The system allows the configuration of all types of services and items during initialization. Thereafter once agreement is made between the insurer and health facility on what is covered and at what price you can prepare different types of price lists that you apply to different facilities that your insurance scheme covers. In the product page you can configure the respective list of medical service or medical item that the insurance scheme will cover. The facility then while reporting claims will have these agreed services and items in their list. Hence the assumption is that all agreed service and items are approved and can be billed by the health facility. There is no pre-approval therefore currently in the process supported by the system whereby a request goes from the facility to the insurer in order to get authorization before processing that treatment to the patient. This has been reported as a new feature request on the service desk (
OSD-42Getting issue details...