Fig 1: Bahmni-Insurance-Integration Work Flow (Created using http://draw.io)
User roles and responsibilities
User Class 1 Registration Desk Staff | User Class 2 Cashier /Pharmacy-Cashier | User Class 3 Claims Manager | User Class 4: Finance staff | User Class 5: Lab/IPD staff |
|---|---|---|---|---|
Registration new Patient | Registration charge (Complete cash payment accounting flow) | Verify Insurance eligibility and Balance | Generate Claims reports | Check the status of payment before service |
Registration old patient | Lab service charge (Complete cash payment accounting flow) | Tag quotation’s mode of payment as Insurance | Generate non-claims reports | |
Registration Insured Patient | Pharmacy charges (Complete cash payment accounting flow) | Complete accounting flow for services claims | Generate Not-claimable reports | |
IPD Charges(Bed charges, procedures,etc.) | Consolidate the Claims (Rx, Labs)-final draft claim | |||
Pharmacy-cashier need to complete claims accounting flow for Rx | Submit Claims/ Track Claims response | |||
Correct and Resend claims for rejected claims | ||||
Upload medical evidence doc from mobile app | ||||
Break the quotation into claimable and cash payment quotations | ||||
Take consent from patient for Claim | ||||