Function Claim

The function Claim is navigated to by clicking on the menu item Claim in the main menu. The function Claim allows creating of claims and posting them in the memory before uploading them to the web IMIS. The Claim Page appears immediately:

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Image 2.6.1 (Claim Page)

The following data fields appear in the Claim Page:

  • Health Facility Code
The code of the health facility for which the claim is created. The data field is prefilled by the code of the health facility for which the claim administrator is acting. Mandatory.
  • Claim Admin
The code of the claim administrator that is responsible for creation of the claim. The data field is prefilled by the code of the claim administrator with which the application is launched. Mandatory.
  • Claim Code
The code of the claim that is created. Mandatory.
  • Guarantee No
The identification of an guarantee document associated with the claim. Optional.
  • Insurance Number
Either type in the insurance number of the insuree for whom the claim is created or obtain the insurance number by scanning of a QR code by clicking on the QR button. Mandatory.
  • Start Date
Tap on the data field and select a starting date of a contact of the insuree with the health facility for which the claim is created in the date selector. Mandatory.
  • End Date
Tap on the data field and select an ending date of a contact of the insuree with the health facility for which the claim is created in the date selector. By default it is pre-filled with the starting date. Optional.
  • Diagnosis
Select a main diagnosis from the drop down list of available diagnoses. Mandatory.
  • Diagnosis 1-4
Select a secondary diagnosis (up to four ones) from the drop down list of available diagnoses. Optional.
  • Visit Type
Select just one of the options: Emergency, Referral , Other. Mandatory.

Clicking on the <three dots vertically> icon in the upper right corner of the Claim Page the menu for selection of whether medical services/items should be entered.

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Image 2.6.2 (Claim Page – the menu for selection of the list of medical services/items)

Clicking on the menu item Add Services the Add Services Page and the following data fields appear.

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Image 2.6.3 (Add Services Page)

  • Select Service
Click on the data field and write a letter that is present in the code or the name of a medical service that should be included. A list of available services (that is prepared within the function Map Services or Refresh Mapping) appears. Select an appropriate medical service from the list. Mandatory.
  • Quantity
Enter the number of the medical service that should be included in the claim. The default is 1. Mandatory.
  • Amount
Enter the price of the medical service that should be included in the claim. The price should be entered only if the medical service is designated in the corresponding definition of an insurance product in the web IMIS as a medical service with a price given by a health facility. Optional.

Click on the button ADD+ to the medical service to the claim. Click on the icon <- in the upper part of the Add Services Page to return to the Claim Page.

Clicking on the menu item Add Items the Add Items Page and the following data fields appear.

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Image 2.6.4 (Add Items Page)

  • Select Item
Click on the data field and write a letter that is present in the code or the name of a medical item that should be included. A list of available items (that is prepared within the function Map Items or Refresh Mapping) appears. Select an appropriate medical item from the list. Mandatory.
  • Quantity
Enter the number of the medical item that should be included in the claim. The default is 1. Mandatory.
  • Amount
Enter the price of the medical item that should be included in the claim. The price should be entered only if the medical item is designated in the corresponding definition of an insurance product in the web IMIS as a medical item with a price given by a health facility. Optional.

Click on the button ADD+ to add the medical item to the claim.

Click on the icon <- in the upper part of the Add Items Page to return to the Claim Page.

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Image 2.6.5 (Claim Page)

Click on the button Post Claim to save just created claim in the memory of the device.

Click on the button New Claim to clear the data fields (with exception Health Facility Code and Claim Admin) and to prepare the Claim Page to an entry of another claim.

Click on the icon <- in the upper part of the Claim Page to return to the Home Page .