100 to define the percentage (%) of the share of allocated contribution for given insurance product and the period specified. payment_newentage (%) of the numner of insured population by given insurance product and living in the catchment area of the individual health facility.
  Weight number insured families
  Enter the valid integer from 0 to 100 to define the percentage (%) of the numner of insured families by given insurance product and living in the catchment area of the individual health facility.
  Weight number visits
  Enter the valid integer from 0 to 100 to define the percentage (%) of the number of contacts of insured by given insurace product and living in the catchment area of the individual health facility.
  Weight amount adjusted
  Enter the valid integer from 0 to 100 to define the percentage (%) of the adjusted amount on claims for insured by given insurance product and living in the catchment area of the individual health facility.

The capitation formula is defined as follow:

Where

• CapitationPayment_𝑖 is the amount of capitation payment for i-th health facility

• Indicator_𝑖^𝑎 is the value of the indicator of the type a for the i-th health facility.

• Indicator_𝑖^𝑎 may be:

  • Population living in catchments area of the health payment_newfacility

  • Number of families living in catchments area of the health facility

  • Insured population living in catchments area of the health facility

  • Insured number of families living in catchments area of the health facility

  • Numbpayment_new of claims (contacts) with the health facility by insured in the catchment area

  • Adjusted amount

• AllocatedContribution is the amount of contributions for given insurance product for given period

• ShareContribution is the formula parameter Share of contribution

• Share^𝑎 is the weight of the indicator of the type a .

• Share^𝑎 may be:

  • Weight of Population

  • Weight of Number of Families

  • Weight of Insured Population

  • Weight of Number of Insured Families

  • Weight of Number of Visits

  • Weight of Adjusted Amount

• Payment: Commission
  

  

  Commission Rate(%)
  Enter the valid number to define the percentage to be paid.

• Payment: Fees
  

  

  Fee rate(%)

  This is the total percentage of the amount needs to be paid.

  Payment origin

  Enter the name of the origin of the payment. For instance, if the name of the payment gateway is ABC then the value should be ABC in this field.

• Payment: Unconditional cash payment
  

  

  Lumpsum to be paid
  Enter a valid number to be paid as a lumpsum amount
  Invoice label
  Enter the label of the invoice to which the lumpsum amount applies
  Ones all the the mandatory fields are entered, click on the SAVE button in the bottom right of the page. The user will be redirected to the Payment plans page with the newly created record displayed and selected in the result panel.

Result Panel

Click on the new version menu icon on the payment plan you want to create a new version. This will open the selected payment plan in an edit mode. Make the necessary changes and click on the save button. This will create a new record in the system with the changes applied. A user will be redirected to the previous page and a new version of the payment plan will be displayed in the result panel. This will also inactive the previous record.

• Edit
  

  

  Click on the pencil icon on the payment plan you want edit. This will open the selected payment plan in edit mode.

  

  A user can modify the payment plan and then click on the save button at the bottom right of the page to save the changes.

• Delete
  

  

  Click on the trash icon on the payment plan you want to delete. This will open up a confirmation dialog.
  

  

  
  Confirm the action by clicking on the OK button and this will delete the payment plan. A user can click on the CANCEL button to abort the operation.

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.

Navigation

All functionality for use with the administration of uploading/downloading of selected registers can be found under the main menu Tools, sub menu Registers.

Clicking on the sub menu Registers re-directs the current user to the Registers Page: (Img. 197)

Registers page

The Registers Page is divided into eight sections: (Img. 198)

A - Upload of the list of diagnoses

• 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 diagnoses

• Update Only
  Updates only diagnoses that are already included in the list of diagnoses

• Insert 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 diagnoses

• Insert, 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 file

• Dry Run
  If checked, only diagnostics is provided without real uploading

• Upload

  By clicking on the Upload button, a prompt popup message will appear, require a user to agree or disagree:(Upload Diagnoses)

  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:

<!DOCTYPE Diagnoses> [
  <!ELEMENT Diagnoses (Diagnosis)*>
  <!ELEMENT Diagnosis (DiagnosisCode, DiagnosisName)>
  < !ELEMENT DiagnosisCode (#CDATA)>
  < !ELEMENT DiagnosisName (#CDATA)>
]>

B - Upload of the register of locations

• 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 locations

• Update Only
  Updates only locations that are already included in the register of locations

• Insert 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 locations

• Dry Run
  If checked only diagnostics is provided without real uploading

• Upload

  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:

  <!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)>
  ]>

C - Upload of the register of health facilities

• 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 facilities

• Update Only
  Updates only health facilities that are already included in the register of health facilities

• Insert 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 facilities

• Dry Run
  If checked only diagnostics is provided without real uploading.

• Upload

  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:

<!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)>
]>

D - Download of the list 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 list of diagnoses should be opened or saved or canceled: (Download Diagnoses)
  

  

E - Download of the register of 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 register of locations should be opened or saved or canceled (Download locations)
  

  

F - Download of the register of health facilities

• 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)
  

  

G - Buttons

• Cancel
  By clicking on Cancel button, user will be re-directed to the Home page.

H - Information Panel
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.

Navigation

All functionality for use with the administration of policy renewals can be found under the main menu Tools, sub menu Policy Renewals

Clicking on the sub menu Policy Renewals re=directs the current user to the Policy Renewal Page.

Policy Renewal Page

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).

1. Select Criteria Panel
   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.

2. Button Panel

   • Cancel: Re-directs to the Home Page

   • Preview: 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.

3. Information Panel
   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

After selecting specific criteria; preview the report (Img. 211) by clicking on the preview button.

Preview Journal on Renewals

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.

Feedback Prompts

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.

Navigation

All functionality for use with the administration of feedback prompt can be found under the main menu Tools, sub menu Feedback Prompts

Clicking on the sub menu Feedback Prompts re-directs the current user to the Feedback Prompt Page (Img. 213).

The Feedback Prompt Page is divided into three panels (Img. 214).

1. Select Criteria Panel
   The Select Criteria Panel or the filter panel allows a user to select specific criteria for feedback.

   • SMS Status
     Select SMS Status from the list

   • Region
     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.

2. Buttons Panel

   • 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.
     

     

3. Information Panel
   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.

Pre-conditions

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.

Navigation

All functionality related to openIMIS extracts can be found under the main menu Tools, sub menu IMIS Extracts

Clicking on the sub menu IMIS Extracts re-directs the current user to the IMIS Extracts Page.

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).

IMIS Extracts (online mode)

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 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).

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 Download link that will appear after the creation of the extract, as shown below.

The extract file is called IMISDATA.DB3 and needs first to be copied (downloaded) to the local machine. After clicking the Download button, the operator is able to select the destination folder (locally) for the file to download as shown below.

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 Create button.

Three types of extracts could be generated:

• Differential Extract (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.

  

• Full extract (Download F)

  The Full extract will always contain all information in the database. These extracts are only generated in case the Full extract and the With Insuree checkbox are checked as shown below.

  

  By clicking the 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.

• Empty Extract (Download E)

  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 Full extract has to be checked as shown below.

  

After clicking the Create button, the system will create the extract file and will on completion display the following message:

The message is only shown to provide some details on how much information is exported to the extract file.

Depending on the 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:

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:

• 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)

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 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:

In case the extract is created in the background, the following dialog box appears:

D - Upload Claims section

• Browse
  Browse for the file from the IMIS-Offline or IMIS (Claims ) application containing claims to be uploaded.

• Upload
  Upload claims contained in the selected file.

E - Upload Enrolment section

• Browse
  Browse for the file from the IMIS-Offline or IMIS (Policies )application containing newly enrolled or renewed policies to be uploaded.

• Upload
  Upload policies contained in the selected file.

F - Upload Feedback section

• Browse
  Browse for the file from the IMIS-Offline or IMIS (Policies )application containing feedbacks to be uploaded.

• Upload
  Upload feedbacks contained in the selected file.

G - Button section

The Cancel button brings the operator back to the Home Page.

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.

IMIS Extracts (OFFLINE MODE)

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 Choose File button, the file selector dialog appears as shown below:

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.

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 Reports 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

All functionality for use with the administration of Reports can be found under the main menu Tools, sub menu Reports.

Clicking on the sub menu Reports re-directs the current user to the Reports Page (Img. 243).

The Reports Page is divided into four panels (Img. 243).

1. Select Criteria
   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 officers

   • Payer
     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 Commissions

   • SCOPE
     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.

     • 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.

2. Report Type Selector
   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:

   • 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

3. Button Panel

   • 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.

4. Information Panel
   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 Utilities is restricted to the users with the role of openIMIS Administrator.

The 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

All functionality for use with the administration of utilities can be found under the main menu Tools, sub menu Utilities

Clicking on the sub menu Utilities re-directs the current user to the Utilities Page.

Backup

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 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 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 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 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 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 Funding is restricted to the users with the system role of Accountant or with a role including an access to Tools/Funding.

The 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

The functionality for entering of funds can be found under the main menu Tools, sub menu Funding

Clicking on the sub menu Funding re-directs the current user to the Funding Page.

Funding Page

1. Data Entry

   

   • Region

     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.

   • District

     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.

   • Product

     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.

   • Payer

     Select from the list of institutional payers the funding authority/agency.

   • Payment Date

     Enter the date of receiving of the funding.

   • Contribution Paid

     Enter the amount of the funding.

   • Receipt Number

     Enter an identification of the document accompanying the funding.

2. Saving

   Once all mandatory data is entered, clicking on the Save 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.

3. Mandatory data

   If mandatory data is not entered at the time the user clicks the 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.

4. Cancel

   By clicking on the Cancel button, the user will be re-directed to the Home Page.

1.5.7 Email Settings

Access to the Email Settigns is restricted to the users with the role of Accountant.

The Email Settigns is the page where the setting of the outbound email server are entered.

Navigation

The functionality for entering of funds can be found under the main menu Tools, sub menu Email Settigns

Clicking on the sub menu Email Settigns re-directs the current user to the Email settings Page.

Email settings page

1. Data Entry

   

   • Email

     SMTP Login to be used on the email server in order to send email

   • Password

     SMTP password to be used on the email server in order to send email.

   • SMTP Host

     SMTP email server address or IP

   • Port

     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 Enable SSL

   • Enable SSL

     Check to box if the SMTP mail server require encryption

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 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.

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 Download Claims. If an offline user is Offline Scheme Administrator, section C will contain facility to Download Enrolments

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 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.

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 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.

Getting started

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

1. 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.

2. 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.

3. 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

4. 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

5. 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)

6. 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 used

2. Mobile Applications

Child Pages

This page in other languages:

Old Content (to be removed)

• Web Application

  • Users and logins

  • Claims

  • Administration of Registers

  • Group/family, Insurees and Policies

  • Tools

  • Offline mode

  • Group insurance

• Mobile Applications

  • The mobile application IMIS Claims

  • The mobile application IMIS Policies

• Installation Guide

• Open a Ticket

• openIMIS Wiki