Bahmni-OpenIMIS Integration User guide

Bahmni login

Login credentials (Claim admin name and password) for Claim admins is created and managed by an administrator using administrator interface in OpenMRS.

Claim admins can change their password after the first login.

Open

Registration module

This module will be used at the front desk at the health facility. 

Patient’s demographic information will be recorded in this module and it can be used by either clinical or non-clinical staff. 

Depending on facility workflow, it can be configured to capture clinical information such as vitals, height, weight, etc.

This module is also used to search for previously registered patients and make their visit active to the particular department (depending upon number of departments defined by the facility).

During registration, registration staff asks each individual, whether they are enrolled in an insurance program or not. However It is not mandatory to provide national health insurance number (NHIS).

User can collect the insurance information like Insurance Number, Primary contact point etc. as shown in fig

This NHIS number separates general patients with patients who are enrolled in an insurance program. This Insuree number syncs from OpenMRS to ODOO

When User proceeds to another page by starting visit for the patient user will be able to see the eligibility details for same patient as shown in fig

Insuree Eligibility Details Page

Open

Clinical module

This module is used by medical care providers to review the patient’s  history and also to start their new treatment process of current visit. 

Inside clinical module:

Claim admin can see active patients list, patient in disposition list, My patient list, Today’s patients, Admitted, etc. after entering clinical module.

Claim admin can either select active patient displayed in the “Active list” or can search in search space for the desired patient’s ip.

Claim admin have to go to “Consultation” tab for providing information is current visit.

1. Patient’s dashboard: Dashboard contains patient’s past records of diagnosis, lab results, vitals, treatments, etc based on requirement of health facility. 

2. Observation: Observation Consultation templates/forms are listed this tab, where medical care providers can select particular forms based on patient’s medical condition. 

3. Orders: Laboratory tests listed in EMR are  mapped with laboratory tests services from OpenIMIS. Test orders can be sent from this order tab 

4. Diagnosis: Diagnosis in EMR is ICD10 standard.Diagnosis provided by medical care provider will be sent to OpenIMIS during claim request. 

5. Treatment : Medicines orders can be sent from this tab, These orders will be synced into ODOO and will be sent to OpenIMIS during claim request  

6. Deposition: This tab is used to end consultation of patients with short description on the status of the patient.

ODOO Insurance Module

Odoo Login

In clinical management system Odoo is useful in Billing, Pharmacy, Insurance claim and Stock management.

Patient as a Customer

Whenever patients are registered from registration module in Bahmni, patients are synced to customers under sales module.

To check the patient sync Click on Sales > Customers > Search patient name or ID from top right.

After selecting the patient, individual details can be seen as shown in the picture.

Manage Quotations and sales Orders

Bahmni integrates OpenMRS with Odoo which is an open source ERP product. It is useful in Billing, and Stock management. Any patient registered in OpenMRS is synced as a customer in Odoo.

Any Drugs, LabTests added in OpenMRS is synced as product / service in Odoo. When clinicians place any order, it syncs in Odoo as Sales Quotation so that the patient can be billed. 

To proceed quotations as insurance claims

Select Sales > Quotation > Edit from (step 2 in the above picture)   and change payment type from cash to insurance and Save. Payment type from order line for multiple items  will get change with Insurance type.

Claim Admin can also change the payment options for each line items as well as shown in fig 

Check Eligibility 

When user selects insurance as payment options, Check Eligibility button is visible which when clicked displays the popup with eligibility details as shown in fig

Quotations to SalesOrder 

User can confirm the quotations to create SalesOrder.

Sales Order to Invoice 

User can create invoice from Sales Order

Register Payment for Invoice 

User can now validate invoice and proceed to register payment . While registering payment User should select appropriate journal for e.g if payment option is Insurance, then select “Insurance Journal ” else if payment option is cash then select “Cash Journal”

Insurance Module

The Insurance module provides the interface to proceed the claims submission flow. User can see the “Insurance” menu in the header menu bar. User can submit, track claims and set the configurations from this module.Once the user generates the invoices with payment option as Insurance then claims draft are created. 

Configurations > Insurance Settings 

User can set different configuration parameters like URL and credentials for connecting to Insurance-Connect service. 

Configurations > Insurance - Odoo Product mapping

Odoo products should be mapped with Items/Services provided by OpenIMIS system. Items/Services from OpenIMIS is provided in CSV format for now. Once the Rest based or Fhir end point is available for such products resources then we can implement web based solution.

Claim admin have to check each item listed in “Insurance product name” and map the available item uploaded through csv. Both medical supply and laboratory items should be mapped in the same process. 

1. Upload product csv

Follow following step: go to Insurance > Insurance-Odoo product mapping > Import > Load file 

CSV file to be loaded should be prepared in the attached format and saved prior to upload step.

Selecting “Load file” would take user to UI for select the csv saved. Find the csv and select which to upload. 

 Insurance > Claims

This view displays the list of claims which are in draft or confirmed stage. 

Claims in draft stage are those claims which are not yet confirmed thus other claim items can added for same patient in same visit. That mean if other quotations are processed as Insurance payment option then would eventually be added into this claim

Once the claims are confirmed no claim items can be added and they are ready to be submitted to OpenIMIS.

 Claim admin can see five tabs after clicking “Claims” viz.

1. Claim items: It contains product name, quantity of the product, unit price of the product, total price of product, claim status of the item and rejection reason. Rejection reason will appear when the claim item is rejected.

2. Sale Orders: This tab shows information about the sales orders associated with the claim.

3. Eligibility details: Claim admin can check eligibility of the claim made using this tab. 

4. Claim history: Claim admin can check the claim’s history. This is required to track the status of claims. Claim history contains the information like status of claims , Claim’s admin, comments etc.

Claims Submission

Claims > Submitted Claims

From submitted tab, Claim Admin can view the list of submitted claim with the claim number, Insuree, amount claimed and status of Claim process.

Submitted claims are those which are submitted to OpenIMIS system. Such Claims will have status like Checked,Processed, Valuated, Rejected. Claim Admin can also verify  Sales order, eligibility and claim history and confirm the claim.

• Claim : Passed case with status Checked 

• Claim : Passed case with status Valuated

• Claim : Passed case with status Checked with some items rejected

• Claim : Rejected case with rejection reason

Track Claims

 After the  submission of  claims will be processed.The processed claims can be tracked  by

Track Claim button. The processed claim status is displayed as Checked or Processed or Approved/Rejected or Valuated.

Edit Claim Fhir and Resubmit