Complex Products – Mobile App Claims (user manual)

Objective

This page describes the process for entering services on the mobile application when it contains a complex service, and the associated validation rules according to the type of complex service:

• Type F: Capped complex service (Fee-for-service bundle)

• Type P: Flat-rate complex service (Flat-fee bundle)

1. Preconditions

Before entering a claim with a complex service on mobile, ensure that:

• The mobile user has the Claim Administratorrole (on the web).

• The user is linked to a Health Facility.

• The complex service is present in the price list of the user's Health Facility.

• The master data has been downloaded to the mobile device in order to retrieve the configuration of the complex services.

Useful reference (sync / master data / offline):
IMIS Extracts (User Manuals) — https://openimis.atlassian.net/wiki/spaces/KB/pages/3722182985

2. Create / assign the Claim Administrator role to a user (Web)

The Claim Administrator role allows a user to:

• log in to the claims mobile application,

• enter claims,

• synchronize claims to the web.

Steps (Web)

1. Go to the menu: Administration -> Users

2. Click on the + button (Add)

3. Fill in the user information

4. Assign the Claim Administrator role

5. Verify / fill in the user's Health Facility

6. Click on Save

Expected result: the user can authenticate on the mobile application using their code and access service entry.

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Img. 12.1 Creating a user with the Claim Administrator role

3. Verify that the Complex Service is included in the Health Facility price list (Web)

3.1 Find the user's Health Facility

1. Go to: Administration -> Health Facility

2. Search for the user's health facility by its name or code

3. Open the health facility details

4. Note the Price list associated with this health facility

3.2 Verify the presence of the complex service in the Price List

1. Go to: Administration -> Price List

2. Search for the Price List noted above

3. Verify that the complex service is present (and the box is checked)

Expected result: the complex service will be available on mobile after downloading the master data.

4. Download the master data in the mobile application (Mobile)

After installing the Claims mobile application, you must download the master data to retrieve:

• services,

• items,

• complex services,

• and their sub-services / sub-items.

Steps (Mobile)

1. Open the Claims mobile application

2. Enter the code of the user having the Claim Administrator role

3. Start the download of the master data

4. Wait for the download to finish

Expected result: the list of services on mobile includes the complex services configured on the web.

For details on "sync / online / offline," refer to:
https://openimis.atlassian.net/wiki/spaces/KB/pages/3722182985

5. Enter a claim with a complex service (Mobile)

5.1 Access the list of services

1. Open the side panel

2. Click on Claim

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5.2 Create a new claim

1. In the list of services, click on the + button

2. Fill in the general information for the service (insured, dates, etc.)

3. In the Services section, click on the + button to add a service

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5.3 Add the complex service

1. In the service addition window, search for the complex service code

2. Select the service from the result

3. A panel of sub-services et sub-items appears

4. Fill in the quantities for each sub-service / sub-items (according to the rules below)

5. Valide the addition of the service to the claim by clicking on ADD+

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6. Return to the general information page and click on the button POST CLAIM

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7. The claim is now created in the application

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8. Retourner à la page précédente pour verifier la prestation créée

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9. Return to the previous page (Dashboard) and verify that the claim is awaiting synchronization (pending 1)

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Expected result: the claim contains a complex service with its components (sub-services/items) correctly entered and is ready to be synchronized.

6. Validation rules for complex services (Mobile)

This section describes the expected behavior of the mobile application during data entry.

6.1 Case of a capped service — Type F (Fee-for-service bundle)

Rule: the amount of the service must not exceed the amount calculated during the registration/configuration of the complex service on the web. Therefore, the quantities entered for sub-services/sub-items must not exceed the maximum quantities defined.

Example :

• At the bundle creation, a sub-service has a max quantity = 2

• The bundle cap is based on:

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• During mobile entry, if the user enters 3, then:

  • a warning message is displayed (max quantity exceeded),

  • the quantity must be automatically reset to the maximum authorized value (2)..

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Expected result: the total amount of the bundle remains capped and does not exceed the authorized value.

6.2 Case of a flat-rate service — Type P (Flat-fee bundle)

Rule: the bundle has a fixed flat-fee amount (defined during registration) and does not vary according to the quantities entered for the sub-services/sub-items. The quantities of the components must strictly correspond to the quantities defined at creation.

Example:

• Bundle configured with a sub-service quantity = 2

• The bundle amount is a flat-fee amount (entered / fixed at registration)

• During mobile entry, if the user enters a quantity other than 2:

  • the quantity taken into account for the sub-service concerned becomes 0

  • the total amount of the bundle remains unchanged (fixed)

Expected result: the flat-fee is not modified by the quantities; any quantity divergence does not impact the amount (and neutralizes the component).

For further information on calculation rules for complex products, consult the page Service and Items Module UHC (Medication).

7. Synchronization to the Web (reminder)

After entry, claims can be :

• Synchronized online (if connection available) from the mobile app,

• Exported as a file (offline mode), then imported on the web via extracts.

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Claim synchronization page