Payment plan calculation rule: Fee-for-service

github

version = 1
status = active
UUID = 0a1b6d54-eef4-4ee6-ac47-2a99cfa5e9a8
calculation_rule_name = “payment: fee for service “

type = account_payable

sub_type = third_party_payment

dateValidTo = None

dateValidFrom = 2000-01-01

list of impacted parameters: NULL (will take data from product, claims … )

FROM_TO = [ {"from": "QuerySet(Claim)", "to": "Bill"}, {"from": "Claim", "to": "BillItem"} ]

the claims part of the Queryset must have the same RUNID and HF

description = “ This calculation will, for the selected level and product, calculate how much the insurance need to pay the HF for the fee for service health financing “

Service

activeForObject(self, instance, context, type, sub_type)

check_calculation

BatchRUn → Location

if HF → locations

if location → ProductS (Product also related to Region if the location is a district)

if claim → claim product (MAX Product id from item and services)

if product → paymentPlans

if paymentPlan → check if UUID = this.UUID

calculate(cls, instance, *args[date_from, date_to, productid, location])

billCreationFromCalculation(date_from, date_to, type, sub_type, product_id, location)

Registration on signals from other module(existing or not):

• billCreationFromCalculation

Batchrun will trigger billCreationFromCalculation and will send: when the payment plan would be deliver the batch run page could be replaced by payment plan (this page could call billCreationFromCalculation service on selected payment plans) page and bill page.

if active_for_object(<fakepaymentplan>, 'submit', type, sub_type):

convert(from, to, obj_from, **argv)

to convert a “from” object (obj_from) to a to object

from = ‘HF' + claim queryset

to = 'bill'

obj_from HF

argv, claimlist queryset(claim) / claim

Batch run tacken from the first claim

convert_batch(from, to, **agrv)

argv : product/Paymentplan and dateStart, dateEnd, location or HF (optionnal, will take location from Product)

Create queryset to retrieve the claims per HF/Product

convert the queryset

Save the bill in database

get_linked_class

See classes defiened in check calculation

Converter

[to be updated]

1. two way of creating the bills are possible for the valuation, in both case there will be one “bill” per HF/Product

   1. (Chosen)One asset (line) per claim, claim details as asset description: claimed amount as unit price, net amount as net price, discount calculated based on net and unit price

   2. one asset (line) per item or service with claim detail as asset description: item/service claimed unit price as unit price, net as valuated price, quantity as quantity, discount calculated based on net and unit price

bill:

billItem