Idea: Service case for claims
Content
Summary
Currently openIMIS supports the definition (and thereafter the claiming) of individual services and items.
Many insurers would like to bundle some services and items as 'cases' - for eg. a surgery case can be a combination of a few individual services (including follow-up) and the drugs required during and after the surgery.
It would be good to have the option of creating such packages by selecting the already defined services and items. The health facilities can claim for this 'case'. It makes it easy to review claims as automated checks for duplicate services/items (within case, and beyond) can be done..
Prioritisation
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Possible approach ( minimal viable product)
Database modeling
The service table will have a new type ( ServType) “bundle“ schema change NOT required
a new table “tblSubServices“ will be created (no customization yet possible per product)
parent_service
child_service/items
quatity_inbundle
price_inbundle
Nice to have: add parent service id in the claim service and items
Backend change
a new model and graphQL will be reauired to manage “tblSubServices“
Nice to have: support parent service id in the claim service and items
Frontend change
When a service with the type “Bundle“ is selected, the FE call the graphQL query for the tblSubServices for the selected parent service.
then the frontend adds all the services and items part of the bundle as normal service and items
Source
This was the idea mentioned during interviews with various stakeholders in February 2021.
Github:
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