Content

1 Summary
2 Overview
3 Prioritisation
4 Possible approach ( minimal viable product)
- 4.1 Database modeling
- 4.2 Backend change
- 4.3 Frontend change
5 Source
6 Involved Entities
7 Process Description
8 Additional Reading
9 Child Pages

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..

Overview

Process Group	JLN Group - Claims Management
Function	Service cases for claims
Source	https://openimis.atlassian.net/jira/servicedesk/projects/OSD/queues/issue/OSD-108
Related	Mobile Strategy

Prioritisation

Score
Current Relevance
Future Relevance
Global Good
Local Funding

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: GitHub - openimis/client-fe_js

openIMIS

Idea: Service case for claims