Bahmni Insurance Odoo Architecture

Overview: 

Odoo insurance module is a custom module developed in Odoo, integrating insurance services in Bahmni. This module is responsible for consolidating sales order in order to create claim items and sends them to insurance-integration services for processing. It is also responsible for checking and updating the status of the claims in the system. 

Architecture:

Open

ER Diagram

Workflow:

1. NHIS Number

   The patient information is synced  from OpenMRS to Odoo. The patient information includes insurance related information like NHIS Number, NHIS primary contact etc. These data are passed to Odoo as additional patient information, which is handled by bahmni_atom_feed. Configurations to sync these is here.
   
   

   
   
   

2. Eligibility Request

   Eligibility request is handled by bahmni-insurance-module, during the sales order confirmation. This module checks whether a patient is eligible for the items/services mentioned in the sales order. A call to insurance-integration is made to get the insurance details of the patient, which is then validated by this module.

   
   
   

3. Print consent

   This module is responsible to take consent of patient before processing insurance. A printable pdf format with patient's consent is generated by this module.

   
   
   

4. Claim Draft Creation

   After confirmation of sales order, an invoice for the sales order is generated. Simultaneously, a claim draft is generated is the sales order is of payment type (Insurance/Partial). The claim draft includes items mentioned in sales order and claimable items.

   
   
   

5. Claim Confirmation

   After claim draft is generated, then it needs to be confirmed. After confirmation, additional items can't be added into the claim.

   
   
   

6. Claim Submission

   This module is also responsible for handling the claim submission. Once a claim is confirmed, it is submitted to imis-integration for processing. Before submitting, a claim code is generated by bahmni-insurance-odoo module which is unique to each claim. Later on this code is used to track the claim.

   
   
   

7. Claim Tracking

   Once a claim is submitted then, it can be tracked using bahmni-insurance-odoo module. Claim tracking involves checking the status of the claim. The module makes a call to insurance-integration module, which returns the status of the claim, status of those claimed items, amount approved and rejection reason if any item is rejected.