Web application user manual¶
v1.3.0
The open Insurance Management Information System ( openIMIS ) is a web based software to manage health insurance schemes. It includes functionality for setup of the software to requirements of health insurance schemes, administration of policies and policy holders and for claim processing. This manual is a guide on the use and functionality of the software rather than in-depth technical reference. The Contents section, provide a reference to the page of each major chapter and the sub chapters within. By clicking on the content title (online version), the reader is re-directed to the position of the content title.
Users and logins¶
Administration of registers¶
Registers of openIMIS serve as a principal tool by which openIMIS is adjusted to needs of health insurance schemes. With exception of the register of Users that can be managed only by users with the role openIMIS Administrator, all other registers can be managed by users with the role Scheme Administrator.
The register of Users defines who can login to openIMIS and under what constraints. The register of Locations defines administrative division of the territory, on which a health insurance scheme is operated. The register of Payers allows specification of institutional payers that can pay contributions on behalf of policy holders (households, groups of persons). The register of Enrolment Agents specifies all persons (either employed or contracted) by the scheme administration that are entitled to distribute/sell policies to population. The register of Claim Administrators specifies all employees of health facilities that are entitled to submit claims to the scheme administration. The register of Health Facilities contains all contractual health facilities that can submit claims to the scheme administration. The register of Medical Items specifies all possible medical items (drugs, prostheses, medical devices etc.) that can be used in definitions of packages of insurance products and in pricelists associated with contractual health facilities. The register of Pricelists that splits into two divisions for Medical Services and for Medical Items contains pricelists valid for individual health facilities or their groups reflecting results of price negotiations between contractual health facilities and the scheme administration. Finally, the register of Products includes definitions of all insurance products that can be distributed/ sold within the health insurance scheme.
Insurance Products Administration¶
The register of insurance products contains all insurance products in the health insurance scheme. There may be several insurance products available for distribution/selling in a territory, e.g. one basic product and one or several supplemental insurance products. The insurance products may at the different levels. For example that basic insurance product may be at the national level whereas the supplemental insurance products may be at the regional level. Administration of the register of insurance products is restricted to users with the role of Scheme Administrator.
Pre-conditions¶
An insurance product may only be added or thereafter edited, after the approval of the management of the scheme administration.
Product Control Page¶
Clicking on the sub menu
Products
re-directs the current user to theProduct Control Page
.The
Product Control Page
is the central point for administration of insurance products. By having access to this page, it is possible to add, edit, duplicate and search. The panel is divided into four panels. (Image 5)
Search Panel
The search panel allows a user to select specific criteria to minimise the search results. In the case of Products the following search options are available, which can be used alone, or in combination with each other.
Product Code
Type in the beginning of; or the full
Product Code
; to search for products with aProduct Code
, which starts with or matches completely, the typed text.
Product Name
Type in the beginning of; or the full
Product Name
to search for products with aProduct Name
, which starts with or matches completely, the typed text.
Date From
Type in a date; or use the Date Selector Button, to search for products with a
Date From
, which is on or is greater than the date typed/selected. Note: To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Date To
Type in a date; or use the Date Selector Button, to search for products with a
Date To
, which is on or is greater than the date typed/selected. Note: To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 6); by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- Anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 6 - Calendar Selector - Search Panel
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select products from a specific region. The option National means that the found insurance products should be common for all regions. Note: The list will only be filled with the regions assigned to the current logged in user and with the option National. All nationwide products and all regional products relating to the selected region will be found. If no district is selected then also all district products for districts belonging to the selected region will be found.
District
Select the
District
; from the list of districts by clicking on the arrow on the right of the selector to select products from a specific district. Note: The list will be only filled with the districts belonging to the selected region. All nationwide products, all regional products relating to the selected region and all district products for the selected district will be found.
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 7).
Search Button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the result panel.
Result Panel
The result panel displays a list of all products found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 8). The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 9).
Button Panel
With exception of the
Cancel
button, which re-directs to the Home Page (Image 2), and the Add button which re-directs to the product page, the button panel (the buttonsEdit
andDuplicate
) is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a product has been added, updated or deleted or if there was an error at any time during the process of these actions.
Product Page¶
Data Entry
Image 10 - Product Page
Product Code
Enter the product code for the product. Mandatory, 8 characters.
Product Name
Enter product name for the product. Mandatory, 100 characters maximum.
Region
Select the region in which the product will be used, from the list by clicking on the arrow on the right hand side of the lookup. The option National means that the insurance product is nationwide and it is not constraint to a specific region. Note: The list will only be filled with the regions assigned to the current logged in user and with the option National. Mandatory.
District
Select the district in which the product will be used, from the list by clicking on the arrow on the right hand side of the lookup. Note: The list will only be filled with the districts assigned to the selected region and assigned to the current logged in user. If no district is selected then the product is considered to be either nationwide (the option National is selected in the field Region) or regional associated with the selected region.
Date From
Type in the date or use the
Date Selector Button
to provide the date for which underwriting for the insurance product can be done from.Date From
determines the earliest date from which underwriting can be done. Note: To clear the date entry box; use the mouse to highlight the full date and then press the space key. Mandatory.
Date To
Type in the date or use the Date Selector Button to provide the date until which underwriting can be done to.`Note: To clear the date entry box; use the mouse to highlight the full date and then press the space key.` Mandatory.
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 11). By default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted. At anytime during the use of the pop-up, the user can see the date oftoday
.
- Clicking on
today
will close the pop-up and display the today’s date in the corresponding date entry box.- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 11 - Calendar Selector - Search Panel
Conversion
Select from the list of products, a reference to the product which replaces the current product in case of renewal after the
Date to
. Note: Selecting the current product will prevent the record from saving, and cause a message to be displayed in the Information Panel.
Lump Sum
Enter the lump sum contribution (an amount paid irrespective of the number of members up to a threshold) to be paid by a household/group for the product. If the lump sum is zero no lump sum is applied irrespective of the threshold members. Decimal up to two digits.
Threshold Members
Enter the threshold number of members in product for which the lump sum is valid.
Number of Members
Enter the maximal number of members of a household/group for the product.
Contribution Adult
Enter the contribution to be paid for each adult (on top of the threshold number of members). Decimal up to two digits.
Contribution Child
Enter the contribution to be paid for each child (on top of the threshold number of members). Decimal up to two digits.
Insurance Period
Enter duration of the period in months, in which a policy with the product will be valid. Mandatory.
Administration Period
Enter duration of the administration period in months. The administration period is added to the enrolment date/renewal date for determination of the policy start date.
Max Instalments
Enter maximal number of instalments in which contributions for a policy may be paid. Mandatory.
Grace Period Payment
Enter duration of the period in months, in which a policy has a grace period (not fully paid up) before it is suspended. Mandatory, although it is by default and can be left at zero.
Grace Period Enrolment
Enter duration of the period in months after the starting date of a cycle (including this starting date), in which underwriting of a policy will still be associated with this cycle.
Grace Period Renewal
Enter duration of the period in months after the starting date of a cycle (including this starting date), in which renewing of a policy will still be associated with this cycle.
Enrolment Discount percentage
Enter the enrolment discount percentage for the insurance product. The discount percentage is applied on the total contributions calculated for a policy underwritten earlier than
Enrolment disc. period
months before the start date of the corresponding cycle.
Enrolment Discount Period
Enter the enrolment discount period of the insurance product in months.
Renewal Discount Percentage
Enter the renewal discount percentage for the insurance product. The discount percentage is applied on the total contributions calculated for a policy renewed earlier than
renewal disc. period
months before the start date of the corresponding cycle.
Renewal Discount Period
Enter the renewal discount period of the insurance product in months.
Medical Services
Select from the list of available medical services (from the register of Medical Services) the medical services covered within the insurance product, by either clicking on the
Check All
box at the top of the list of medical services, or by selectively clicking on the check box to the left of the medical service.
Medical Services Grid
Code
Displays the code for the medical service
Name
Displays the name of the medical service
Type
Displays the type of the medical service
Level
Displays the level of the medical service
Limit
Indicates the type of limitation of coverage for the medical service. This may be adjusted per medical service, select between Co-Insurance [C] and Fixed amount [F]. Co-insurance means coverage of a specific percentage of the price of the medical service by policies of the insurance product. Fixed amount means coverage up the specified limit. C is the default value. Limit O is used for claims having the type of visit Other, Limit R is used for claims having the type of visit Referral and Limit E is used for claims having the type of visit Emergency.
Origin
Indicates where the price for remuneration of the service comes from. This may be adjusted per service, the options are: [P] Price taken from the price list of a claiming health facility, [O] Price taken from a claim and [R] Relative price, the nominal value of which is taken from the price list and the actual value of which is determined backwards according to available funds and volume of claimed services and medical items in a period. [R] is the default value.
Adult
Indicates the limitation for adults. If the type of limitation is a co-insurance then the value is the percentage of the price covered by policies of the insurance product for adults. If the type of limitation is a fixed limit the value is an amount up to which price of the service is covered for adults by policies of the insurance product. Default is 100%. Adult O is for Other, Adult R is for Referral and Adult E is for Emergency claims according to the type of visit (Visit Type).
Child
Indicates the limitation for children. If the type of limitation is a co-insurance then the value is the percentage of the price covered for children by policies of the insurance product. If the type of limitation is a fixed limit the value is an amount up to which price of the service is covered for children by policies of the insurance product. Default is 100%. Child O is for Other, Child R is for Referral and Child E is for Emergency claims according to the type of visit (Visit Type).
No Adult
It indicates the maximal number of provisions of the medical service during the insurance period for an adult.
No Child
It indicates the maximal number of provisions of the medical service during the insurance period for an child.
Waiting Period Adult
Indicates waiting period in months (after the effective date of a policy) for an adult.
Waiting Period Child
Indicates waiting period in months (after the effective date of a policy) for a child.
Ceiling Adult
It indicates whether the medical service is excluded from comparison against ceilings defined in the insurance product for adults. Default is that the medical service is not excluded from comparisons with ceilings. [H] means exclusion only for provision of in-patient care, [N] means exclusion only for out-patient care and [B] means exclusion both for in-patient and out-patient care.
Ceiling Child
It indicates whether the medical service is excluded from comparison against ceilings defined in the insurance product for children. Default is that the medical service is not excluded from comparisons with ceilings. [H] means exclusion only for provision of in-patient care, [N] means exclusion only for out-patient care and [B] means exclusion both for in-patient and out-patient care.
medical items
Select from the list of available medical items (from the register of Medical Items) the medical items covered within the product; by either clicking on the Check All box at the top of the list of medical items, or by selectively clicking on the check box to the left of the medical item.
medical items grid
Code
Displays the code for the medical item
Name
Displays the name of the medical item
Type
Displays the type of the medical item
Package
Displays the packaging of the medical Item
Limit
Indicates the type of limitation of coverage for the medical item. This may be adjusted per medical item, select between Co-Insurance [C] and Fixed amount [F]. Co-insurance means coverage of a specific percentage of the price of the medical item by policies of the insurance product. Fixed amount means coverage up the specified limit. C is the default value. Limit O is used for claims having the type of visit Other, Limit R is used for claims having the type of visit Referral and Limit E is used for claims having the type of visit Emergency.
Origin
It indicates where the price for remuneration of the item, comes from: This may be adjusted per medical item, the options are: [P] Price taken from the price list of a claiming health facility, [O] Price taken from a claim and [R] Relative price, the nominal value of which is taken from the price list and the actual value of which is determined backwards according to available funds and the volume of claimed services and medical items in a period. [R] is the default value.
Adult
It indicates the limitation for adults. If the type of limitation is a co-insurance then the value is the percentage of the price covered for adults by policies of the insurance product. If the type of limitation is a fixed limit the value is an amount up to which price of the item is covered for adults by policies of the insurance product. Default is 100%. Adult O is for Other, Adult R is for Referral and Adult E is for Emergency claims according to the type of visit (Visit Type).
Child
It indicates the limitation for children. If the type of limitation is a co-insurance then the value is the percentage of the price covered for children by policies of the insurance product. If the type of limitation is a fixed limit the value is an amount up to which price of the service is covered for children by policies of the insurance product. Default is 100%. Child O is for Other, Child R is for Referral and Child E is for Emergency claims according to the type of visit (Visit Type).
No Adult
It indicates the maximal number of provisions of the medical item during the insurance period for an adult.
No Child
It indicates the maximal number of provisions of the medical item during the insurance period for a child.
Waiting Period Adult
It indicates waiting period in months (after the effective date of a policy) for an adult.
Waiting Period Child
It indicates waiting period in months (after effective date of a policy) for a child.
Ceiling Adult
It indicates whether the medical item is excluded from comparison against ceilings defined for adults in the insurance product. The default is that the medical item is not excluded from comparisons with ceilings. [H] means exclusion only for provision of in-patient care, [N] means exclusion only for out-patient care and [B] means exclusion both for in-patient and out-patient care.
Ceiling Child
It indicates whether the medical item is excluded from comparison against ceilings defined for children in the insurance product. The default is that the medical item is not excluded from comparisons with ceilings. [H] means exclusion only for provision of in-patient care, [N] means exclusion only for out-patient care and [B] means exclusion both for in-patient and out-patient care.
Account Code Remuneration
Enter the account code of the insurance product used in the accounting software for remuneration of the product. 25 characters maximum.
Account Code Contribution
Enter the account code of the insurance product used in the accounting software for paid contributions. 25 characters maximum.
Registration Lump Sum
Enter the lump sum (for a household/group) for registration fee to be paid at the first enrolment of the household/group. Registration fee is not paid for renewals of policies.
Assembly Lump Sum
Enter the lump sum (for a household/group) for additional assembly fee to be paid both at the first enrolment and renewals of policies.
Registration Fee
Enter the registration fee per member of a household/group. If registration lump sum is non zero, registration fee is not considered. Registration fee is not paid for renewals of policies.
Assembly Fee
Enter the assembly fee per member of a household/group. If assembly lump sum is non zero, assembly fee is not considered. Assembly fee is paid both at the first enrolment and renewals of policies.
Start Cycle 1
Start Cycle 2
Start Cycle 3
Start Cycle 4
If one or more starting dates (a day and a month) of a cycle are specified then the insurance product is considered as the insurance product with fixed enrolment dates. In this case, activation of underwritten and renewed policies is accomplished always on fixed dates during a year. Maximum four cycle dates can be specified.
Ceiling Interpretation
Specify whether Hospital and Non-Hospital care should be determined according to the type of health facility (select [Hospital]) that provided health care or according to the type of health care (select [In-patient]) acquired from a claim. In the first case all health care provided in hospitals (defined in the field
HF Level
in the register of Health Facilities) is accounted forHospital Ceilings/Deductibles
and for calculation of relative prices for theHospital
part. It means that if clamed health care was provided out-patient in a hospital, it is considered for calculation of ceilings/deductibles and for calculation of relative prices as hospital care. In the second case only in-patient care (determined from a claim when a patient spent at least one night in a health facility) is accounted forHospital Ceilings/Deductibles
and for calculation of relative prices for hospital part. Other health care including out-patient care provided in hospitals is accounted forNon hospital Ceilings/Deductibles
and also such health care is used for calculation of relative prices for non-hospital part. Mandatory.
Treatment
Deductibles and Ceilings for treatments may be entered for general care (
Hospitals and Non-hospitals
) or for hospital care (Hospitals
) only and/or for non-hospital care (Non-Hospitals
) only. An amount may be set, indicating the value that a patient should cover within his/her own means, before a policy of the insurance product comes into effect (Deductibles
) or the ceiling (maximum amount covered) within a policy of the insurance product (Ceilings
) for a treatment (the treatment is identified health care claimed in one claim)
Insuree
Deductibles and Ceilings for an insuree may be entered for general care (
Hospitals and Non-hospitals
) or for hospital care (Hospitals) only and/or for non-hospital care (Non-Hospitals
) only. An amount may be set, indicating the value that an insuree should cover within his/her own means, before a policy of the insurance product comes into effect (Deductibles
) or the ceiling (maximum amount covered) within a policy of the insurance product (Ceilings
) for an insuree for the whole insurance period.
Policy
Deductibles and Ceilings for a policy may be entered for general care (
Hospitals and Non-hospitals
) or for hospital care (Hospitals
) only and/or for non-hospital care (Non-Hospitals) only. An amount may be set, indicating the value that policy holders should cover within their own means, before a policy of the insurance product comes into effect (Deductibles
) or the ceiling (maximum amount covered) for the policy (all members of a family/group) of the insurance product (Ceilings
) for the whole insurance period.
Extra Member Ceiling
Additional (extra) ceiling for a policy may be entered for general care (
Hospitals
andNon-hospitals
) or for hospital care (Hospitals
) only and/or for non-hospital care (Non-Hospital
s ) only per a member of a family/group aboveThreshold Members
.
Maximum Ceiling
Maximal ceiling for a policy may be entered for general care (
Hospitals
andNon-hospitals
) or for hospital care (Hospitals
) only and/or for non-hospital care (Non-Hospitals
) only if extra ceilings are applied for members of a family/group aboveThreshold Members
.
Number
Maximal number of covered claims per an insuree during the whole insurance period according to the category of a claim. The options are claims of the category
Consultations
,Surgery
,Delivery
andAntenatal care
. Maximal numbers may be also specified for Hospitalizations (in-patient stays) and (out-patient visits)Visits
. The claim category is determined as follows:
If at least one service of the category Surgery is given in the claim it is of category Surgery
otherwise
if at least one service of the category Delivery is given in the claim it is of category Delivery
otherwise
if at least one service of the category Antenatal care is given in the claim it is of category Antenatal care
otherwise
if the claim is a hospital one the claim it is of category Hospitalization
otherwise
if at least one service of the category Consultation is given in the claim it is of category Consultation
otherwise
the claim is of the category Visit
Ceiling
Maximal amount of coverage can be specified for claims according to the category of a claim. The options are claims of the category
Consultations
,Surgery
,Delivery
,Antenatal care
, Hospitalizations, andVisits
. The category of claim is determined according to the procedure described withNumber
.Note. It is possible to specify only one of the following ceilings –per Treatment, per Insuree or per Policy. If ceilings per category of claims are specified together with ceilings per Treatment, per Insuree or per Policy than evaluation of claims may be dependent under special circumstances on the order of claimed medical services/items in a claim.
distribution Period
Distribution periods may be entered for general care (
Hospitals
andNon-hospitals
), or for hospital care (Hospitals
) only and/or for non-hospital care (Non-Hospitals
) only. Select from the list (NONE, Monthly, Quarterly, Yearly), the period that is to be used for calculation of the actual value of relative prices for the insurance product; by clicking on the arrow on the right. The default value is ‘NONE’ which means that relative prices are not calculated for general health care or for hospital care or non-hospital care within the insurance product. By selecting Monthly, Quarterly or Yearly will cause a pop-up (Image 14) with the relative periods (1 period for yearly, 4 for quarterly, 12 for monthly). Percentages should be entered to indicate the distribution over the periods as per the product description. Enter to each field an appropriate percentage of paid contributions for policies of the insurance product allocated proportionally to corresponding calendar period. It means, for example, that in case of the distribution Monthly we put in each slot percentage of paid contributions of the insurance product that are allocated to the corresponding month and that is to be used for calculation of relative prices.It is not required to enter a value in each period, zero values are accepted. Once all the percentage values have been entered, click on the button OK to submit the values to the respective grid. Clicking on the button
Cancel
will cancel the action closing the popup and cancelling the change in the distribution.
Capitation Payment
The section allows definition of parameters of a capitation formula used for remuneration of selected levels of health facilities within the insurance product. The report Capitation Payment is used for calculation of the amount of capitation payment for individual health facilities. The parameters of the capitation formula are the following:
Level 1
The first level of health facilities can be selected that should be included in the calculation of capitation payments. The options are the following levels of a health facility: Dispensary, Health Centre, and Hospital.
Sub Level 1
The sub-level of the first level of health facilities can be selected that should be included in calculation of capitation payments. If the sub level is not selected, all health facilities of the specified level are included irrespective of their sub-level.
Level 2
The second level of health facilities can be selected that should be included in the calculation of capitation payments. The options are the following levels of a health facility:
Dispensary
,Health Centre
, andHospital
.
Sub Level 2
The sub-level of the second level of health facilities can be selected that should be included in calculation of capitation payments. If the sub level is not selected, all health facilities of the specified level are included irrespective of their sub-level.
Level 3
The third level of health facilities can be selected that should be included in the calculation of capitation payments. The options are the following levels of a health facility:
Dispensary
,Health Centre
, andHospital
.
Sub Level 3
The sub-level of the third level of health facilities can be selected that should be included in calculation of capitation payments. If the sub level is not selected, all health facilities of the specified level are included irrespective of their sub-level.
Level 4
The fourth level of health facilities can be selected that should be included in the calculation of capitation payments. The options are the following levels of a health facility:
Dispensary
,Health Centre
, andHospital
.
Sub Level 4
The sub-level of the fourth level of health facilities can be selected that should be included in calculation of capitation payments. If the sub level is not selected, all health facilities of the specified level are included irrespective of their sub-level.
Share of Contribution
The share of allocated contributions for given insurance product and the period specified for the report Capitation Payment that should be used for calculation of capitation payments for individual health facilities. The amount specified is interpreted as a percentage.
Weight of Population
The weight can be entered that is used for the number of population living in catchments areas of individual health facilities. The amount specified is interpreted as a percentage.
Weight of Number of Families
The weight can be entered that is used for the number of families living in catchments areas of individual health facilities. The amount specified is interpreted as a percentage.
Weight of Insured Population
The weight can be entered that is used for the number of insured population by given insurance product and living in catchments areas of individual health facilities. The amount specified is interpreted as a percentage.
Weight of Number of Insured Families
The weight can be entered that is used for the number of insured families by given insurance product and living in catchments areas of individual health facilities. The amount specified is interpreted as a percentage.
Weight of Number of Visits
The weight can be entered that is used for the number of contacts of insured by given insurance product and living in catchments areas of individual health facilities. The amount specified is interpreted as a percentage.
Weight of Adjusted Amount
The weight can be entered that is used for the adjusted amount on claims for insured by given insurance product and living in catchments areas of individual health facilities. The amount specified is interpreted as a percentage.
Note. The capitation formula is defined as follows:
Where
\(\text{CapitationPayment}_{i}\) is the amount of capitation payment for i-th health facility
\(\text{Indicator}_{i}^{a}\) is the value of the indicator of the type a for the i-th health facility. \(\text{Indicator}_{i}^{a}\)
may be:
- Population living in catchments area of the health facility
- Number of families living in catchments area of the health facility
- Insured population living in catchments area of the health facility
- Insured number of families living in catchments area of the health facility
- Number of claims (contacts) with the health facility by insured in the catchment area
- Adjusted amount
\(\text{AllocatedContribution}\) is the amount of contributions for given insurance product for given period
\(\text{ShareContribution}\) is the formula parameter Share of contribution
\(\text{Share}^{a}\) is the weight of the indicator of the type a .
\(\text{Share}^{a}\) may be:
- Weight of Population
- Weight of Number of Families
- Weight of Insured Population
- Weight of Number of Insured Families
- Weight of Number of Visits
- Weight of Adjusted Amount
Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the Product Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the product has been saved will appear on the Information Panel.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Product Control Page.
Adding a Product¶
Click on the
Add
button to re-direct to the Product Page.When the page opens all entry fields are empty. See the Product Page information on the data entry and mandatory fields.
Editing a Product¶
Click on the
Edit
button to re-direct to the ProductPage.The page will open with the current information loaded into the data entry fields. See the Product Page for information on the data entry and mandatory fields
Duplicating a Product¶
Click on the
Duplicate
button to re-direct to the Product Page.The page will open with all the current information for the selected product, (except for the product code which should be unique), loaded into the data entry fields. See the Product Page for information on the data entry and mandatory fields. To save the record, enter a unique code before clicking on save.
Deleting a Product¶
Because of potential problems with synchronization of data between off-line and on-line version, it is not possible delete insurance products currently.
Health Facilities Administration¶
The register of health facilities contains all health facilities contracted and/or eligible for submitting of claims by/to the health insurance scheme. Health Facility administration is restricted to users with the role of Scheme Administrator.
Pre-conditions¶
A health facility may only be added if the management of the scheme administration contracts it or if eligibility of submitting of claims can be derived from the legislation. It may thereafter be edited; however, approval of the management of the scheme administration is required for a change of the pricelists associated with the health facility. Deletion of a health facility normally will occur when a Health Facility stops its activity or the contract with the health facility with the scheme administration is cancelled.
Navigation¶
All functionality for use with the administration of health facilities can be found under the main menu
Administration
, sub menuHealth Facilities.
Clicking on the sub menu
Health Facilities
re-directs the current user to the Health Facilities Control Page.
Health Facilities Control PAGE¶
TheHealth Facilities Control Page
is the central point for all health facilities administration. By having access to this page, it is possible to add, edit, delete and search. The page is divided into four panels (Image 16)
Search Panel
The Search Panel allows a user to select specific criteria to minimise the search results. In the case of health facilities the following search options are available which can be used alone or in combination with each other.
Code
Type in the beginning of; or the full
Code
; to search for health facilities with aCode
, which starts with or matches completely, the typed text.
Name
Type in the beginning of; or the full
Name
; to search for health facilities with aName
, which starts with or matches completely, the typed text.
Fax
Type in the beginning of; or the full
Fax
to search for health facilities with aFax
, which starts with or matches completely, the typed number.
Level
Select the
Level
; from the list of levels of health facilities (Dispensary, Health Centre, Hospital) by clicking on the arrow on the right of the selector, to select health facilities of a specific level of service.
Phone Number
Type in the beginning of; or the full
Phone Number
to search for health facilities with aPhone Number
, which starts with or matches completely, the typed number.
Type in the beginning of; or the full
Legal Form
Select the
Legal Form
; from the list of legal forms (Government, District organization, Private Organisation, Charity) by clicking on the arrow on the right of the selector, to select health facilities of a specific legal form.
Region
Select the
Region
; from the list of districts by clicking on the arrow on the right of the selector to select health facilities from a specific region. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then this region will be automatically selected.
District
Select the
District
; from the list of districts by clicking on the arrow on the right of the selector to select health facilities from a specific district. Note: The list will only be filled with the districts that belong to the selected region and that are assigned to the current logged in user. If this is only one then the district will be automatically selected.
Care Type
Select the
Care Type
from the list of types (In-patient, Out-patient, Both) of provided health care by clicking on the arrow on the right of the selector, to select health facilities with a specific type.
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 17)
Search button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the Result Panel.
Result Panel
The result panel displays a list of all health facilities found, matching the selected Criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 18). The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 19)
Button Panel
With exception of the
Cancel
button, which re-directs to the Home Page, and theAdd
button which re-directs to the health facility page, the button panel (the buttonsEdit
andDelete)
is used in conjunction with the current selected record (highlighted with blue). The user should select first a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a health facility has been added, updated or deleted or if there was an error at any time during the process of these actions.
Health Facility Page¶
Data Entry
Code
Enter the code for the health facility. Mandatory, 8 characters.
name
Enter the name for the health facility. Mandatory, 100 characters maximum.
Legal Form
Select the legal form of the health facility from the list (Government, District organization, Private Organisation, Charity), by clicking on the arrow on the right hand side of the lookup. Mandatory.
Level
Select a level from the list levels (Dispensary, Health Centre, Hospital), by clicking on the arrow on the right hand side of the lookup. Mandatory.
Sub Level
Select a sub-level from the list sub-levels (No Sublevel, Integrated, Reference), by clicking on the arrow on the right hand side of the lookup. Mandatory.
Address
Enter the address of the health facility. Mandatory, 100 characters maximum.
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to enter the region in which the health facility is located. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then this region will be automatically selected. Mandatory.
District
Select the
district
; from the list of districts by clicking on the arrow on the right of the selector to enter the district in which the health facility is located. Note: The list will only be filled with the districts assigned to the selected region and to districts assigned to the currently logged in user. If this is only one then the district will be automatically selected. Mandatory.
Phone Number
Enter the phone number for the health facility. 50 characters maximum.
Fax
Enter the fax number for the health facility. 50 characters maximum.
Enter the email for the health facility. 50 characters maximum.
Care Type
Select the type of health care provided by the health facility from the list (In-patient, Out-patient, Both), by clicking on the arrow on the right hand side of the lookup. Mandatory.
Price Lists (Medical Services)
Select the health facilities price lists (for medical services) from the list by clicking on the arrow on the right hand side of the lookup. The pricelist contains the list of medical services and their prices agreed between the health facility (or corresponding group of health facilities) and the scheme administration which can be invoiced by the health facility and remunerated by the scheme administration. Note: The list will only be filled with the pricelists associated with the previously selected district, regional and nationwide pricelists assigned to the current logged in user.
Price Lists (Medical Items)
Select the health facilities price lists (medical items) from the list by clicking on the arrow on the right hand side of the lookup. The pricelist contains the list of medical items and their prices agreed between the health facility (or corresponding group of health facilities) and the scheme administration which can be invoiced by the health facility and remunerated by the scheme administration. Note: The list will only be filled with the pricelists associated with the previously selected district, regional and nationwide pricelists assigned to the current logged in user.
Account Code
Enter the account code (Identification for the accounting software), which will be used in reports on remuneration to be received by the health facility. 25 characters maximum.
Region, District, Municipality, Village, Catchment grid
Check the locations that define the catchment area of the health facility. Specify the percentage of the population of a village that belong to the catchment area in the catchment column. Default is 100%.
Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to theHealth Facility Control Page
, with the newly saved record displayed and selected in the result panel. A message confirming that the health facility has been saved will appear on the Information Panel.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Health Facilities Control Page.
Adding a Health Facility¶
Click on the
Add
button to re-direct to the Health Facility PageWhen the page opens all entry fields are empty. See the Health Facility Page for information on the data entry and mandatory fields.
Editing a Health Facility¶
Click on the
Edit
button to re-direct to the Health Facility Page.The page will open with the current information loaded into the data entry fields. See the Health Facility Page for information on the data entry and mandatory fields
Deleting a Health Facility¶
Click on the
Delete
button to delete the currently selected record.Before deleting a confirmation popup (Image 21) is displayed, which requires the user to confirm if the action should really be carried out?
When a health facility is deleted, all records retaining to the deleted health facility will still be available by selecting historical records.
Medical Services Administration¶
The register of Medical Services contains all medical services that can be included in packages of benefits of insurance products administered and remunerated by the health insurance scheme. Administration of the register of medical services is restricted to users with the role of Scheme Administrator.
Pre-conditions¶
A medical service may only be added or thereafter edited or deleted, after the approval of the management of the scheme administration.
Navigation¶
All functionality for use with the administration of Medical Services can be found under the main menu
Administration
, sub menuMedical Services.
Clicking on the sub menu
Medical Services
re-directs the current user to the Medical Services Control Page.
Medical Services Control Page¶
TheMedical Services Control Page
is the central point for all medical service administration. By having Access to this panel, it is possible to add, edit, delete and search. The panel is divided into four panels (Image 23)
Search Panel
The Search Panel allows a user to select specific criteria to minimise the search results. In the case of medical services the following search options are available which can be used alone or in combination with each other.
Code
Type in the beginning of; or the full
Code
; to search for medical services with aCode
, which starts with or matches completely, the typed text.
Name
Type in the beginning of; or the full
Name
to search for medical services with aName
, which starts with or matches completely, the typed text.
Type
Select the
Type
; from the list of types (Preventive, Curative) by clicking on the arrow on the right of the selector, to select medical services of a specific type.
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 24)
Search Button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the result panel.
Result Panel
The Result Panel displays a list of all medical services found, matching the selected Criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 25). The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 26).
Button Panel
With exception of the cancel button, which re-directs to the Home Page, and the
Add
button which re-directs to the Medical Service Page, the button panel (the buttonsEnd
andDelete
) is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a medical service has been added, updated or deleted or if there was an error at any time during the process of these actions.
Medical Service Page¶
Data Entry
Code
Enter the code for the medical service. Mandatory, 6 characters.
Name
Enter the name of the medical service. Mandatory, 100 characters maximum.
Category
Choose the category (Surgery, Consultation, Delivery, Antenatal, Other) which the medical service belongs to.
Type
Choose one from the options available (Preventive, Curative), the type of the medical service. Mandatory.
Level
Select from the list )Simple Service, Visit, Daz of Staz, Hospital Case), the level for the medical service. Mandatory.
Price
Enter the price a general price that can be overloaded in pricelists. Full general price (including potential cost sharing of an insuree) for the medical service. Mandatory.
Care Type
Choose one from the options available (Out-patient, In-patient, Both), the limitation of provision of the medical service to the specific type of health care. Mandatory.
Frequency
Enter the limitation of frequency of provision in a number of days within which a medical service can be provided to a patient not more than once. If the frequency is zero, there is no limitation. Note: By default the frequency is 0.
Patient
Choose one or a combination of the options available, to specify which patient type the medical service is applicable to. Note: By default all patient options are checked (selected).
Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the Medical Services Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the medical service has been saved will appear on the Information Panel.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Medical Services Control Page.
Adding a Medical Service¶
Click on the
Add
button to re-direct to the Medical Service Page.When the page opens all entry fields are empty. See the Medical Service Page for information on the data entry and mandatory fields.
Editing a Medical Service¶
Click on the
Edit
button to re-direct to the Medical Service Page.The page will open with the current information loaded into the data entry fields. See the Medical Service Page for information on the data entry and mandatory fields.
Deleting a Medical Service¶
Click on the
Cancel
button to delete the currently selected record; the user is re-directed the Medical Services Control Page.Before deleting a confirmation popup (Image 28) is displayed, which requires the user to confirm if the action should really be carried out?
When a medical service is deleted, all records retaining to the deleted medical service will still be available by selecting historical records.
Medical Items Administration¶
The register of Medical Items contains all medical items (drugs, prostheses) that can be included in packages of benefits of insurance products within the health insurance scheme and are remunerated by the scheme administration. Administration of the register of medical items is restricted to users with the role of Scheme Administrator
Pre-conditions¶
A medical item may only be added or thereafter edited or deleted, after the approval of the management of the scheme administration.
Navigation¶
All functionality for use with the administration of medical items can be found under the main menu
Administration
, sub menuMedical Items
Clicking on the sub menu
Medical Items
re-directs the current user to the Medical Items Control Page.
Medical Items Control Page¶
TheMedical Items Control Page
is the central point for all medical item administration. By having access to this page, it is possible to add, edit, delete and search. The panel is divided into four panels (Image 30)
Search Panel
The search panel allows a user to select specific criteria to minimise the search results. In the case of medical items the following search options are available which can be used alone or in combination with each other.
Code
Type in the beginning of; or the full
Code
; to search for medical items with aCode
, which starts with or matches completely, the typed text.
Name
Type in the beginning of; or the full
Name
to search for medical items with aName
, which starts with or matches completely, the typed text.
Type
Select the
Type
; from the list of types (Drugs, Medical Prostheses) by clicking on the arrow on the right of the selector, to select medical items of a specific type.
Package
Type in the beginning of; or the full
Package
; to search for medical items with aPackage
, which starts with or matches completely, the typed text.
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 31).
Search button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the Result Panel.
Result Panel
The result panel displays a list of all medical items found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 32). The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 33)
Button Panel
With exception of the
Cancel
button, which re-directs to the Home Page, and theAdd
button which re-directs to the Medical Item Page, the button panel (the buttonsEdit
andDelete
) is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a medical item has been added, updated or deleted or if there was an error at any time during the process of these actions.
Medical Item Page¶
Data Entry
Code
Enter the code for the medical item. Mandatory, 6 characters.
Name
Enter the name of the medical item. Mandatory, 100 characters maximum.
Type
Choose one from the options available, the type of the medical item. Mandatory.
Package
Enter the package (Indication of type and volume of package in a suitable coding system) for the medical item. Mandatory, 255 characters maximum.
Price
Enter the price (a general price that can be overloaded in pricelists). Full general price including potential cost sharing of an insuree) for the medical item. Mandatory.
Care Type
Choose one from the options available, the limitation of provision of the medical item within the specific type of health care (In-patient, Out-patient or Both). Mandatory.
Frequency
Enter the limitation of frequency of provision in a number of days within which a medical item cannot be provided to a patient not more than once. If the frequency is zero, there is no limitation. Note: By default the frequency is 0.
Patient
Choose one or a combination of the options available, to specify which patient type the medical item may be provided to. Note: By default all patients’ options are checked (selected).
Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the Medical Items Control Page, with the newly saved record displayed and selected in the Result Panel. A message confirming that the medical item has been saved will appear on the Information Panel.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Medical Items Control Page.
Adding a Medical Item¶
Click on the
Add
button to re-direct to the Medical Item Page.When the page opens all entry fields are empty. See the Medical Item Page for information on the data entry and mandatory fields.
Editing a Medical Item¶
Click on the
Edit
button to re-direct to the Medical Item Page.The page will open with the current information loaded into the data entry fields. See the Medical Item Page for information on the data entry and mandatory fields.
Deleting a Medical Item¶
Click on the
Delete
button to delete the currently selected recordBefore deleting a confirmation popup (Image 35) is displayed, which requires the user to confirm if the action should really be carried out?
When the medical item is deleted, all records retaining to the deleted medical item will still be available by selecting historical records.
Medical Service Price Lists Administration¶
Price lists of medical services are tools for specification which medical services and at which prices can be invoiced by contractual health facilities to the scheme administration. Administration of price lists of medical services is restricted to users with the role of Scheme Administrator
Pre-conditions¶
A price list of medical services may only be added, after an agreement with a health facility or a group of health facilities on specific prices. Editing of the price list may occur only after an approval of the management of the scheme administration. Deletion of a price list of medical services normally will occur when a price list becomes obsolete.
Navigation¶
All functionality for use with the administration of price lists medical services can be found under the main menu
Administration
, sub menuPrice Lists
and sub menuMedical Services
Clicking on the sub menu
Medical Services
re-directs the current user to the Price List Medical Services Control Panel.
Price List Medical Services Control Page¶
ThePrice List Medical Services Control Page
is the central point for administration of all price lists of medical service. By having access to this panel, it is possible to add, edit, delete and search. The panel is divided into four panels (Image 36)
Search Panel
The search panel allows a user to select specific criteria to minimise the search results. In the case of price lists for medical services the following search options are available which can be used alone or in combination with each other.
Name
Type in the beginning of; or the full
Name
; to search for price lists medical services with aName
, which starts with or matches completely, the typed text.
Date
Type in the full
Date
to search for price lists of medical services with a creationDate
which matches completely, the typed date. Note: You can also use the button next to the date field to select a date.
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 38); by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- Anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 38 - Calendar Selector - Search Panel
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select price lists of medical services from a specific region. The option National means that the price list is common for all regions. Note: The list will only be filled with the regions assigned to the current logged in user and with the option National. All nationwide pricelists and all regional pricelists relating to the selected region will be found. If no district is selected then also all district pricelists for districts belonging to the selected region and assigned to the currently logged in user will be found.
District
Select the
District
; from the list of districts by clicking on the arrow on the right of the selector to select price lists of medical services from a specific district. Note: The list will be only filled with the districts belonging to the selected region. All nationwide pricelists, all regional pricelists relating to the selected region and all district pricelists for the selected district will be found.
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 39)
Search button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the Result Panel.
Result Panel
The Result Panel displays a list of all price lists of medical services found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 40). The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 41)
Button Panel
With exception of the
Cancel
button, which re-directs to the Home Page, and theAdd
button which re-directs to the Price List Medical Service Page, the Button Panel (the buttonsEdit
andDuplicate
) is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a price list of medical services has been added, updated or deleted or if there was an error at any time during the process of these actions.
Price List Medical Services Page¶
Data Entry
Name
Enter the name for the price list of medical services. Mandatory, 100 characters maximum.
Date
Enter the creation date for the price list of medical services. Note: You can also use the button next to the date field to select a date to be entered.
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to enter the region in which the price list of medical services is to be used. The region National means that the price list is common for all regions. The list will only be filled with the regions assigned to the current logged in user and with the option National. Mandatory.
District
Select the
District
; from the list of districts by clicking on the arrow on the right of the selector to enter the district in which the price list of medical services is to be used. Note: The list will be only filled with the districts belonging to the selected region and currently logged in user. It is not mandatory to enter a district, not selecting a district will mean the price list of medical services is used in all districts of the region or nationwide if the region National is selected.
Medical Services
Select from the list of available medical services the medical services which the price list of medical service should contain, by either clicking on the
check all
box at the top of the list of medical services, or by selectively clicking on thecheck box
to the left of a medical service. The list shows the medical services displaying the code, name, type and price for reference. There is also an extra column, Overrule, which can be used to overrule the pre-set price. By clicking once on the row desired item in the overrule column, a new price can be entered for the individual service. This occurs when price agreed between a health facility or group of health facilities and the health insurance administration differs from the common price in the register of medical services.Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the Price List Medical Services Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the price list medical service has been saved will appear on the Information Panel.Mandatory Data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Price List Medical Services Control Page.
Adding a Price List of Medical Services¶
Click on the
Add
button to re-direct to the Price List Medical Services Page.When the page opens all entry fields are empty. See the Price List Medical Services Page for information on the data entry and mandatory fields.
Editing a Price List of Medical Services¶
Click on the
Edit
button to re-direct to the Price List Medical Services Page.The page will open with the current information loaded into the data entry fields. See the Price List Medical Services Page for information on the data entry and mandatory fields.
Duplicating a Price List of Medical Services¶
Click on the
Duplicate
button to re-direct to the Price List Medical Services Page.The page will open with all the current information for the selected pricelist, (except for the pricelist name which should be unique), loaded into the data entry fields. See the Price List Medical Services Page for information on the data entry and mandatory fields. To save the record, enter a unique code before clicking on save.
Deleting a Price List of Medical Services¶
Click on the
Delete
button to delete the currently selected record.Before deleting a confirmation popup (Image 43) is displayed, which requires the user to confirm if the action should really be carried out?
When a price list medical service is deleted, all records retaining to the deleted price list medical service will still be available by selecting historical records.
Medical Item Price Lists Administration¶
Pricelists of medical items are tools for specification which medical items and at which prices can be invoiced by contractual health facilities to the scheme administration. Administration of pricelists of medical items is restricted to users with the role of Scheme Administrator.
Pre-conditions¶
A price list of medical items may only be added, after an agreement with a health facility or a group of health facilities on specific prices. Editing of the price list may occur only after an approval of the management of the scheme administration. Deletion of a price list of medical items normally will occur when a price list becomes obsolete.
Navigation¶
All functionality for use with the administration of medical items price lists can be found under the main menu
Administration
, sub menuPrice Lists
, sub menuMedical Items.
Clicking on the sub menu
Medical Items
re-directs the current user to the Price List Medical Items Control Page.
Price List Medical Items Control Page¶
ThePrice List Medical Items Control Page
is the central point for all medical item price list administration. By having access to this panel, it is possible to add, edit, delete and search. The panel is divided into four panels (Image 48).
Search Panel
The search panel allows a user to select specific criteria to minimise the search results. In the case of price lists for medical items the following search options are available which can be used alone or in combination with each other.
Name
Type in the beginning of; or the full
Name
; to search for price lists medical items with a Name, which starts with or matches completely, the typed text.
Date
Type in the full
Date
to search for price lists of medical items with a creation Date which matches completely, the typed date. Note: You can also use the button next to the date field to select a date.
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 45); by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- At anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 46 - Calendar Selector - Search Panel
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select price lists of medical items from a specific region. The option National means that the price list is common for all regions. Note: The list will only be filled with the regions assigned to the current logged in user and with the option National. All nationwide pricelists and all regional pricelists relating to the selected region will be found. If no district is selected the also all district pricelists for districts belonging to the selected region will be found.
District
Select the
District
; from the list of districts by clicking on the arrow on the right of the selector to select price lists medical items from a specific district. Note: The list will be only filled with the districts belonging to the selected region and assigned to the currently logged in user. All nationwide pricelists, all regional pricelists relating to the selected region and all district pricelists for the selected district will be found.
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 47).
Search button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the result panel.
Result Panel
The Result Panel displays a list of all price lists of medical items found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 48). The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 49)
Button Panel
With exception of the
Cancel
button, which re-directs to the Home Page, and theAdd
button which re-directs to the Price List Medical Item Page, the button panel (the buttonsEdit
andDelete
) is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a price list medical item has been added, updated or deleted or if there was an error at any time during the process of these actions.
Price List Medical Item Page¶
Data entry
Name
Enter the name for the price list of medical items. Mandatory, 100 characters maximum.
Date
Enter the creation date for the price list of medical items. Note: You can also use the button next to the date field to select a date to be entered.
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to enter the region in which the price list of medical items is to be used. The district National means that the price list is common for all regions. Note: The list will only be filled with the regions assigned to the current logged in user and with the option National. Mandatory.
District
Select the
District
; from the list of districts by clicking on the arrow on the right of the selector to enter the district in which the price list of medical items is to be used. Note: The list will be only filled with the districts belonging to the selected region and currently logged in user. It is not mandatory to enter a district, not selecting a district will mean the price list of medical items is used in all districts of the region or nationwide if the region National is selected .
Medical Items
Select from the list of available medical items the medical items which the price list medical item contains, by either clicking on the
check all box
at the top of the list of medical items, or by selectively clicking on thecheck box
to the left of the medical item. The list shows the medical items displaying the code, name, type and price for reference. There is also an extra column, Overrule, which can be used to overrule the pre-set price. By clicking once on the row desired item in the overrule column, a new price can be entered for the individual item. This occurs when price agreed between a health facility or group of health facilities and the health insurance administration differs from the common price in the register of medical items.Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the Price list Medical Items Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the price list of medical items has been saved will appear on the Information Panel.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save button
, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Price List Medical Items Control Page.
Adding a Price List of Medical Items¶
Click on the Add button to re-direct to the Price List Medical Item Page.
When the page opens all entry fields are empty. See the Price List Medical Item Page for information on the data entry and mandatory fields.
Editing a Price List of Medical Items¶
Click on the Edit button to re-direct to the Price List Medical Item Page.
The page will open with the current information loaded into the data entry fields. See the Price List Medical Item Page for information on the data entry and mandatory fields.
Duplicating a Price List of Medical Items¶
Click on the Duplicate button to re-direct to the Price List Medical Item Page.
The page will open with all the current information for the selected price list, (except for the price list name which should be unique), loaded into the data entry fields. See the Price List Medical Item Page for information on the data entry and mandatory fields. To save the record, enter a unique code before clicking on
Save
.
Deleting a Price List of Medical Items¶
Click on the
Delete
button to delete the currently selected record; the user is re-directed to the Price List Medical Items Control Page.Before deleting a confirmation popup (Image 51) is displayed, which requires the user to confirm if the action should really be carried out?
When a price list of medical items is deleted, all records retaining to the deleted price list of medical items will still be available by selecting historical records.
Users administration¶
User administration is restricted to users with the role of openIMIS Administrator.
Pre-conditions¶
A user may only be added or thereafter edited, after the approval of the management of the scheme administration. Deletion of a user normally will occur when a user leaves his/her post within the health insurance scheme and/or the scheme administration.
Navigation¶
All functionality for use with the administration of users can be found under the main menu
Administration
, sub menuUsers
.Clicking on the sub menu
Users
re-directs the current user to the User Control Page.
User Control Page¶
TheUser Control Page
is the central point for all user administration. By having access to this page, it is possible to add, edit, delete and search users. The page is divided into four panels (Image 52).
Search Panel
The search panel allows a user to select specific criteria to minimise the search results. In the case of users the following search options are available which can be used alone or in combination with each other.
Last Name
Type in the beginning of; or the full Last name; to search for users with a Last name, which starts with or matches completely, the typed text.
Login Name
Type in the beginning of; or the full Login name, to search for users with a Login name, which starts with or matches completely, the typed text.
Phone Number
Type in the beginning of; or the full Phone Number, to search for users, with a Phone Number which starts with or matches completely, the typed text.
Type in the beginning of; or the full Email, to search for users, with an Email which starts with or matches completely, the typed text.
Other Names
Type in the beginning of; or the full Other Names, to search for users, with Other names which start with or match completely the typed text.
Role
Select the Role; from the list of roles by clicking on the arrow on the right of the selector, to select users of a specific role.
Health Facilities
Select the Health Facility; from the list of health facilities by clicking on the arrow on the right of the selector, to select users from a specific health facility. Note: The list will only be filled with the health facilities belonging to the districts assigned to the currently logged in user.
Region
Select the Region; from the list of regions by clicking on the arrow on the right of the selector to find users with access to a specific region. Note: The list will only be filled with the regions assigned to the current logged in user.
District
Select the District; from the list of districts by clicking on the arrow on the right of the selector to find users with access to a specific district. The list will be only filled with the districts belonging to the selected region.
Language
Select the Language; from the list of languages by clicking on the arrow on the right of the selector, to select users with a specific language.
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 54).
Search Button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the result panel.
Result Panel
The result panel displays a list of all users found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 55). The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 56)
Button Panel
With exception of the
Cancel
button, which re-directs to the Home Page, and theAdd
button which re-directs to the User Page, the button panel (the buttonsEdit
andDelete
) is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a user has been added, updated or deleted or if there was an error at any time during the process of these actions.
User Page¶
Data Entry
Language
Select the user’s preferred language from the list by clicking on the arrow on the right hand side of the lookup. Mandatory.
Last name
Enter the last name (surname) for the user. Mandatory, 100 characters maximum.
Other Names
Enter other names of the user. Mandatory, 100 characters maximum.
Phone Number
Enter the phone number for the user. 50 characters maximum.
Enter the e-mail address for the user. 50 characters maximum.
Login Name
Enter the Login name for the user. This is an alias used for logging into the application; a minimum of 6 and a maximum of 25 characters should be used for the login. Each Login Name should be unique. Mandatory.
Password
Enter the password for the user. This is used at login to grant access to the application; a minimum of 8 and a maximum of 25 characters should be used for the password. The password should have at least one digit. Mandatory.
Confirm Password
Re-enter the password. The password must be entered twice, to ensure that there was no mistyping in the first entry. Mandatory.
Health Facility
Select the health facility that the user belongs to, if applicable, from the list of health Facilities from the list by clicking on the arrow on the right hand side of the lookup. Note: The list will only be filled with the Health Facilities belonging to the districts assigned to the currently logged in user.
Roles
Select from the list of available roles the Roles which the user carries out, by either clicking on the
Check All
box at the top of the list of Roles, or by selectively clicking on theCheck box
to the left of the role. Mandatory (at least one role must be selected)
Regions
Select from the list of available regions the region(s) which the user will have access to, by either clicking on the
Check All
box at the top of the list of regions, or by selectively clicking on theCheck box
to the left of a region. Mandatory (at least one region must be selected). The selection can be done indirectly by selecting a district or some districts.
Districts
Select from the list of available districts the district(s) which the user will have access to, by either clicking on the
Check All
box at the top of the list of districts, or by selectively clicking on theCheck box
to the left of the district. Districts are pre-selected based on the selected region(s). The pre-selection can be modified. Mandatory (at least one district must be selected). The selection can be done indirectly by just selecting a region or some regions.Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the User Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the user has been saved will appear on the Information Panel.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data fields will take the focus (by an asterisk on the right of the corresponding data field).Cancel
By clicking on the
Cancel
button, the user will be re-directed to the User Control Page.
Adding a User¶
Editing a User¶
Deleting a User¶
Click on the Delete button to delete the currently selected record
Before deleting a confirmation popup (Image 58) is displayed, this requires the user to confirm if the action should really be carried out.
When a user is deleted, all records retaining to the deleted user will still be available by selecting historical records.
User roles/profiles administration¶
User roles/profiles administration is restricted to users with the role of openIMIS Administrator.
Navigation¶
All functionality for use with the administration of user roles can be found under the main menu
Administration
, sub menuUsers Profile
.Clicking on the sub menu
Users
re-directs the current user to the User roles/profiles control page.
User roles/profiles control page¶
The User roles/profile control page
is the central point for all user roles/profiles administration. By having access to this page, it is possible to add, edit, delete and search users roles/profiles. The page is divided into four panels (Image User roles/profiles control page).
Search Panel
The search panel allows a user to select specific criteria to minimise the search results. The following search options are available which can be used alone or in combination with each other.
Role Name
When set the search will display the roles with a name that start with the content of the filter , % can be used as a wildcard meaning a search with %er will display all the result containing er in the name
System
When set to TRUE the search will display the default roles, when set to FALSE the search will display only the custom roles
Blocked
When set to TRUE the search will display the roles that were blocked, when set to FALSE the search will display only the unblocked roles
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (User roles results).Result Panel
The Result Panel displays a list of all roles/profiles found, matching the selected criteria in the Search Panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image User roles results panel). The leftmost record contains a hyperlink which if clicked, re-directs the user to the Change user role/profile Page.
- Blue background: Selected record
- Yellow background: hovered records
- Strikethrough: historical records
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image User roles/profile control page)
Button Panel
- The
Add
button will add a new role/profile (not available ifHistorical
was checked)- The
Edit
button will edit a role/profile. not available ifHistorical
was checked)- The
Duplicate
bbutton will duplicate a role/profile (not available ifHistorical
was checked)- The
Delete
button will deleting a role/profile (not available ifHistorical
was checked)- The
Cancel
button re-directs to the Home Page.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a user role/profile has been added, updated or deleted or if there was an error at any time during the process of these actions.
User role/profile Page¶
Data Entry - Role details
Role Name
Enter the name of the role/profile, this name will be used as reference in the User roles/profiels control page and Users page
Alternative language
Translation of the role name for the second language of openIMIS
Data Entry - Rights details
Insurees and Policies
list of the right available for the Insurees and Policies module:
- CRUD rights (Create, read/search, update/edit and Delete):
- Family/Group
- Insuree
- Policy
- Contribution
- Business specific roles
- Renew policy
- Enquire insuree
Claims
list of the right available for the Claims module:
- CRUD rights (Create, read/search, update/edit and Delete):
- Claims
- Business specific roles:
- Claims:
- Submit
- Review
- Feedback
- Update
- Process
- Claim Batch:
- Process
- Filter
- Preview
Administration
list of the right available for the Administration module:
- CRUD rights (Create, read/search, update/edit and Delete):
- Products
- Health Facilities
- Pricelists – Medical Services
- Pricelists – Medical Items
- Medical Services
- Medical Items
- Enrolment Officers
- Claim Administrators
- Users
- User roles/profiles
- Payers
- Locations
- Business specific roles
- Duplicate Products
- Duplicate Pricelists – Medical Services
- Duplicate Pricelists – Medical Items
- Duplicate User roles/profiles
- Move Locations
Tools
list of the business rights available for the Tools module
- Register
- Upload Diagnoses
- Upload Health Facilities
- Upload Locations
- Download Diagnoses
- Download Health Facilities
- Download Locations
- Extracts
- Download Mater-data
- Create Phone Extracts
- Create Offline Extract
- Upload Claims
- Upload Enrolments
- Upload Feedback
- Run report
- Primary Operational Indicators-policies
- Primary Operational Indicators-claims
- Derived Operational Indicators
- Contribution Collection
- Product Sales
- Contribution Distribution
- User Activity Report
- Enrolment Performance Indicators
- Status of Registers
- Insurees without Photos
- Payment Category Overview
- Matching Funds
- Claim Overview
- Percentage of Referrals
- Families and insurees Overview
- Pending Insurees
- Renewals
- Capitation Payment
- Rejected Photos
- Utilities/Email setting
- Backup
- Restore
- Execute Script
- Email Setting
Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data fields will take the focus (by an asterisk on the right of the corresponding data field).Buttons
Save
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the User Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the user has been saved will appear on the Information Panel.
Cancel
By clicking on the
Cancel
button, the user will be re-directed to the User roles/profiles control page.
Adding a User role/profile¶
Click on the Add button to re-direct to the User role/profile Page.
When the page opens all entry fields are empty. See the User role/profile Page. for information on the data entry and mandatory fields.
Editing a User role/profile¶
Click on the Edit button to re-direct to the User role/profile Page.
The page will open with the current information loaded into the data entry fields. See the User role/profile Page. for information on the data entry and mandatory fields.
Duplicating a User role/profile¶
Click on the Duplicate button to re-direct to the User role/profile Page.
The page will open with all the current rights for the selected user role/profile, (except for theuser role/profile name which should be unique), loaded into the data entry fields. See the User role/profile Page for information on the data entry and mandatory fields. To save the record, enter a unique code before clicking on
Save
.
Deleting a User role/profile¶
Click on the Delete button to delete the currently selected record.
Before deleting a confirmation popup (Image User roles/profile delete confirmation) is displayed, this requires the user to confirm if the action should really be carried out.
When a user roles/profile is deleted, the rights that it provide are not available to the users having that role/profile.
Default User roles and rights¶
The table below shows the default roles in openIMIS.
¶ Role Responsibilities Available functionality Enrolment Officer He/she enrols insurees and submits enrolment forms to a health insurance administration; handles policy modifications; collects feedback from scheme patients and submits to the health insurance administration. * Capture a photo of an Insuree.* Send a photo* Inquiry on an Insuree* Collect feedback from an Insuree Village ExecutiveOfficer (VEO)He/she collects feedbacks and collects changes on insurees during insurance periods * Collect feedback from an Insuree* Inquiry on an InsureeManager Oversees operations of the health insurance scheme;runs openIMIS operational reports analyses data generated from the IMIS. * Create managerial statistics* Authorize issuance of a substitution* membership cardAccountant Transfers data on collected Contributions to an external accounting system. Calculates claim amounts per health facility, runs openIMIS operational reports and presents claims decision overview to management of a health insurance administrator. Processes approved claims to health facility sub-accounts. * Transfer of data on Contributions to accounting system* Valuation of a claim* Transfer of a batch of claims for paymentClerk Enters and modifies data on families, insurees, policies and contributions. Enters data on claims if the claims are submitted in a paper form. Medical Officer Provides technical advice on claims verification from a medical standpoint. SchemeAdministratorAdministers registers (all except the register of users) openIMISAdministratorAdministers operations of the IMIS. Is responsible for backups of data.
¶ Role Responsibilities Available functionality Receptionist Verifies membership and issues to a patient a claim form. ClaimAdministratorPools claim forms of a health facility, enters and submits claims. * Opening of a batch of claims* Entry of a claim HFAdministratorOff-line HealthFacility administration Offline HFAdministratorOff-line HealthFacility administration * Creation of clerk* Creation of offline Extract
Enrolment Officers Administration¶
Enrolment Officers administration is restricted to users with the role of Scheme Administrator.
Pre-conditions¶
An enrolment officer may only be added after the approval of the management of the scheme administration with engaging of a new enrolment officer. Editing may be done on all fields; however, approval of the management of the scheme administration is usually required for a substitution of an enrolment officer. Deletion will normally occur when an enrolment officer leaves his post within the scheme administration.
Navigation¶
All functionality for use with the administration of enrolment officers can be found under the main menu
Administration
, sub menuEnrolment Officers
.Clicking on the sub menu
Enrolment Officers
re-directs the current user to the Enrolment Officers Control Page..
Enrolment Officers Control Page¶
The Enrolment Officers Control Page is the central point for all Enrolment Officer administration. By having access to this page, it is possible to add, edit, delete and search. The page is divided into four panels (Image 60).
Search Panel
The search panel allows a user to select specific criteria to minimise the search results. In the case of officers the following search options are available which can be used alone or in combination with each other.
Last Name
Type in the beginning of; or the full
Last name
; to search for officers with aLast name
, that starts with or matches completely, the typed text.
Code
Type in the beginning of; or the full
Code
to search for officers with aCode
, that starts with or matches completely, the typed text.
Other Names
Type in the beginning of; or the full
Other Names
to search for officers withother names
, that starts with or matches completely, the typed text.
Birth Date From
Type in a date; or use the Date Selector Button, to enter the
Birth Date From
to search for officers having the same or later birth date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Birth Date To
Type in a date; or use the Date Selector Button, to enter the
Birth Date To
to search for officers having the same or earlier birth date. Note: To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Date Selector button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 61); by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- At anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 61 - Calendar Selector - Search Panel
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select enrolment officers acting in a specific region. Note: The list will only be filled with the regions assigned to the current logged in user.
District
Select the
District
; from the list of districts by clicking on the arrow on the right of the selector to select enrolment officers acting in a specific district. Note: The list will be only filled with the districts belonging to the selected region and assigned to the current logged in user.
Phone Number
Type in the beginning of; or the full
Phone Number
to search for enrolment officers with a Phone Number, that starts with or matches completely, the typed number.
Type in the beginning of; or the full
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 62).
Search Button
Once the criteria have been entered, use the
search button
to filter the records, the results will appear in the result panel.Result Panel
The result panel displays a list of all officers found, matching the selected Criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 63). The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 64)
Button Panel
With exception of the
Cancel
button, which re-directs to the Home Page, and theAdd
button which re-directs to the Enrolment Officer Page, the button panel (the buttonsEdit
andDelete
is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once an officer has been added, updated or deleted or if there was an error at any time during the process of these actions.
Enrolment Officer Page¶
Data Entry
Enrolment Officers Details
Code
Enter the code for the enrolment officer. Mandatory, 8 characters maximum.
Last Name
Enter the last name (surname) for the enrolment officer. Mandatory, 100 characters maximum.
Other Names
Enter other names of the enrolment officer. Mandatory, 100 characters maximum.
Date of Birth
Enter the date of birth for the enrolment officer. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Phone Number
Enter the phone number for the enrolment officer. 50 characters maximum.
Enter the e-mail address for the enrolment officer. 50 characters maximum.
Permanent Address Details
Enter details of the place of living of the enrolment officer.
Region
Select from the list of available regions the region to a district in which the enrolment officer will act. Mandatory
District
Select from the list of available districts the district in which the enrolment officer will act. Note: The list will be only filled with the districts belonging to the selected region. Mandatory .
Substitution
Select from the list of available enrolment officers the enrolment officer which will substitute the current enrolment officer Substitution means that all prompts to renewals/feedback will be directed to the substituting enrolment officer. Note: The list contains enrolment officers who already exist in the system and who have at least on location common with the enrolment officer to be substituted.
Works To
Enter the date which the substituted enrolment officer will work up to. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Communicate
Check the box
Communicate
if the enrolment officer should receive SMS messages alerting him/her about a need of renewing policies of families/groups he/she is assigned to.
Municipalities
Select from the list of available municipalities the municipality(s) which the enrolment officer is acting in, by either clicking on the
Check All
box at the top of the list of municipalities, or by selectively clicking on theCheck box
to the left of the municipality. Mandatory (at least one municipality must be selected.
Villages
Select from the list of available villages the village(s) which the enrolment officer is acting in, by either clicking on the
Check All
box at the top of the list of villages, or by selectively clicking on theCheck box
to the left of the village. Villages are pre-selected based on the selected municipality. The pre-selection can be modified. Mandatory (at least one village must be selected.
village Officer Details
Code
Enter the code for the Village Executive officer. 25 characters maximum.
Last name
Enter the last name (surname) for the Village Executive officer. 100 characters maximum.
Other Names
Enter other names of the Village Executive officer. 100 characters maximum.
Phone Number
Enter the phone number for the Village Executive officer. 25 characters maximum.
Enter the e-mail address for the Village Executive officer. 50 characters maximum.
Date of Birth
Enter the date of birth for the Village Executive officer. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Include Login
Enable the enrolment officer to use openIMIS web by creating web credentials (enrolment officers primary interface is the enrolment application running on android device that doesn’t require openIMIS user), the change must be saved to be taken into account.
Once the login is created, it will be visible in the User Control Page
Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the Enrolment Officers Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the officer has been saved will appear on the Information Panel.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Enrolment Officers Control Page.
Adding an Enrolment Officer¶
Click on the
Add
button to re-direct to the Enrolment Officer Page.When the page opens all entry fields are empty. See the Enrolment Officer Page for information on the data entry and mandatory fields
Editing an Enrolment Officer¶
Click on the
Edit
button to re-direct to the Enrolment Officer Page.The page will open with the current information loaded into the data entry fields. See the Enrolment Officer Page for information on the data entry and manditory fields.
Deleting an Enrolment Officer¶
Click on the
Delete
button to delete the currently selected record.Before deleting a confirmation popup (Image 66) is displayed, which requires the user to confirm if the action should really be carried out?
When an officer is deleted, all records retaining to the deleted officer will still be available by selecting historical records.
Claim Administrators Administration¶
The register contains employees of contractual health facilities responsible for preparation and/or submission of claims. Administration of the register of claim administrators is restricted to users with the role of Scheme Administrator.
Pre-conditions¶
A claim administrator may be added after the agreement of a contractual health facility and the management of the scheme administration.
Navigation¶
All functionality for use with the administration of claim administrators can be found under the main menu
Administration
, submenuClaim Administrators
.Clicking on the sub menu
Claim Administrators
re-directs the current user to the Claim Administrators Control Page.
Claim Administrators Control Page¶
TheClaim Administrators Control Page
is the central point for the administration of all claim administrators. By having access to this panel, it is possible to add, edit, delete and search claim administrators. The panel is divided into four panels (Image 68).
Search Panel
The search panel allows a user to select specific criteria to minimise the search results. In the case of claim administrators the following search options are available which can be used alone or in combination with each other.
Last Name
Type in the beginning of; or the full
Last name
; to search for claim administrator with aLast name
, which starts with or matches completely, the typed text.
Code
Type in the beginning of; or the full
Code
to search for claim administrator with aCode
, which starts with or matches completely, the typed text.
Other Names
Type in the beginning of; or the full
Other Names
to search for claim administrator withOther Names
which starts with or matches completely, the typed text.
Birth Date From
Type in a date; or use the Date Selector Button, to enter the
Birth Date From
to search for claim administrators having the same or later birth date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Birth Date To
Type in a date; or use the Date Selector Button, to enter the Birth Date To to search for claim administrators having the same or earlier birth date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 69); by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- At any time during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 69 - Calendar Selector - Search Panel
HF Code
Select
HF Code
(a health facility code); from the list of health facility codes by clicking on the arrow on the right of the selector to select claim administrators from a specific health facility. Note: The list will only be filled with the health facilities from districts which are assigned to the current logged in user.
Phone Number
Type in the beginning of; or the full
Phone Number
to search for claim administrators with aPhone Number
, which starts with or matches completely, the typed number.
Type in the beginning of; or the full
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image Insuree Enquiry Results).
Search Button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the Result Panel.
Result Panel
The Result Panel displays a list of all claim administrators found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 71). The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 72)
Button Panel
With exception of the
Cancel
button, which re-directs to the Home Page, and theAdd
button which re-directs to the Claim Administrator Page, the button panel (the buttonsEdit
andDelete
) is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once an officer has been added, updated or deleted or if there was an error at any time during the process of these actions.
Claim Administrator Page¶
Data Entry
claim administrator details
Code
Enter the code for the claim administrator. Mandatory, 8 characters maximum.
Last name
Enter the last name (surname) for the claim administrator. Mandatory, 100 characters maximum.
Other Names
Enter other names of the claim administrator. Mandatory, 100 characters maximum.
Date of Birth
Enter the date of birth for the claim administrator. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Phone Number
Enter the phone number for the claim administrator. 50 characters maximum.
Enter the e-mail for the claim administrator. 50 characters maximum.
HF Code
Select from the list of available health facilities the health facility which the claim administrator will have access to and will act for. Mandatory.
Include Login
Enable the claim administrator to use openIMIS web by creating web credentials (claim administrators primary interface is the claim application running on android device that doesn’t require openIMIS user), the change must be saved to be taken into account.
Once the login is created, it will be visible in the User Control Page
Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the Claim Administrators Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the claim administrator has been saved will appear on the Information Panel.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right side of the corresponding field).Cancel
By clicking on the Cancel button, the user will be re-directed to the Claim Administrators Control Page.
Adding a Claim Administrator¶
Click on the
Add
button to re-direct to the Claim Administrator Page.When the page opens all entry fields are empty. See the Claim Administrator Page for information on the data entry and mandatory fields
Editing a Claim Administrator¶
Click on the
Edit
button to re-direct to the Claim Administrator Page..The page will open with the current information loaded into the data entry fields. See the Claim Administrator Page for information on the data entry and mandatory fields
Deleting a Claim Administrator¶
Click on the
Delete
button to delete the currently selected recordBefore deleting a confirmation popup (Image 74) is displayed, which requires the user to confirm if the action should really be carried out.
When a claim administrator is deleted, all records retaining to the deleted claim administrator will still be available by selecting historical records.
Payers Administration¶
The register of payers contains all institutional payers that can pay contributions on behalf of policy holders (e.g. private organizations, local authorities, cooperatives etc.). Payer administration is restricted to users with the role of Scheme Administrator.
Pre-conditions¶
A payer may only be added or thereafter edited or deleted, after the approval of the management of the scheme administration.
Navigation¶
All functionality for use with the administration of payers can be found under the main menu
Administration
, sub menuPayers.
Clicking on the sub menu
Payers
re-directs the current user to the Payer Control Page.
Payer Control Page¶
The Payer control Page is the central point for all payer administration. By having access to this page, it is possible to add, edit, delete and search (institutional) payers. The page is divided into four panels (Image 76).
Search Panel
The search panel allows a user to select specific criteria to minimise the search results. In the case of payers the following search options are available which can be used alone or in combination with each other.
Name
Type in the beginning of; or the full
name
; to search for payers with aname
, that starts with or matches completely, the typed text.
Type in the beginning of; or the full
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select payers from a specific region. The option National means that the payer is common for all regions. Note: The list will only be filled with the regions assigned to the current logged in user and with the option National. All nationwide payers and all regional payers relating to the selected region will be found. If no district is selected then also all district payers for districts belonging to the selected region will be found.
District
Select the
district
; from the list of districts by clicking on the arrow on the right of the selector to select payers from a specific district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the currently logged in user. If this is only one then the district will be automatically selected
Phone Number
Type in the beginning of; or the full
Phone Number
to search for payers with aPhone Number
, that starts with or matches completely, the typed number.
Type
Select the
Type
; from the list of types of payers by clicking on the arrow on the right of the selector to select payers of specific type.
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 77).
Search Button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the result panel.
Result Panel
The result panel displays a list of all payers found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 78). The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 79).
Button Panel
With exception of the
Cancel
button, which re-directs to the Home Page, and theAdd
button which re-directs to the Payer Page, the button panel (the buttonsEdit
andDelete
) is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a payer has been added, updated or deleted or if there was an error at any time during the process of these actions.
Payer Page¶
Data Entry
Type
Select the type of the payer from the list by clicking on the arrow on the right hand side of the lookup. Mandatory.
Name
Enter the name for the payer. Mandatory, 100 characters maximum.
Address
Enter address of the payer. Mandatory, 100 characters maximum.
Phone Number
Enter the phone number for the payer. 50 characters maximum.
Fax
Enter the fax number for the payer. 50 characters maximum.
Enter the email for the payer. 50 characters maximum.
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to enter the region to which the payer belongs. The region National means that the payer is common for all regions. Note: The list will only be filled with the regions assigned to the current logged in user and with the option National. Mandatory.
District
Select the
district
to which the payer belongs, from the list by clicking on the arrow on the right hand side of the lookup. Note: The list will only be filled with the districts assigned to the selected region and currently logged in user. If this is only one then the district will be automatically selected. It is not mandatory to enter a district. Not selecting a district will mean the payer operates in all districts of the region or nationwide if the region National is selected.Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the Payer Control Page, with the newly saved record displayed and selected in the result panel. A message confirming that the payer has been saved will appear on the Information Panel.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right of the corresponding data field).Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Payer Control Page.
Adding a Payer¶
Click on the
Add
button to re-direct to the Payer Page.When the page opens all entry fields are empty. See the Payer Page for information on the data entry and mandatory fields.
Editing a Payer¶
Click on the
Edit
button to re-direct to the Payer Page.The page will open with the current information loaded into the data entry fields. See the Payer Page for information on the data entry and mandatory fields.
Deleting a Payer¶
Click on the Delete button to delete the currently selected record.
Before deleting a confirmation popup (Image 81) is displayed, which requires the user to confirm if the action should really be carried out?
When a payer is deleted, all records retaining to the deleted payer will still be available by selecting historical records.
Locations Administration¶
Administration of locations is restricted to users with the role of Scheme Administrator.
Pre-conditions¶
A region, district, municipality or village may only be added or thereafter edited, after the approval of the management of the scheme administration.
Navigation¶
All functionality for use with the administration of locations can be found under the main menu
Administration
, sub menuLocations.
Clicking on the sub menu
Locations
re-directs the current user to the Locations Page.
Locations Page¶
The Locations page is the central point for all locations administration. By having access to this page, it is possible to add, edit, delete and move regions, districts, municipalities and villages. The page is divided into three panels (Image 83). Note. Only regions and districts with associated municipalities and villages, belonging to the logged in user will be available to edit or delete. On adding a new region or district, the user will automatically become associated with this region or district.
Locations Panel
This is the working panel and is divided into four vertical panels of
Regions, Districts, Municipalities
andVillages.
Button Panel
It has four buttons,
Add
,Edit
,Delete
andMove
for actions on the locations and theCancel
button for re-directing to the Home Page.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a region, district or municipality or village has been added, updated, moved or deleted or if there was an error at any time during the process of these actions.
Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Home Page.
Adding a Region, District, Municipality, Village¶
Focusing on the appropriate level of locations by clicking on the black or the empty bar on the top of the appropriate panel and clicking on theAdd
button will open up in the top of the screen an empty entry box. Here one could enter the new code (Code) and name (Name) of a region, district, municipality or village. For villages, the number of male inhabitants (M), female inhabitants (F), inhabitants with the unspecified gender (O) and the number of families (Fam.) can be specified. On clicking theSave
button the new record will be saved.
Editing a Region, District, Municipality, Village¶
Selecting the location to edit and clicking on theEdit
button will open up in the top of the screen an entry box with the name of the location. Here one could change the name. On clicking theSave
button, the record will be saved.
Deleting a Region, District, Municipality, Village¶
Select first the location to delete and click the
Delete
button. Note. It is not possible to delete a region, district or municipality with associated districts, municipalities or villages respectively.Before deleting a confirmation popup (Image 85) is displayed, which requires the user to confirm if the action should really be carried out?
When a region, district, municipality or village is deleted, all records retaining to the deleted region, district, municipality or village will still be available by selecting historical records.
Moving a District, Municipality, Village¶
Moving of a location is needed when the administrative division of the territory, on which a health insurance scheme is active, changes. Clicking on the
Move
button will re-direct to the Move Location Page (Image 86).The
Move Location Page
is divided into six panels.
Locations Panels (A ,B,C,D)
The pair of A and B panels is used for moving of a village to another municipality. The pair of B and C panels is used for moving of a municipality to another district. The pair C and D is used for moving a district to another region.
For moving a location, select a location (village, municipality, district) in two adjacent panels by selecting of higher level locations in the fields
Region, District, Municipality
and clicking on the selected location (village, municipality, district) in a panel and on a new parent location in the next panel.Actual moving of a location into a new parent locations is done by clicking on the green arrow between the two corresponding location panels.
Button Panel
It has only the
Cancel
button for re-directing to the Location Page.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a district, municipality or village has been moved or if there was an error at any time during the process of this action.
Group/family, Insurees and Policies¶
In openIMIS the policies are assigned to group only, if a policy need to be assigned to an individual then a group of one must be created.
Because of this approach, the Family Overview Page is the starting point to manage, insuree (add, edit), policies(add, edit, renew …) and contribution
Insuree Enquiry¶
This functionality is available to users will all roles. The function Insuree Enquiry can be accessed at any time, after login. On the top right hand of the main menu, there is a search feature, allowing the user to enter an Insurance Number for a “quick enquiry”.
By typing in a valid insurance number and pressing the enter key or clicking on the green search button, a pop-up will appear (Image 87), providing a photo of the insuree and information about the current policy or policies covering of the insuree.
The Information includes the following:
- The photo of the insuree
- The name, date of birth and gender of the insuree
- The (insurance) product code, product name and expiry date of a policy
- The status (I for Idle, A for Active, S for Suspended and E for Expired) of the policy at the time of inquiring
- The deductible amount remaining for the insuree to pay before the policy is claimable, for hospitals and non-hospitals
- The ceiling amount claimable by a health facility on behalf of the insuree for both hospitals and non-hospitals.
- Age of the insuree
- First Service Point (FSP) of the insuree
- Region of FSP
- District of FSP
- Level of FSP
Family/Group¶
Find Family¶
Access to theFind Family Page
is restricted to users with the role of Accountant, Clerk and Health Facility Receptionist.
Pre-conditions
Need to enquire on, or edit a family and/or insurees, policies and contributions associated.
Navigation
Find Family can be found under the main menu
Insurees and Policies
sub menuFamilies/Groups
Clicking on the sub menu
Families/Groups
re-directs the current user to the Find Family Page.The Find Family Page is the first step in the process of finding of a family and thereafter accessing the Family Overview Page of insurees, policies and contributions. This initial page can be used to search for specific families or groups based on specific criteria. The page is divided into four panels (Image 90):
Search Panel
The search panel allows a user to select specific criteria to minimise the search results. The following search options are available which can be used alone or in combination with each other.
Last Name
Type in the beginning of; or the full
Last name
; to search for families/groups, who’s family head/group headLast name
, starts with or matches completely, the typed text.
Other Names
Type in the beginning of; or the full
Other Names
to search for families/groups, who’s family head/group headOther Names
starts with or matches completely, the typed text.
Insurance Number
Type in the beginning of; or the full
Insurance Number
to search for families/groups, who’s family head/group headInsurance Number
, starts with or matches completely, the typed text.
Phone Number
Type in the beginning of; or the full
Phone Number
to search for families/groups, who’s family head/group headPhone Number
, starts with or matches completely, the typed number.
Birth Date From
Type in a date; or use the Date Selector Button, to enter the
Birth Date From
to search for families/groups, who’s family head/group head, has the same or later birth date thanBirth Date From
. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Birth Date To
Type in a date; or use the Date Selector Button, to enter the
Birth Date To
to search for families/groups, who’s family head/group head, has the same or earlier birth date thanBirth Date To
. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 91) by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- At anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 91 - Calendar Selector - Search Panel
Gender
Select the
Gender
; from the list of gender by clicking on the arrow on the right of the selector, to select families/groups, who’s family head/group head is of the specific gender.
Poverty Status
Select the
Poverty Status
; from the list of has poverty status by clicking on the arrow on the right of the selector, to select families/groups that have a specific poverty status.
Type in the beginning of; or the full
Confirmation Type
Type in the beginning of; or the full
Confirmation Type
to search for families/groups, who’sConfirmation Type
. starts with or matches completely the typed text.
Confirmation No.
Type in the beginning of; or the full
Confirmation No.
to search for families/groups, who’sConfirmation No.
starts with or matches completely the typed text.
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select families/groups from a specific region. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected.
District
Select the
District
; from the list of districts by clicking on the arrow on the right of the selector to select families/groups from a specific district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selected.
Municipality
Select the
Municipality
; from the list of municipalities by clicking on the arrow on the right of the selector to select families/groups from a specific municipality. Note: The list will only be filled with the municipalities in the selected district above.Select the
Village
; from the list of villages by clicking on the arrow on the right of the selector to select families/groups from a specific village. Note: The list will only be filled with the villages in the selected municipality above.
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 92).
Search Button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the Result Panel.
Result Panel
The Result Panel displays a list of all families/groups found, matching the selected criteria in the Search Panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 93). The leftmost record contains a hyperlink which if clicked, re-directs the user to the Family Overview Page for the Family selected or if it is an historical record then the Change Family Page, for detailed viewing.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 94)
Button Panel
The
Cancel
button re-directs to the Home Page.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a family/group has been added, updated or deleted or if there was an error at any time during the process of these actions.
Family/Group Overview¶
Access to the Family Overview Page is restricted to users with the role of Accountant or Clerk.
Pre-conditions
Need to enquire on, or edit a family/group or manage the insurees, policies and contributions associated with it.
Navigation
Family Overview Page cannot be navigated directly to; the first step is to find the family/group by means of using Find Family Page, Find Insuree Page, Find Policy Page or Find Contribution Page. Once a specific family, insuree, policy or contribution is selected by means of selecting the hyperlink in the Result Panel of the respective Find Page, the user is re-directed to the Family Overview Page.
Family Overview Page¶
The
Family Overview Page
is the central point for all operations with regards to the families/groups, Insurees, policies and contributions associated with it. The page is divided into 6 panels (Image Family overview)
Family /Group Panel
The Family/Group Panel provides information about the family including the Insurance Number and the Last Name and Other Names of the head of family and the District, Municipality, Village and Poverty status of the family. In the Family/Group panel action buttons allow to add, edit and delete the family/group.
The
green plus sign
is for adding a new family/group via the Family/Groupe Page.The
yellow pencil sign
is for editing a family/group via the Family/Groupe Page.The
red cross sign
is for deleting a family/group.Insurees Panel
The Insurees Panel displays a list of the insurees within the family/group. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 115). The leftmost record contains a hyperlink which if clicked, re-directs the user to the insuree record for editing or detailed viewing.
In the Insurees Panel, action buttons allow to add, edit and delete insurees belonging to the family/group.
The
green plus sign
is for adding a new insuree via the Insuree Page.The
yellow pencil sign
is for editing an insuree via the Insuree Page.The
red cross sign
is for deleting an insuree .Policies Panel
The Policies Panel displays a list of the policies held by the family/group. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 117). The leftmost record contains a hyperlink which if clicked, re-directs the user to the policy for editing or detailed viewing. By default the first policy is selected and therefore in the Contribution Panel, only the contributions paid on that policy will be displayed in the Contribution Panel By selecting another policy in the list, the Contribution Panel, will refresh with the contributions paid on the newly selected policy.
In the fifth Product column of Policy data grid, there is a link showing product for the policy on the corresponding row. When the link is clicked; a popup browser window (:ref:image118) will open up showing the details of the product (in read-only mode).
In the
Policies Panel
, action buttons allow to add, edit and delete policies.The
green plus sign
is for adding a new policy via the Policy Page.The
yellow pencil sign
is for editing a policy via the Policy Page.The
red cross sign
is for deleting a policy.The
blue R sign
is for renewing a policy via the Policy Page.Contributions Panel
The
Contribution Panel
displays a list of contributions paid on the policy currently selected in thePolicies Panel
. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 120) The leftmost record contains a hyperlink which if clicked, re-directs the user to the contribution for editing or detailed viewing.In the second Payer column of Contributions data grid, there is a link showing (institutional) payer of the contribution on the corresponding row. When the link is clicked; a popup browser window (Image 121) will open up showing the details of the payer in read-only mode.
In the
Contributions Panel
, action buttons allow to add, edit and delete contributions.The
green plus sign
is for adding a new contribution.The
yellow pencil sign
is for editing a contribution.The
red cross sign
is for deleting a contribution.Button Panel
The
Cancel
button re-directs to the Home Page.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once an insuree, a policy or a contribution have been added, updated or deleted or if there was an error at any time during the process of these actions.
Family/Group Page¶
Region
Select from the list of available regions the region, in which the head of family/group permanently stays. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected. Mandatory.
District
Select from the list of available districts the district, in which the head of family/group permanently stays. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selected. Mandatory.
Municipality
Select from the list of available municipalities the municipality, in which the head of family/group permanently stays. Note: The list will only be filled with the municipalities belonging to the selected district. Mandatory.
Village
Select from the list of available villages the village, in which the head of family/group permanently stays. Note: The list will only be filled with the villages belonging to the selected municipality. Mandatory.
Poverty Status
Select whether the family/group has the poverty status. Mandatory.
Confirmation Type
Select the type of a confirmation of the social status of the family/group.
Confirmation No.
Enter alphanumeric identification of the confirmation of the social status of the family/group.
Group Type
Select the type of the group/family.
Address Details.
Enter details of the permanent address of the family/group.
Insurance Number
Enter the insurance number for the head of family/group. Mandatory.
Last name
Enter the last name (surname) for the head of family/group. Mandatory.
Other Names
Enter other names of the head of family/group. Mandatory.
Birth Date
Enter the date of birth for the head of family/group. Note: You can also use the button next to the birth date field to select a date to be entered.
Gender
Select from the list of available genders the gender of the head of family/group. Mandatory.
Marital Status
Select from the list of available marital statuses the marital status of the head of family/group. Mandatory.
Beneficiary Card
Select from the list of card whether or not an insurance identification card was issued to the head of family/group. Mandatory.
Current Region
Select from the list of available regions the region, in which the head of family/group temporarily stays.
Current District
Select from the list of available districts the district, in which the head of family/group temporarily stays. Note: The list will only be filled with the districts belonging to the selected region
Current Municipality
Select from the list of available municipalities the municipality, in which the head of family/group temporarily stays. Note: The list will only be filled with the municipalities belonging to the selected district.
Current Village
Select from the list of available villages the village, in which the head of family/group temporarily stays. Note: The list will only be filled with the villages belonging to the selected municipality.
Current Address Details
Enter details of the temporal address of the head of family/group.
Profession
Select the profession of the head of family/group.
Education
Select the education of the head of family/group.
Phone Number
Enter the phone number for the head of family/group.
Enter the e-mail address of the head of family/group.
Identification Type
Select the type of the identification document of the head of family/group.
Identification No.
Enter alphanumeric identification of the document of head of family/group.
Region of FSP
Select from the list of available regions the region, in which the chosen primary health facility (First Service Point) of the head of family/group is located.
District of FSP
Select from the list of available districts the district, in which the chosen primary health facility (First Service Point) of the head of family/group is located. Note: The list will only be filled with the districts belonging to the selected region.
Level of FSP
Select the level of the chosen primary health facility (First Service Point) of the head of family/group.
First Service Point
Select from the list of available health facilities the chosen primary health facility (First Service Point) of the head of family/group. Note: The list will only be filled with the health facilities belonging to the selected district which are of the selected level.
Browse
Browse to get the photo for the head of family/group related to his/her insurance number.
Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the Family Overview Page, with the newly saved record displayed and selected in the result panel. A message confirming that the family member has been saved will appear on the Information Panel.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk).Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Find Family Page.
Adding a Family¶
Click on the
Green Plus Sign
to re-direct to the Family/Group Page.When the page opens all entry fields are empty. See the Family/Group Page for information on the data entry and mandatory fields.
Editing a Family/Group¶
Click on the Yellow Pencil Sign to re-direct to the Change Family/Group Page
The page will open with the current information loaded into the data entry fields, plus there are options to change the head of the family/group and move an insuree to the family/group.
Changing a Head of Family/Group¶
The head of the Family/Group is the main contact associated with a policy. For various reasons it may be necessary to change the head of a family/group. The new head must be a head of family in another family.
Enter the insurance number for the new head of family/group, click on check, to confirm that the insurance number is valid and that it really is the person expected. The name will appear to the right of the check button. If all is OK, click on the Change button to complete the change. On a successful change, the user will be re-directed back to the Family Overview Page; the new head will be displayed in the Family/Group Information Panel
Moving an Insuree¶
Insurees may be moved from one family/group to another. The new insuree must not be a head of family/group in another family/group.
Enter the insurance number for the insuree to move. Click on check, to confirm that the insurance number is valid and that it really is the person expected. The name will appear to the right of the check button. If all is OK, click on the Change button to complete the change. On a successful change, the user will be re-directed back to the Family Overview Page the new insuree will be displayed in the insuree Information Panel.
Deleting a Family/Group¶
Click on the Red Cross Sign button to delete the currently selected record.
Before deleting a confirmation popup (Image 125) is displayed, which requires the user to confirm if the action should really be carried out? Deleting of a family requires deleting of all its dependants first.
When a family is deleted, all records retaining to the deleted family will still be available by selecting historical records.
Insuree¶
Find Insuree¶
Access to the Find Insuree Page is restricted to users with the role of Accountant, Clerk and Health Facility Receptionist.
Pre-conditions
Need to enquire on, or edit an insuree, and the family/group, policies and contributions associated.
Navigation
All functionality for use with the administration of insurees can be found under the main menu
Insurees and Policies
, sub menuInsurees
.Clicking on the sub menu
Insurees
re-directs the current user to the Find Insuree Page.
Find Insuree Page
The
Find Insuree Page
is the first step in the process of finding an insuree and thereafter accessing the family/group overview of insurees, policies and contributions. This initial page can be used to search for specific Insurees or groups of insurees based on specific criteria. The panel is divided into four panels (Image 96)
Search Panel
The Search Panel allows a user to select specific criteria to minimise the search results. In the case of insurees the following search options are available, which can be used alone or in combination with each other.
Last Name
Type in the beginning of; or the full
Last name
; to search for insurees with aLast name
, which starts with or matches completely, the typed text.
Other Names
Type in the beginning of; or the full
Other Names
to search for insurees withOther Names
which starts with or matches completely, the typed text.
Insurance Number
Type in the beginning of; or the full
Insurance Number
to search for insurees with theInsurance Number
, which starts with or matches completely, the typed text.
Marital Status
Select the
Marital Status
; from the list of marital status by clicking on the arrow on the right of the selector, to select insurees of a specific marital status.
Phone Number
Type in the beginning of; or the full
Phone Number
to search for insurees with aPhone Number
, which starts with or matches completely, the typed number.
Birth Date From
Type in a date; or use the Date Selector Button, to enter the
Birth Date From
to search for insurees who have the same or later birth date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Birth Date To
Type in a date; or use the Date Selector Button, to enter the
Birth Date To
to search for insurees who have the same or earlier birth date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 97) by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- At anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 97 - Calendar Selector - Search Panel
Gender
Select the
Gender
; from the list of genders by clicking on the arrow on the right of the selector, to select insurees of a specific gender.
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select insurees from a specific region. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected.
District
Select the
District
; from the list of districts by clicking on the arrow on the right of the selector to select insurees from a specific district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selected.
Municipality
Select the
Municipality
; from the list of wards by clicking on the arrow on the right of the selector to select insurees from a specific municipality. Note: The list will only be filled with the wards in the selected district above.
Village
Select the
Village
; from the list of villages by clicking on the arrow on the right of the selector to select insurees from a specific village. Note: The list will only be filled with the villages in the selected municipality above.
Photo Assigned
Select whether all insurees are searched [All] or only insurees with a photo assigned [Yes] or only insurees with no photo assigned [No].
Historical
Click on Historical to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 98)
Search Button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the Result Panel.
Result Panel
The result panel displays a list of all Insurees found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 99). The leftmost record contains a hyperlink which if clicked, re-directs the user to the Family Overview Page of the insuree’s family, or the Insuree Page if it is a historical record for viewing purposes.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 100)
Button Panel
The
Cancel
button re-directs to theHome Page
.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a insuree has been added, updated or deleted or if there was an error at any time during the process of these actions.
Insuree Page¶
Data Entry
Relationship
Select from the list of available relationships of the insuree to the head of family/group.
Insurance Number
Enter the insurance number for the insuree. Mandatory.
Last name
Enter the last name (surname) for the insuree. Mandatory, 100 characters maximum.
Other Names
Enter other names of the insuree. Mandatory, 100 characters maximum.
Birth Date
Enter the date of birth for the insuree. Note: You can also use the button next to the birth date field to select a date to be entered.
Gender
Select from the list of available genders the gender of the insuree. Mandatory.
Marital Status
Select from the list of available options for the marital status of the insuree. Mandatory.
Beneficiary Card
Select from the list of options whether or not the card was issued to the insure. Mandatory.
Current Region
Select from the list of available regions the region, in which the insuree temporarily stays.
Current District
Select from the list of available districts the district, in which the insuree temporarily stays. Note: The list will only be filled with the districts belonging to the selected region
Current Municipality
Select from the list of available municipalities the municipality, in which the insuree temporarily stays. Note: The list will only be filled with the municipalities belonging to the selected district.
Current Village
Select from the list of available villages the village, in which the insuree temporarily stays. Note: The list will only be filled with the villages belonging to the selected municipality.
Current Address Details.
Enter details of the temporal address of the insuree.
Profession
Select from the list of available professions the profession of the insuree.
Education
Select from the list of available educations the education of the insuree.
Phone Number
Enter the phone number for the insuree.
Enter the e-mail address of the insuree.
Identification Type
Select the type of the identification document of the insuree.
Identification No.
Enter alphanumeric identification of the document of the insuree.
Region of FSP
Select from the list of available regions the region, in which the chosen primary health facility (First Service Point) of the insuree is located.
District of FSP
Select from the list of available districts the district, in which the chosen primary health facility (First Service Point) of the insuree is located. Note: The list will only be filled with the districts belonging to the selected region.
Level of FSP
Select the level of the chosen primary health facility (First Service Point) of the insuree.
First Service Point
Select from the list of available health facilities the chosen primary health facility (First Service Point) of the insuree. Note: The list will only be filled with the health facilities belonging to the selected district which are of the selected level.
Browse
Browse to get the photo for the insuree related to his/her insurance number.
Note: There is an automated service in the openIMIS Server which will run on configured time basis repeatedly and assign related photos to insurees without photos if any exist in the openIMIS database. So after a user has input insuree’s insurance number and no photo is displayed, there is no need to browse for the photo as that process will be done automatically by the service if the service is configured.
Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the Family Overview Page, with the newly saved record displayed and selected in the result panel. A message confirming that the insuree has been saved will appear on the Information Panel.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk)Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Family Overview Page.
Adding an Insuree¶
Click on the Green Plus Sign to re-direct to the Insuree Page.
When the page opens all entry fields are empty. See the Insuree Page for information on the data entry and mandatory fields.
Editing an Insuree¶
Click on the Yellow Pencil Sign to re-direct to the Insuree Page.
The page will open with the current information loaded into the data entry fields. See the Insuree Page for information on the data entry and mandatory fields.
Deleting an Insuree¶
Click on the Red Cross Sign to delete the currently selected record.
Before deleting a confirmation popup (Image 127) is displayed, which requires the user to confirm if the action should really becarried out?
When an insuree is deleted, all records retaining to the deleted insuree will still be available by selecting historical records.
Policy¶
Find Policy¶
Access to theFind Policy Page
is restricted to users with the role of Accountant, Clerk or Health Facility Receptionist.
Pre-conditions
Need to enquire on, or edit a policy, and the family/group, insurees and contributions associated.
Navigation
Find Policy Page can be found under the main menu
Insurees and Policies
, sub menuPolicies
.Clicking on the sub menu
Policies
re-directs the current user to thefind policy page.
Find Policy Page
The
Find Policy Page
is the first step in the process of finding a policy and thereafter accessing the Family Overview Page of insurees, policies and contributions. This initial page can be used to search for specific policies or groups of policies based on specific criteria. The panel is divided into four panels (Image 102)
Search Panel
The Search Panel allows a user to select specific criteria to minimise the search results. In the case of policies the following search options are available which can be used alone or in combination with each other.
Enrolment Date From
Type in a date; or use the Date Selector Button, to enter the
Enrolment Date From
to search for policies with anEnrolment Date
equal or later than the specified date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Enrolment Date To
Type in a date; or use the Date Selector Button, to enter the
Enrolment Date to
to search for policies with anEnrolment Date
equal or earlier than the specified date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Effective Date From
Type in a date; or use the Date Selector Button, to enter the
Effective Date From
to search for policies with anEffective Date
equal or later than the specified date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Effective Date To
Type in a date; or use the Date Selector Button, to enter the ^^Effective Date To’’ to search for policies with an ^^Effective Date^^ equal or earlier than the specified date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Start Date From
Type in a date; or use the Date Selector Button, to enter the
Start Date From
to search for policies with aStart Date
equal or later than the specified date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Start Date To
Type in a date; or use the Date Selector Button, to enter the
Start Date to
to search for policies with aStart Date
equal or earlier than the specified date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Expiry Date From
Type in a date; or use the Date Selector Button, to enter the
Expiry Date From
to search for policies with anExpiry Date
equal or later then the specified date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 103); by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- At anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 103 - Calendar Selector - Search Panel
Enrolment Officer
Select the
Enrolment Officer
; from the list of enrolment officers by clicking on the arrow on the right of the selector, to select policies related to a specific enrolment officer.
Product
Select the
Product
; from the list of products by clicking on the arrow on the right of the selector, to select policies for a specific product.
Policy Status
Select the
Policy Status
; from the list of policy statuses by clicking on the arrow on the right of the selector, to select policies for a specific policy status.A policy can have the following statuses:
- Idle (Policy data entered but policy not yet activated)
- Active (Policy partially or fully paid and made active)
- Suspended (Policy was not fully paid for within the grace period)
- Expired (Policy is not active anymore as the insurance period elapsed)
Balance
Types in a positive
Balance
to search for policies with a balance equal or greater than the typed amount. For example if 0 (zero) is entered, all policies with a balance, will be displayed. If 1,000 is entered, then only policies with a balance equal to or greater than 1,000 will be displayed.The balance is the difference between the policy value and total of contributions paid. For the policy
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select policies from a specific region. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected.
District
Select the
District
; from the list of districts by clicking on the arrow on the right of the selector to select policies for families/groups residing in a specific district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selected.
Policy Type
Select whether new policies [New Policy] or renewed policies [Renewal] should be searched for.
Inactive Insurees
Check the box to select only policies for families/groups with insurees which are non-active (not covered) despite the policy of their family/group is active. The reason may be addition of a new insuree (member) to the family/group with an active policy without adequate payment of additional contributions or because the maximum number of members in the family/group exceeds the maximum number determined by the insurance product of the policy.
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 104)
Search button
Once the criteria have been entered, use the
Search
button to filter the records, the results will appear in the Result Panel.Result Panel
The Result Panel displays a list of all policies found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 105). The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 106)
Button Panel
The
Cancel
button re-directs to the Home Page.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a policy has been added, updated or deleted or if there was an error at any time during the process of these actions.
Policy Page¶
Data Entry
Enrolment Date
Enter the enrolment date for the policy. Mandatory. Note: You can also use the button next to the enrolment date field to select a date to be entered.
Product
Select from the list of available products the product of the policy. Mandatory.
Effective Date
The effective date for the policy is calculated automatically later on. The effective date is the maximum of the start date and the date when the last contribution was paid or when the user enforced activation of the policy.
Start Date
The start date for the policy is calculated automatically. Either it is the enrolment date plus the administration period of the insurance product associated with the policy for free enrolment (without cycles) or it is a cycle start date determined according to enrolment date and the administration period for enrolment in fixed cycles. The start date may be modified by the user.
Expiry Date
The expiry date for the policy is calculated automatically. When entering a new policy, the expiry date is the start date plus the insurance period of the insurance product associated with the policy for free enrolment or the cycle start date plus the insurance period for enrolment in fixed cycles.
Enrolment Officer
Select from the list of available enrolment officers the enrolment officer related to the policy. Mandatory
Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. The user will be re-directed back to the Family Overview Page, with the newly saved record displayed and selected in the result panel. A message confirming that the policy has been saved will appear on the Information Panel.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk).Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Family Overview Page.
Adding a Policy¶
Click on the
Green Plus Sign
to re-direct to the Policy Page.When the page opens all entry fields are empty. See the Policy Page for information on the data entry and mandatory fields.
Editing a Policy¶
Click on the
Yellow Pencil Sign
to re-direct to the Policy Page.The page will open with the current information loaded into the data entry fields. See the Policy Page for information on the data entry and mandatory fields.
Deleting a Policy¶
Click on the
Red Cross Sign
to delete the currently selected policy.Before deleting of a policy, all contributions of the policy should be deleted. Before deleting a confirmation popup (Image 129) is displayed, which requires the user to confirm if the action should really be carried out?
When a policy is deleted, all records retaining to the deleted policy will still be available by selecting historical records.
Contribution¶
Find Contribution¶
Access to the Find Contribution Page is restricted to users with the role of Accountant or Clerk.
Pre-conditions
Need to enquire on, or edit a contribution, or the family/group, insurees and policies associated.
Navigation
Find Contribution can be found under the main menu
Insurees and Policies
, sub menuContributions
Clicking on the sub menu
Contributions
re-directs the current user to the Find Contribution Page.
Find Contribution Page
The
Find Contribution Page
is the first step in the process of finding a contribution and thereafter accessing the Family Overview Page of insures, policies and contributions. This initial page can be used to search for specific contributions or groups of contributions based on specific criteria. The page is divided into four panels (Image 108).
Search Panel
The Search Panel allows a user to select specific criteria to minimise the search results. In the case of contributions the following search options are available which can be used alone or in combination with each other.
Payer
Select the
Payer
; from the list of payers by clicking on the arrow on the right of the selector, to select contributions related to a specific payer.
Payment Type
Select the
Payment Type
; from the list of types by clicking on the arrow on the right of the selector, to select contributions related to a specific payment type.
Payment Date From
Type in a date; or use the Date Selector Button, to enter the
Payment Date From
to search for contributions with aPayment Date
equal or later than the specified date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Payment Date To
Type in a date; or use the Date Selector Button, to enter the
Payment Date To
to search for contributions with aPayment Date
equal or earlier than the specified date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 109); by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- At anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 109 - Calendar Selector - Search Panel
Contribution Paid
Type in the
Contribution Paid
to search for contributions with the paid amount, greater or equal to the typed amount.
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select contributions for policies from a specific region. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected.
District
Select the
District
; from the list of districts by clicking on the arrow on the right of the selector to select contributions paid for policies from a specific district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selected.
Historical
Click on
Historical
to see historical records matching the selected criteria. Historical records are displayed in the result with a line through the middle of the text (strikethrough) to clearly define them from current records (Image 110).
Search Button
Once the criteria have been entered, use the
Search
button to filter the records, the results will appear in the Result Panel.Result Panel
The result panel displays a list of all contributions found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 111) The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 15 records are displayed at one time, further records can be viewed by navigating through the pages using the page selector at the bottom of the result Panel (Image 112).
Button Panel
The
Cancel
button re-directs to the Home Page.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a contribution has been added, updated or deleted or if there was an error at any time during the process of these actions.
Contribution Page¶
Data Entry
Payer
Select from the list of available (institutional) payers the payer of the contribution (if the contribution is not paid by the family/group itself).
Contribution Paid
Enter the paid amount for the contribution. Mandatory.
Receipt No.
Enter the receipt identification for the contribution. Receipt identification has to be unique within all policies of the insurance product. Mandatory.
Payment Date
Enter the date of payment for the contribution. Mandatory. Note: You can also use the button next to the date of payment field to select a date to be entered.
Payment Type
Select from the list of available types of payment the payment type of the contribution. Mandatory.
Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. Depending on the contribution paid, the following messages will appear.
- If the Contribution paid matches the price of the policy:
- If the contribution paid is lower than the price of the policy:
Followed by:
If you choose Yes, the policy will be (enforced) set as Active. If you choose No, it will remain Idle.
- If the contribution is higher than the price of the policy:
The user will then be re-directed back to the Family Overview Page, with the newly saved record displayed and selected in the result panel. A message confirming that the contribution has been saved will appear on the Information Panel.
Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk).Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Family Overview Page .
Adding a Contribution¶
Click on the
Green Plus Sign
to re-direct to the Contribution Page.When the page opens all entry fields are empty. See the Contribution Page for information on the data entry and mandatory fields.
Editing a Contribution¶
Click on theYellow Pencil
Sign to re-direct to the Contribution Page. The Contribution Page will open with the current information loaded into the data entry fields. See the Contribution Page for information on the data entry and mandatory fields.
Deleting a Contribution¶
Click on the Red Cross Sign button to delete the currently selected record.
Before deleting a confirmation popup (Image 135) is displayed, which requires the user to confirm if the action should really be carried out?
When a contribution is deleted, all records retaining to the deleted contribution will still be available by selecting historical records.
Claims¶
The functionality under the menuClaims
allows complete processing of claims from their entering into IMIS, modification, submission to processing, automatic checking of their correctness, reviewing of them by medical officers, their evaluating and preparation of report to an accounting system for their remuneration to contractual health facilities. Each claim can be consequently in several states. Once it is entered to openIMIS (either by the mobile phone application Claim Management or typed in and saved in IMIS) it goes to the status Entered. When it is submitted and it successfully passes at least some automatic checks, the claim goes to the status Checked. If the claim doesn’t pass automatic checking it goes to the status Rejected and its processing ends. The claim in the status Checked may be reviewed from medical point of view and/or a feedback on it can be collected from the patient. Medical reviewing and feedback acquiring can be by-passed. Ones such (manual) scrutiny of the claim is at the end, the claim may be pushed to the status Processed. In this status the claim is evaluated in nominal prices, taking into account all ceilings, deductibles and other cost sharing rules associated with insurance product or products covering claimed health care. If there is no medical service or medical item price of which a relative one according to the corresponding insurance product, the claim goes automatically to the status Valuated. If there is at least one medical service or medical item with relative pricing, the claim goes to the status Valuated only after a batch for corresponding period is run. The batch for a period (month, quarter, year) finishes evaluation of relative prices on claims on one hand and summarizes all claims in the period for accounting system that is external to openIMIS (it is not a part of it). Different values (prices) of a claim are associated with each stage of processing of claims. When a claim is entered the value of the claim based on nominal prices of claimed medical services/items is designated as Claimed Value. Claimed Value is associated with the state Entered. The value of the claim after automatic checking of claims during submission of the claim and after manual interventions of medical officers is designated as Approved Value. Approved Value is associated with the state Checked. The value of the claim after corrections based on all cost sharing rules of covering insurance products is designated as Adjusted Value. Adjusted Value is associated with the state Processed. The final value of the claim taking into account actual value of relative prices is designated as Paid Value. Paid Value is associated with the state Valuated.
Heath Facility Claims¶
Access to theHealth Facility Claims Page
is restricted to users with the role of Claim Administrator.
Pre-conditions¶
Navigation¶
All functionality for use with the administration of health facility claims can be found under the main menu
Claims
, sub menuHealth Facility Claims
.Clicking on the sub menu
Health Facility Claims
re-directs the current user to the Claims Control Page.
Claims Control Page¶
The Claims Control Page is the central point for all health facility claim administration. By having access to this panel, it is possible to add, edit and search claims. Claims can be edited only in the state Entered. The panel is divided into four panels (Image 136).
Search Panel
The search panel allows a user to select specific criteria to minimise the search results. In the case of claims the following search options are available which can be used alone or in combination with each other.
Region
Select the
Region
; where claiming or searched for health facility is located from the list of regions by clicking on the arrow on the right of the selector to select claims from a specific region. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected
District
Select the
district
; where claiming or searched for health facility is located from the list of districts by clicking on the arrow on the right of the selector to select claims from a specific district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selected.
HF Code
Select the
HF Code
(Health Facility Code) from the list of codes of health facilities by clicking on the arrow on the right of the selector, to select claims from a specific health facility. Note: The list will only be filled with the health facilities belonging to the selected district and assigned to the current logged in user.
HF Name
Type in the beginning of; or the full
HF Name
(Health Facility Name) to search for claims belonging to the health facility whose name start with or match completely the typed text.
Claim Administrator
Select the
Claim Administrator
from the list of claim administrators by clicking on the arrow on the right of the selector, to select claims submitted by a specific claim administrator. Note: The list will only be filled with the claim administrators belonging to the health facility selected.
Visit Type
Select the
Visit Type
from the list of visit types (or hospital stays) by clicking on the arrow on the right of the selector, to select claims with specified visit type.
Insurance Number
Type in the beginning of; or the full
Insurance Number
, to search for claims, on behalf of insurees with the insurance number which starts with or match completely the typed text.
Claim No.
Type in the beginning of; or the full
Claim No.
, to search for claims with the specific claim identification which starts with or match completely the typed text.
Review Status
Select the
Review Status
from the list of options for review status by clicking on the arrow on the right of the selector, to select claims with specific review status.
Feedback Status
Select the
Feedback Status
from the list of options for feedback status by clicking on the arrow on the right of the selector, to select claims with specific feedback status.
Claim Status
Select the
Claim Status
from the list of options for claim status by clicking on the arrow on the right of the selector, to select claims with specific claim status.
Main Dg.
Select the
Main Dg.
from the list of diagnoses status by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box, to select claims with main diagnosis.
Batch Run
Select the
batch run
from the list of batch runs by clicking on the arrow on the right of the selector, to select claims from specific batch run
Visit Date From
Type in a date; or use the Date Selector Button, to search for claims with a
Visit Date From
date which is on or is greater than the date typed/selected. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.Visit Date From
should be the day of admission for in-patient care or the visit date in case of out-patient care.
Visit Date To
Type in a date; or use the Date Selector Button, to search for claims with a
Visit Date From
date which is on or is less than the date typed/selected. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.Visit Date To
should be the day of discharge for in-patient care or the visit date in case of out-patient care.
Claim Date From
Type in a date; or use the Date Selector Button, to search for claims with a
Claim Date
date which is on or is greater than the date typed/selected. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Claim Date To
Type in a date; or use the Date Selector Button, to search for claims with a
Claim Date
date which is on or is less than the date typed/selected. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.*
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 138); by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- At anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 138 - Calendar Selector - Search Panel
Search Button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the Result Panel.
Result Panel
The Result Panel displays a list of all claims found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 139). The leftmost record contains a hyperlink which if clicked, re-directs the user to the actual record for detailed viewing if it is a historical record or editing if it is the current record.
A maximum of 2000 records can be displayed at one time, in a scroll panel. Further records can be viewed by processing the current loaded claims and search claims again.
Button Panel
With exception of the
Cancel
button, which re-directs to the Home Page, and theAdd
button which re-directs to the Claim Page, the button panel (the buttons Load and Submit) is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record except the leftmost hyperlink, and then click on the button.
add
By clicking on the add button, the user is directed to the Claim Page, where new entries for new claim can be added. When the page opens all entry fields are empty. See the Claim Page for information on the data entry and mandatory fields.
load
By clicking on the load button, the user is directed to the Claim Page, where the current selected claim can be edited (provided it in the state Entered).
The page will open with the current information loaded into the data entry fields. See the Claim Page for information on the data entry and mandatory fields.
submit
By clicking on the submit button, claim status of all claims with claim status Entered and which have been selected to be submitted by checking the check box on right end of each record, will be submitted.
On the top of result panel, there is a checkbox to be used to select all claims currently loaded in the result panel and whose claim status is Entered, prior to be submitted.
Once the process is done, a popup window (Image 140) with the result of the process will be shown.
delete
By clicking on the delete button, the current selected claim will be deleted.
Before deleting a confirmation popup (Image 142) is displayed, which requires the user to confirm if the action should really be carried out?
cancel
By clicking on the
Cancel
button, the user will be re-directed to the Home Page.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a claim has been added, updated or deleted or if there was an error at any time during the process of these actions.
Claim Page¶
Data Entry
HF Code
Displays the code of the health facility. The field is read only (taken over from the Claims Control Page) and cannot be edited.
HF Name
Displays the name of the health facility. The field is read only (taken over from the Claims Control Page) and cannot be edited.
Insurance Number
Enter the insurance number of the patient. When done entering this field, the corresponding name of the patient will be filled on the name of the patient (the text box which is read only field and is on the right side of the Insurance Number text field). Mandatory.
Claim No.
Enter the identification of the claim. Mandatory, up to 8 characters. It should be unique within the claiming health facility.
Main Dg.
Select the code of the main diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box. Mandatory.
Sec Dg 1
Select the code of the first secondary diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box.
Sec Dg 2
Select the code of the second secondary diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box
Sec Dg 3
Select the code of the third secondary diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box
Sec Dg 4
Select the code of the fourth secondary diagnosis by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box
Claim Administrator
Displays code of the claim administrator. The field is read only (taken over from the Claim Control Page) and cannot be edited.
Visit Date From
Enter the visit date for out-patient care or the admission date for in-patient care. Mandatory.
Visit Date To
Enter the discharge date for in-patient care.
Date Claimed
Enter the date when the claim was prepared by the health facility.
Guarantee No.
Enter identification of a guarantee letter for prior approval of provision of claimed health care.
Visit Type
Select the type of visit/hospital admission from the drop down list (Emergency, Referral, Other)
Services
service code
When entering the service code, a dropdown suggestion box for the available services with the service code or service name matching your typed text will be shown. Available medical services in the dropdown suggestion box are taken over from the pricelist of medical services associated with the claiming health facility. The desired service can then be selected from the dropdown suggestion box by clicking on it using mouse or selecting it using up and down arrows, then pressing Enter key fill the service code text field, together with quantity and value field in the same row.
Once the selected service has been written on the service data grid row, the dropdown suggestion box will close itself. When needed, the dropdown suggestion box can be closed by clicking any place on the page but outside the dropdown suggestion box.
quantity
This field can be filled manually by entering a number in it or automatically is filled by 1 when the service code above is filled, through dropdown suggestion box. It is this field that receives focus after service code is filled above from the dropdown suggestion box.
price
This field can be filled manually by entering a number in it or automatically is filled when the service code above is filled, through dropdown suggestion box. Automatically filled prices are taken over from the pricelist of medical services associated with the claiming health facility.
explanation
Enter extra information about the service for the scheme administration (a medical officer of the scheme administrator).
Items
item code
When entering the item code, a dropdown suggestion box for the available items with the item code or item name matching your typed text will be shown. Available medical items in the dropdown suggestion box are taken over from the pricelist of medical items associated with the claiming health facility. The desired item can then be selected from the dropdown suggestion box by clicking on it using mouse or selecting it using up and down arrows, then pressing Enter key to fill the item code text field, together with quantity and value field in the same row.
Once the selected item has been written on the item data grid row, the dropdown suggestion box will close itself. When needed, the dropdown suggestion box can be closed by clicking any place on the page but outside the dropdown suggestion box.
quantity
This field can be filled manually by entering a number in it or automatically is filled by 1 when the item code above is filled, through dropdown suggestion box. It is this filled that receives focus after item code is filled above from the dropdown suggestion box.
price
This field can be filled manually by entering a number in it or automatically is filled when the item code above is filled, through dropdown suggestion box. Automatically filled prices are taken over from the pricelist of medical items associated with the claiming health facility.
explanation
Enter extra information about the medical item for the scheme administration (a medical officer of the scheme administrator).
claimed
This field is filled automatically with a new total of quantities multiplied to their corresponding values in both data input grids at any time when there is a change in values in the either quantity fields or value fields anywhere in both data input grids.
explanation
Enter extra information about the whole claim for the scheme administration (medical officer).
# User Controls
On top of services input grid panel and items input grid panel, there is a textbox field (Image 146) and (Image 147) which is filled with a constant representing the current number of rows in the input grid a user is working with. A user can change the current number of rows in the corresponding data input grid by entered a number of rows greater than existing one. This change is only allowed before a user has made changes to the corresponding data input grid.
A user can manually clear the inputs in the row by clicking the
Red Cross
button on the end right of a desired row (Image 148). This action will require a user to confirm for the clearing process to proceed by choosing either yes / no from the popup window (Image 149) asking for user confirmation.Saving
Once all mandatory data is entered, clicking on the
Save
button will save the claim. The user stay in the Claim Page; a message confirming that the claim has been saved will appear on the bottom of the Claim Page.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk).Printing of a claim
By clicking on the
Creating of a new claim
By clicking on the
Add
button, the Claim Page is cleared (with exception of HF Code, HF Name and Claim Administrator) and it ready for entering of a new claim for the same health facility and of the same claim administrator as before.Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Claims Control Page.
Review claims¶
The functionality allows reviewing and adjustments of claims from medical point of view. Reviewing of claims is restricted to users with the role of Medical Officer
Pre-conditions¶
A claim has been already submitted.
Navigation¶
All functionality for use with the administration of claim overview can be found under the main menu
Claims
, sub menuReview.
Clicking on the sub menu
Review
re-directs the current user to the Claims Overview Page.
Claims Overview Page¶
The Claims Overview Page is the central point for all claim review administration. By having access to this panel, it is possible to review, feedback, amend and process claims. The panel is divided into five sections (Image 150).
Search Panel
The search panel allows a user to select specific criteria to minimise the search results. In the case of claims the following search options are available, which can be used alone, or in combination with each other.
Region
Select the
Region
; where searched for health facility is located or where patients are permanently living from the list of regions by clicking on the arrow on the right of the selector to select claims from a specific region. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected
District
Select the
District
; where searched for health facility is located or where patients are permanently living from the list of districts by clicking on the arrow on the right of the selector to select claims from a specific district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selected.
HF Code
Select the
HF Code
; from the list of health facilities codes by clicking on the arrow on the right of the selector to select claims from a specific health facility. Note: The list will only be filled with the health facilities belonging to the selected district and assigned to the current logged in user.
HF Name
Type in the beginning of; or the full
HF Name
, to search for claims belonging to the health facility whose name start with or match completely the typed text.
Claim Administrator
Select the
claim administrator
from the list of claim administrator codes by clicking on the arrow on the right of the selector, to select claims submitted by a specific claim administrator. Note: The list will only be filled with the claim administrators belonging to the health facility selected.
Insurence Number
Type in the beginning of; or the full
Insurence Number
, to search for claims for patients with the insurance number which start with or match completely the typed text.
Claim No.
Type in the beginning of; or the full
Claim No.
, to search for claims with claim identification which start with or match completely the typed text.
Review Status
Select the
Review Status
from the list of the options for review status by clicking on the arrow on the right of the selector, to select claims with a specific review status.
Feedback Status
Select the
Feedback Status
from the list of the options for feedback status by clicking on the arrow on the right of the selector, to select claims with a specific feedback status.
Claim Status
Select the
Claim Status
from the list of options for claim status by clicking on the arrow on the right of the selector, to select claims with a specific claim status.
Main Dg
Select the
Main Dg.
from the list of diagnoses status by typing text, all diagnoses containing the typed text will appear and be selectable underneath the box, to select claims with main diagnosis.
Batch Run
Select the
Batch Run
from the list of batch runs by clicking on the arrow on the right of the selector, to select claims included in a specific batch run.
Visit Date From
Type in a date; or use the Date Selector Button, to search for claims with a
Visit Date From
which is on or is greater than the date typed/selected. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Visit Date To
Type in a date; or use the Date Selector Button, to search for claims with a
Visit Date To
which is on or is less than the date typed/selected. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Claim Date From
Type in a date; or use the Date Selector Button, to search for claims with a
Claim Date From
which is on or is greater than the date typed/selected. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Claim Date To
Type in a date; or use the Date Selector Button, to search for claims with a
Claim Date To
which is on or is less than the date typed/selected. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Visit Type
Select type of out-patient visit or in-patient admission from the list of types of visit to search for claims made on specific visit/admission type.
Date Selector Button
Clicking on the Date Selector Button will pop-up an easy to use, calendar selector (Image 152); by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- At anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 152 - Calendar Selector - Search Panel
Search Button
Once the criteria have been entered, use the search button to filter the records, the results will appear in the Result Panel.
Claim Selection Update Panel
This panel is basically for functionality of updating multiple claims which are currently loaded in the Result Panel at once basing on the claim filter criteria available on this panel. The update on the claims is basically changing Feedback Status and Review Status of a claim from Idle to (Not) Selected for Feedback or (Not) Selected for Review respectively. The filters in this panel work on the claims which are currently loaded on the result panel. The combination of filters is either
Select
alone orSelect
and eitherRandom
orValue
orVariance
or combination ofValue
andVariance
.
Select
A selection dropdown box to select between Review Select and Feedback Select to filter only claims whose review status is Idle or feedback status is Idle respectively from among claims currently in the Result Panel.
Random
Accept a number which is considered to be a percentage of the claims in the Result Panel. Check the random checkbox and enter a number on the text field next to checkbox. The default is 5%.
Value
Accept a number which is considered to be claimed value. This will filter claims from the Result Panel by taking claims whose claimed value is equal or greater than the entered number in the Value text field. Check the value checkbox and enter a number on the text field next to checkbox. The default is 40000.
variance
Accept a number which is considered to be a percentage of the current claim value variance. Calculated by dividing the current claim value (value) and the average sum (Average) of the all claims in the previous year from the current claim date and with the same main diagnosis as that of the current claim, minus one (1) and finally multiply by hundred (100) to get the percentage variance. I.e Percentage Variance = [(Value / Average) – 1] * 100 Enter a number by checking the variance checkbox and enter a number on the text field next to checkbox. The default is 50%.
Update button
Once desired criteria have been set and after clicking this button, then the claims currently displayed in the result panel which satisfy the criteria, will be updated of their Idle Review Status or Feedback Status to either (Not) Selected for Review or (Not) Selected for Feedback respectively.
A popup prompt window will be displayed to confirm the process, as shown on (Image 153) and (Image 154).
Once the update process is over, a popup window (Image 155). Showing the result of the process will be displayed.
Result Panel
The Result Panel displays a list of all claims found, matching the selected criteria in the search panel. The currently selected record is highlighted with light blue, while hovering over records changes the highlight to yellow (Image 156).
A maximum of 2000 records can be displayed at one time, in a scroll panel. Further records can be viewed by processing the current loaded claims and search claims again.
The Feedback and Review Status Columns in each row contain a drop down list with options for claim feedback status and claim review status. A user can change the claim feedback and review status from low status to high status only. Either from Idle to Not Selected or Selected for Feedback in case of the feedback status or Not Selected or Selected for Review in case of the review status. Or from Not Selected to Selected for Feedback in case of the feedback status or Selected for Review in case of the review status. For changes to take effect, a user will have to update the changes by clicking the
Update
button.Button Panel
With exception of the Cancel button, which re-directs to the Claims Overview Page, the button panel is used in conjunction with the current selected record (highlighted with blue). The user should first select a record by clicking on any position of the record.
review
Clicking on this button re-directs a user to the Claim Review Page, where a claim with review status Selected for Review can be reviewed and its current review status changed to Reviewed. If the claim is not in the status Selected for Review then the claim can be only loaded and shown to the user without any subsequent action.
The page will open with the current information loaded into the data entry fields. See the Claim Review Page, for information on the data entry and mandatory fields.
feedback
Clicking on this button re-directs a user to the Claim Feedback Page, where a claim with feedback status Selected for Feedback can be feed backed and its current feedback status changed to Delivered.
The page will open with the current information loaded into the data entry fields. See the Claim Feedback Page for information on the data entry and mandatory fields.
update
Clicking on this button, update the feedback status and review status of claims in the result panel from either Idle to Not Selected or Selected for Feedback or Selected for Review respectively or from Not Selected to Selected for Feedback or Selected for Review respectively.
process
Clicking on this button changes the claim status Checked of all current selected claims in the Result Panel, selected by checking the checkbox on the right end of each record, to claim status Processed.
Claims which can be selected for being processed are ones whose claim status is Checked and Feedback Status and Review Status are not Idle. The checkbox on the top of the Result Panel can be used to select multiple claims. The process happens while a user stays on the same page. Once the process is done, a popup window (Image 157) showing results of the process will be shown.
Cancel
By clicking on the cancel button, the user will be re-directed to the Claims Overview Page.
Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a claim has been reviewed, updated, feedback added on claim or if there was an error at any time during the process of these actions.
Claim Review Page¶
Data Entry
Claim Review Page
will show read-only information of the current claim selected for review, on the top section of the page, on some of the grid columns of the claim services grid and claim items grid and on the bottom of all the grids. As well, the page has input boxes where a user with the role Medical Officer can enter new relevant values for review of the current claim.Read-only information of the current claim includes the following:
HF
The health facility code and name which the claim belongs to.
Main Dg.
The code of the main diagnosis.
Sec Dg1
The code of the first secondary diagnosis.
Sec Dg2
The code of the second secondary diagnosis.
Sec Dg3
The code of the third secondary diagnosis.
Sec Dg4
The code of the fourth secondary diagnosis.
Visit type
The type of the visit or of the hospital stay (Emergency, Referral, Other)
Date Processed
The date on which the claim was processed (sent to the state Processed).
Claim Administrator
The administrator’s code, who was responsible for submission of the current claim.
Insurance Number
The insurance number of the patient.
Claim No.
The unique identification of the claim within the claiming health facility.
Patient Name
The full name of the patient on whom the claim is made.
Date Claimed
The date on which the claim was prepared by the claiming health facility.
Visits Date From
The date on which the patient visited (or was admitted by) the health facility for treatment on which the claim is basing on.
Visit Date To
The date on which the patient was discharged from the health facility for treatment on which the claim is basing on.
Guarantee No.
Identification of a guarantee letter.
Claimed
The sum of prices of all claimed services and items at the moment of submission of the claim.
approved
The value of the claim after automatic checking during its submission and after the corrections of the claim done by a medical officer.
Adjusted
The value of the claim after automatic adjustments done according to the conditions of coverage by the patient’s policy.
Explanation
Explanation to the claim provided by the claiming health facility.
claim status
Claim status is shown on the very bottom right end side after the two grids. This is status which claim gets after submission.
Adjustment
Enter a text summarizing adjustments in claim done by a medical officer.
Services and Items data entry grids.
Approved Quantity (app.qty)
Enter a number of approved provisions of the corresponding medical service or item.
Approved Price (app. price)
Enter an approved price of the corresponding medical service or item.
justification
Enter justification for the entered corrections of the price and quantity of the medical service or item.
status
Select either the status in the claim Passed or Rejected for the corresponding medical service or item respectively.
rejection reason
The last column of each of the two grids, headed with character ‘R’, gives rejection reason number for each of the claimed services or claimed items in the claim services grid or the claim items grid respectively. Rejection reasons are as follows:
The rejection description is displayed on the screen when the mouse pointer is above the given line (Image Rejection Description)
Reason Code Reason Description -1 Rejected by a medical officer 0 Accepted 1 Item/Service not in the registers of medical items/services 2 Item/Service not in the pricelists associated with the health facility 3 Item/Service is not covered by an active policy of the patient 4 Item/Service doesn’t comply with limitations on patients (men/women, adults/children) 5 Item/Service doesn’t comply with frequency constraint 6 Item/Service duplicated 7 Not valid insurance number 8 Diagnosis code not in the current list of diagnoses 9 Target date of provision of health care invalid 10 Item/Service doesn’t comply with type of care constraint 11 Maximum number of in-patient admissions exceeded 12 Maximum number of out-patient visits exceeded 13 Maximum number of consultations exceeded 14 Maximum number of surgeries exceeded 15 Maximum number of deliveries exceeded 16 Maximum number of provisions of item/service exceeded 17 Item/service cannot be covered within waiting period 18 N/A 19 Maximum number of antenatal contacts exceeded Saving
Once appropriate data is entered, clicking on the
Save
button will save the claim. The user will be re-directed back to the Claims Overview Page; a message confirming that the claim has been saved will appear on the Information Panel. TheSave
button appears only if the claim was reviewed in the status Selected for Review.reviewing
Once appropriate data is entered, clicking on the
Reviewed
button will save the claim and change the claim Review Status from Selected for Review to Review. The user will be re-directed back to the Claims Overview Page; a message confirming that the claim has been saved will appear on the Information Panel. TheReviewed
button appears only if the claim was reviewed in the status Selected for Review.data entry validation
If inappropriate data is entered at the time the user clicks the
Save
or `` review`` button, an error message will appear in the Information Panel, and the data field will take the focus.Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Claims Overview Page.
Claim Feedback Page¶
The Claim Feedback page will show read-only information of the current claim selected for feedback, on the top section of the page it has input boxes where a user with the role Medical Officer can enter feedback on the current claim or where the user can read a feedback delivered by enrolment officers.
Data Entry
Read-only data of the feedback includes in the section Claim the following:
HF Code
The health facility code which the claim belongs to.
HF Name
The health facility name which the claim belongs to.
Claim Administrator
The administrator’s code, who was responsible for submission of the current claim.
Insurance Number
The insurance number of the patient.
Claim No.
The unique identification of the claim within the claiming health facility.
Last Name
The last name of the patient on whom the claim is made.
Other Names
The other names of the patient on whom the claim is made.
Date Claimed
The date on which the claim was prepared by the claiming health facility.
Visits Date From
The date on which the patient visited (or was admitted by) the health facility for treatment on which the claim is basing on.
Visit Date To
The date on which the patient was discharged from the health facility for treatment on which the claim is basing on.
Review Status
The status of the claim with respect to reviewing.
Feedback Status
The status of the claim with respect to feed backing.
Modifiable data of the feedback included in the section Feedback the following
Enrolment Officer
Select an enrolment officer from the list of enrolment officers, by clicking the arrow on the right side of selection field. The enrolment officer collects feedback from the patient.
Care Rendered
Select ‘Yes’ or ‘No’ from the list, by clicking the arrow on the right side of selection field.
Payment Asked
Select ‘Yes’ or ‘No’ from the list, by clicking the arrow on the right side of selection field.
Drugs Prescribed
Select ‘Yes’ or ‘No’ from the list, by clicking the arrow on the right side of selection field.
Drugs Received
Select ‘Yes’ or ‘No’ from the list, by clicking the arrow on the right side of selection field
Overall Assessment
Choose one level among the six levels available by checking/clicking on the desired checkbox.
Feedback Date
Type in a date of collection of the feedback; or use the date selector button, to enter date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the back space key.
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 161); by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- At anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 161 - Calendar Selector - Search Panel
Saving
Once all mandatory data is entered, clicking on the
Save
button will save the feedback on current claim. The user will be re-directed back to the Claims Overview Page; a message confirming that the feedback has been saved will appear on the Information Panel. If inappropriate data is entered or mandatory data is not entered at the time the user clicks the Save button, an error message will appear in the Information Panel, and the data field will take the focus.Cancel
By clicking on the
Cancel
button, the user will be re-directed to the Claims Overview Page.
Batch Run¶
Administration of batches of claims is restricted to users with the role of Accountant or any custom role with selected rights to batch functionality.
Pre-conditions¶
Navigation¶
All functionality for use with the administration of processing of batches can be found under the main menu
Claims
, sub menuBatch Run
.Clicking on the sub menu
Batch Run
re-directs the current user to the Batch Run Control Page.
Batch Run Control Page¶
The Batch Run Control Page is the central point for batch processing administration. Access to the page is restricted to users with the role of Accountant. By having access to this page, it is possible to process batches, filter, and filter for accounts. The panel is divided into six sections (Image 163)
Batch Processing Panel
The batch processing panel allows a user to process batches based on the following criteria:
Region
Select the
Region
from the list of regions by clicking on the arrow on the right of the selector to select a region. Note: The list will only be filled with the regions assigned to the current logged in user and the option National.
District
Select the
district
from the list of districts by clicking on the arrow on the right of the selector to select a district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is the only one then the district will be automatically selected. If no district is selected then the processing is done only for insurance product defined for the selected region.
Month
Select the
Month
from the list of months by clicking on the arrow on the right of the selector.
Year
Select the
Year
from the list of available years by clicking on the arrow on the right of the selector. Only periods for which a batch hasn’t been run yet are offered in both lists.
Process
Once criteria are chosen, clicking on this button, the claims will be processed based on the selected criteria. If the option
National
was used in the fieldRegion
, the batch will run only for nationwide insurance products. If a region is selected in the fieldRegion
and no district is selected, the batch will run only for regional insurance products for the selected region. If a district is selected in the fieldDistrict
the batch is run only for district insurance products for the selected district.Filter Panel
The filter panel allows a user to filter results of running of batches (calculation of indexes for relative pricing) based on the following criteria:
Type
Select the
Type
; from the list of time group types (Monthly, Quarterly, Yearly) by clicking on the arrow on the right of the selector.
Year
Select the
Year
; from the list of available years by clicking on the arrow on the right of the selector.
Period
Select the
Period
; from the list of months/quarters by clicking on the arrow on the right of the selector.
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select a region. Note: The list will only be filled with the regions assigned to the current logged in user and the option National.
District
Select the District; from the list of districts by clicking on the arrow on the right of the selector to select a district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selected
Product
Select Product from the list of products by clicking on the arrow on the right of the selector.
Category
Select category of health care (Hospital, Non-hospital, General) from the list of categories of health care by clicking on the arrow on the right of the selector.
Filter
Once criteria are chosen, clicking on this filter button will filter based on the selection criteria.
Display Panel
The Display Panel is used to display results of running of batches after the filter or processing. While hovering over records, records get highlighted with a yellow colour (Image 164).
Filter for Accounts Panel
The Filter for Accounts Panel is used in filtering of batch protocols for an accounting system based on the following criteria:
Start Date
Type in a date; or use the Date Selector Button to enter date which is equal or less than claim date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
End Date
Type in a date; or use the Date Selector Button to enter date which is equal or greater than claim date. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 16); by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- At anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 165 - Calendar Selector - Search Panel
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select a region. Note: The list will only be filled with the regions assigned to the current logged in user and the option National.
District
Select the
district
; from the list of districts by clicking on the arrow on the right of the selector to select a district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the District will be automatically selected
HF
Select a health facility from the list of health facilities codes and names clicking on the arrow on the right of the selector. Note: The list will only be filled with the Health Facilities belonging to the Districts assigned to the current logged in user.
Product
Select a product from the list of products by clicking on the arrow on the right of the selector. The list of products contains only nationwide insurance products if the option National is used in the field Region. It contains only regional insurance products for the selected region if no district is selected. It contains only district insurance products for the selected district.
Level
Select a level from the list of levels of health facilities by clicking on the arrow on the right of the selector.
Group By
Select either grouping of the report by health facility (
HF
) or by product (Product
) by checking either the health facility checkbox or product checkbox respectively.
Show All
Check this checkbox, if you need to show all health facilities in the report although they have no claim included.
Show Claims
Check this checkbox, if you need to show all claims in detailed way in the protocol.
Preview
Once criteria are chosen, clicking on this preview button will create a protocol of the selected batch.
Button Panel
This panel contains control button.
Cancel
By clicking on the cancel button, the user will be re-directed to the Home Page.
Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a batch has been processed, filtered or if there was an error at any time during the process of these actions.
Tools¶
Upload / Download selected registers¶
Access to uploading/downloading of selected registers is restricted to the users with the role of openIMIS Administrator.
Navigation¶
All functionality for use with the administration of uploading/downloading of selected registers can be found under the main menu
Tools
, sub menuRegisters
.Clicking on the sub menu
Registers
re-directs the current user to the Registers Page: (Image 166)
Registers page¶
The Registers Page is divided into eight sections: (Image 167)
- Upload of the list of diagnoses
Browse
Select from a file in the XML format serving as a source for uploading of the list of diagnoses. Mandatory.
Strategy
Select a desired strategy for uploading of the list of diagnoses. The following options are available:
Insert Only
Uploads only diagnoses that are not yet included in the list of diagnoses
Update Only
Updates only diagnoses that are already included in the list of diagnoses
Insert and Update
Uploads diagnoses that are not yet included in the list of diagnoses and updates diagnoses that are already included in the list of diagnoses
Insert, Update and Delete
Uploads diagnoses that are not yet included in the list of diagnoses, updates diagnoses that are already included in the list of diagnoses and deletes diagnose that are not included in the source file
Dry Run
If checked, only diagnostics is provided without real uploading.
Upload
- By clicking on the
Upload
button, a prompt popup message will appear, require a user to agree or disagree:(Upload DiagnosesIf user agrees the selected file containing diagnoses will be uploaded.
- A statistics on the number of inserted/updated diagnoses appears:
(Statistics on uploaded diagnoses).
If there are errors an error protocol appears: (Error protocol on uploaded diagnoses)
DTD definition of the XML file for uploading/downloading of diagnoses:
<!DOCTYPE Diagnoses> [
<!ELEMENT Diagnoses (Diagnosis)*>
<!ELEMENT Diagnosis (DiagnosisCode, DiagnosisName)>
< !ELEMENT DiagnosisCode (#CDATA)>
< !ELEMENT DiagnosisName (#CDATA)>
]>
- Upload of the register of locations
Browse
Select from a file in the XML format serving as a source for uploading of the register of locations. Mandatory.
Strategy
Select a desired strategy for uploading of the register of locations. The following options are available:
Insert Only
Uploads only locations that are not yet included in the register of locations
Update Only
Updates only locations that are already included in the register of locations
Insert and Update
Uploads locations that are not yet included in the register of locations and updates locations that are already included in the register of locations
Dry Run
If checked only diagnostics is provided without real uploading.
Upload
By clicking on the Upload button, a prompt popup message will appear, require a user to agree or disagree (Upload Locations). If user agrees the selected file containing locations will be uploaded.
A statistics on the number of inserted/updated locations appears (Upload Locations statistics)
If there are errors an error protocol appears (Upload Locations error)
DTD definition of the XML file for uploading/downloading of locations:
<!DOCTYPE Locations> [
<!ELEMENT Locations (Regions, Districts, Municipalities, Villages)>
<!ELEMENT Regions (Region*)>
<!ELEMENT Region (RegionCode, RegionName)>
< !ELEMENT RegionCode (#CDATA)>
< !ELEMENT RegionName (#CDATA)>
<!ELEMENT Districts (District*)>
<!ELEMENT District (RegionCode,DistrictCode, DistrictName)>
< !ELEMENT RegionCode (#CDATA)>
< !ELEMENT DistrictCode (#CDATA)>
< !ELEMENT DistrictName (#CDATA)>
<!ELEMENT Municipalities (Municipality*)>
<!ELEMENT Municipality (DistrictCode,MunicipalityCode, MunicipalityName)>
< !ELEMENT DistrictCode (#CDATA)>
< !ELEMENT MunicipalityCode (#CDATA)>
< !ELEMENT MunicipalityName (#CDATA)>
<!ELEMENT Villages (Village*)>
<!ELEMENT Village (MunicipalityCode,VillageCode, VillageName,MalePopulation ?, FemalePopulation ?, OtherPopulation,Families ?)>
< !ELEMENT MunicipalityCode (#CDATA)>
< !ELEMENT VillageCode (#CDATA)>
< !ELEMENT VillageName (#CDATA)>
< !ELEMENT MalePopulation (#CDATA)>
< !ELEMENT FemalePopulation (#CDATA)>
< !ELEMENT OtherPopulation (#CDATA)>
< !ELEMENT Families (#CDATA)>
]>
- Upload of the register of health facilities
Browse
Select from a file in the XML format serving as a source for uploading of the register of health facilities. Mandatory.
Strategy
Select a desired strategy for uploading of the register of health facilities. The following options are available:
Insert Only
Uploads only health facilities that are not yet included in the register of health facilities
Update Only
Updates only health facilities that are already included in the register of health facilities
Insert and Update
Uploads health facilities that are not yet included in the register of health facilities and updates health facilities that are already included in the register of health facilities
Dry Run
If checked only diagnostics is provided without real uploading.
Upload
By clicking on the Upload button, a prompt popup message will appear, require a user to agree or disagree: (Upload Health Facilities) If user agrees the selected file containing locations will be uploaded.
A statistics on the number of inserted/updated health facilities appears.
If there are errors an error protocol appears.
DTD definition of the XML file for uploading/downloading of health facilities:
<!DOCTYPE HealthFacilities> [
<!ELEMENT HealthFacilities (HealthFacilityDetails,CatchmentsDetails)>
<!ELEMENT HealthFacilityDetails (HealthFacility)*>
<!ELEMENT HealthFacility (LegalForm, Level, Sublevel, Code, Name, Address, DistrictCode, DistrictName, Phone, Fax, Email, CareType, AccountCode, ItemPriceListName. ServicePricelistName)>
<!ELEMENT LegalForm (D| C|G|P)>
<!ELEMENT Level (D|C|H)>
<!ELEMENT SubLevel (I|N|R)>
<!ELEMENT Code (#CDATA)>
<!ELEMENT Name (#CDATA)>
<!ELEMENT Address (#CDATA)>
<!ELEMENT DistrictCode (#CDATA)>
<!ELEMENT DistrictName (#CDATA)>
<!ELEMENT Phone (#CDATA)>
<!ELEMENT Fax (#CDATA)>
<!ELEMENT Email (#CDATA)>
<!ELEMENT CareType (I|N|B)>
<!ELEMENT AccountCode (#CDATA)>
<!ELEMENT ItemPriceListName (#CDATA)>
<!ELEMENT ServicePriceListName (#CDATA)>
<!ELEMENT CatchmentsDetails(Catchment*)>
<!ELEMENT Catchment (HFCode,VillageCode, VillageName, Percentage)>
<!ELEMENT HFCode (#CDATA)>
<!ELEMENT VillageCode (#CDATA)>
<!ELEMENT VillageName (#CDATA)>
<!ELEMENT Percentage (#CDATA)>
]>
- Download of the list diagnoses
Download
By clicking on the Download button, a prompt popup message will appear, require a user to specify whether the XML file with downloaded list of diagnoses should be opened or saved or canceled: (Download Diagnoses)
- Download of the register of locations
Download
By clicking on the Download button, a prompt popup message will appear, require a user to specify whether the XML file with downloaded register of locations should be opened or saved or canceled (Download locations)
- Download of the register of health facilities
Download
By clicking on the Download button, a prompt popup message will appear, require a user to specify whether the XML file with downloaded canceled (Download facilities)
- Buttons
Cancel
By clicking on
Cancel
button, user will be re-directed to the Home page.
- Information Panel
The Information Panel is used to display messages back to the user.
Policy Renewals¶
Access to management of policy renewals is restricted to the users with the role of Clerk.
Navigation¶
All functionality for use with the administration of policy renewals can be found under the main menu
Tools
, sub menuPolicy Renewals
Clicking on the sub menu
Policy Renewals
re=directs the current user to the Policy Renewal Page.
Policy Renewal Page¶
By having access to this page, it is possible preview the report on policy renewals, preview the journal on policy renewals and update the status of a policy. The journal will contain information on actual prompts being generated by the system. These prompt could already have been sent to the mobile phones of enrolment officers. The report on policy renewals will contain information on the expiration of policies for any given period. The page is divided into two panels (Image 170).
Select Criteria Panel
The Select Criteria Panel or the filter panel allows a user to select specific criteria to minimise the report on policy renewals.
Two tasks are carried out by this form. 1) Preview the report on policy renewal and 2) Preview the journal on policy renewal. Depending on the selected option, filter will be changed accordingly.
If Preview option is selected then a user has the following filters.
Policy Status
Select the policy status from the drop down list by clicking on the right arrow. By selecting any of the options a user can filter the report on particular status of the policy. This filter is not mandatory. User can leave it blank to preview the report on any status.
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select policies from a specific region. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected.
District
Select the
district
; from the list of districts by clicking on the arrow on the right of the selector to select policies from a specific district. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selected.
Municipality
Select the
Municipality
; from the list of municipalities by clicking on the arrow on the right of the selector to preview report from a specific district. Note: The list will only be filled with the municipalities that belong to the selected district. If this is only one then the municipality will be automatically selected.
Village
Select the
village
; from the list of villages by clicking on the arrow on the right of the selector to preview report from a specific village. Note: The list will only be filled with the villages that belong to the selected municipality.
Enrolment Officer
Select the
Enrolment Officer
; from the list of enrolment officers by clicking on the arrow on the right of the selector to preview the report for the specific officer. Note: The list will only be filled with the enrolment officers belonging to the districts assigned to the current logged in user. If this is only one then the enrolment officer will be automatically selected.
Date From
By clicking on the button next to the
Date From
data field a calendar will pop up. Click on his desired date and the textbox will be filled with the selected date. This is a mandatory field. Only the policies for renewal date greater than or equal to theDate From
will be previewed.
Date To
By clicking on the button next to the
Date To
data field a calendar will pop up. Click on his desired date and the textbox will be filled with the selected date. This is a mandatory field. Only the policies for renewal date less than or equal to theDate To
will be previewed.When previewing the journal; the
Policy Status
filter will be replaced withSMS Status
and there will be one more additional filter,Journal On
.
SMS Status
Select the
SMS status
from the drop down list by clicking on the right arrow. By selecting any of the options the user can filter the journal on a particularSMS status
. This filter is not mandatory. By leaving it blank all journals will be displayed.
Journal On
Select the
journal On
from the drop down list by clicking on the right arrow, to filter the journal either on prompt or on expiry of the prompt.Button Panel
Cancel:
Re-directs to the Home Page
Preview:
Click on the preview button to display the report based on the filters.
Update:
Click on this button to manually update the status of the policy on the current day. Although this task is carried out by the IMIS Policy Renewal Service running on the server at specific intervals of time, this button enables the task to be run manually.Information Panel
The Information Panel is used to display messages back to the user. Messages will occur once a user has updated the policy status or if there was an error at any time during the process of these actions.
Preview Report on Renewals¶
After selecting specific criteria; preview the report (Image 172) by clicking on the preview button.
Preview Journal on Renewals¶
Just like preview of the policy renewals the journal report can also be previewed. The difference between the Policy Renewal report and the Journal is; one forecasts the renewal while the other gives a report on the status of the renewal. Below is an example of a Journal Report.
Feedback Prompts¶
Access to administration of feedback prompts is restricted to the users with the role of Medical Officer.
Navigation¶
All functionality for use with the administration of feedback prompt can be found under the main menu
Tools
, sub menuFeedback Prompts
Clicking on the sub menu
Feedback Prompts
re-directs the current user to the Feedback Prompt Page (Image 174).The Feedback Prompt Page is divided into three panels (Image 175).
Select Criteria Panel
The Select Criteria Panel or the filter panel allows a user to select specific criteria for feedback.
SMS Status
Select
SMS Status
from the list
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select a specific region for feedbacks. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected.
District
Select the
district
from the list of districts by clicking on the arrow on the right of the selector to select district for feedbacks. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the District will be automatically selected.
Municipality
Select the
Municipality
from the list of municipalities you wish to prompt for feedbacks. Note: The list will only be filled with the municipalities that belong to the selected district. If this is only one then the municipality will be automatically selected.
Village
Select the
village
; from the list of villages you wish to prompt for feedbacks. Note: The list will only be filled with the villages that belong to the selected municipality.
Enrolment Officer
Select the
Enrolment Officer
; from the list of enrolment officers by clicking on the arrow on the right of the selector to preview the report for the specific officer. Note: The list will only be filled with the enrolment officers belonging to the districts assigned to the current logged in user. If this is only one then the enrolment officer will be automatically selected.
Start Date
Type in a date; or use the Date Selector Button, to enter the
Start Date
for feedbacks. Mandatory. *Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
End Date
Type in a date; or use the Date Selector Button, to enter the
End Date
for feedbacks. Mandatory. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Send SMS
By Clicking
Send SMS
button, user actually sends an SMS. When an SMS is sent successfully as message will be given. If failed to be sent, a failure message will appear.Buttons Panel
Information Panel
The Information Panel is used to display messages back to the user. Messages will occur if there was an error at any time during the processing of the reports.
IMIS Extracts¶
Access to the openIMIS Extracts page is restricted to users with the role of Scheme Administrator (IMIS Central online) or HF Administrator (offline installations). This page will contain all functionality for data synchronization between openIMIS Central and openIMIS offline installations as well as the generation of extract files for the mobile phones (Android). Depending on the type of installation, the interface will enable and disable certain functions.
Pre-conditions¶
The extract functionality is covering extracts for the mobile phone applications and the openIMIS ‘offline’ installations. Offline extracts are only to be generated in case a district has so called ‘off-line’ installations in areas where no Internet connectivity is available.
Extracts are to be downloaded to the local PC that is initiating the creation of the extract.
Standard procedures should be formulated to stipulate the time interval between Extract creations and the management of transporting and installing/transferring these extracts into the target environment: mobile phones or offline openIMIS clients.
Navigation¶
All functionality related to openIMIS extracts can be found under the main menu
Tools
, sub menuIMIS Extracts
Clicking on the sub menu
IMIS Extracts
re-directs the current user to theIMIS Extracts Page.
This page opens in two different modes depending on the type of openIMIS installation: openIMIS Central (live server) or openIMIS offline (installed on local network in a health facility or an office of the scheme administration).
IMIS Extracts (online mode)¶
The Master Data section is used for generation of the data needed for off-line operation of IMIS (Policies) application run on Android platforms. The following data files can be downloaded:
- Master data for running IMIS (Policies) application (Download Master Data)
- Prompts for renewal of policies (Download Renewals)
- Prompts for acquiring of feedbacks (Download Feedbacks)
- Enrolment Officers Code: Enter the code of an enrolment officer for whom the master data and prompts should be generated.
B - Create Phone Extract section
The Phone extract panel is used for the generation of so called SQLite database files for the mobile phone applications. Each district will have its own phone extract file that needs to be distributed to the mobile phones within the district. To generate a phone extract file, the operator has to select a region and a district from the list of available districts. In case the user is having access to its own district only, the district will be automatically selected and shown on the display.
By clicking the
Create
button in panel the section, a phone extract will be created. This process might take a while. As long as the hour glass (as a cursor) is shown, openIMIS is still processing the file. The file size depends on the amount of photographs included in the extract. The file size could range into hundreds of MBs. To alleviate this problem two options are available:
With Insurees
Checking this box means that a complete phone extract (including photos) will be generated. Leaving it unchecked a shortened phone extract without photos will be generated.
In background
Checking this box means that the phone extract will be created in background and the user will be notified by e-mail (provided his/her e-mail is entered in the register of users).
In case the extract is created in the background, the following dialog box appears:
If the extract is not created in background the user is notified about successful creation by the following message as shown below.
The extract will be downloaded to your local computer by clicking the
Download
link that will appear after the creation of the extract, as shown below.The extract file is called IMISDATA.DB3 and needs first to be copied (downloaded) to the local machine. After clicking the
Download
button, the operator is able to select the destination folder (locally) for the file to download as shown below.The extract is now ready to be transferred/copied to the mobile phones. This process is performed manually by connecting the mobile phone to the computer with the provided USB cable. The user needs to copy, manually, the file from the local machine into the ‘IMIS’ Folder on the mobile phone.
C - Offline Extract section
The offline extract section is used to generate the openIMIS ‘offline’ extract files for the health facilities or offices of the scheme administration that run openIMIS offline. To generate an offline extract file, the operator has to select a region and a district from the list of available districts. In case the user is having access to its own district only, the district will be automatically selected and shown on the display. When an operator belongs to one specific district, the district box is already selected with the district of the user. To create a new extract, the operator needs to click the
Create
button.Three types of extracts could be generated:
Differential Extract
(Download D)
Differential extracts will only contain the differences in data compared with the previous extract. The first differential extract (sequence 000001) will contain all data as it will be the first extract. Thereafter, this type of the extract, will only contain any differences after the previous extract. This will result in smaller files sent to the health facilities in off-line mode. When we click the create button, the differential extract is always generated and will be assigned the next sequence number. A separate Photo extract will be created containing only photographs linked to changes compared with the previous extract. Differential extracts with insure and policy data are only generated in case the
With Insuree
checkbox is checked as shown below.Full extract
(Download F)
The Full extract will always contain all information in the database. These extracts are only generated in case the
Full extract
and theWith Insuree
checkbox are checked as shown below.By clicking the
Create
button, in case ofFull extract
is checked, two extracts will be generated, one differential extract and one full extract. Both extracts will have the same sequence number. This implies that full extracts are not always needed/generated. A separate photo extract will be created containing all photographs.Empty Extract
(Download E)
Empty extracts will only contain the data from registers and no data on insurees and their policies/photos. If a full set of register data should be included in the extract, the checkbox
Full extract
has to be checked as shown below.After clicking the
Create
button, the system will create the extract file and will on completion display the following message:The message is only shown to provide some details on how much information is exported to the extract file.
Depending on the
Full extract
option, we will be re-directed to the extract page and will see the newly generated extract sequence in the list or will get a new message as shown below:After clicking OK the statistics of the full extract will be shown:
We are now ready to download the extract to our computer.
The combo box next to the district selector contains information on all generated extracts with the sequence number and date. (e.g. Sequence 000007 – Date 06-09-2012). If the extract selector does not show any entries (blank) it means that no previous extracts were created. At least one full extract needs to be generated. This is needed to initialise a new offline openIMIS installation.
To download the actual extracts, the operator needs to select the desired extract sequence from the list of available extracts.
Four different types of extracts could be downloaded by clicking one of the following buttons:
Download D
(Differential extract)
Will download the selected differential extract with the following filename
Filename: OE_D_<DistrictID>_<Sequence>.RAR (e.g. OE_D_1_8.RAR)
Download F
(Full extract)
Will download the latest full extract with the following filename
Filename: OE_F_<DistrictID>_<Sequence>.RAR (e.g. OE_F_1_8.RAR)
Download E
(Empty extract)
Will download the latest full extract with the following filename
Filename: OE_E_<DistrictID>_<Sequence>.RAR (e.g. OE_F_1_8.RAR)
Download Photos D
(Differential Photo extract)
Will download the selected differential photo extract with filename:
Filename: OE_D_<DistrictID>_<Sequence>.RAR (e.g. OE_D_1_8_Photos.RAR)
Download Photos F
(Full Photo extract)
Will download the latest FULL photo extract with the following filename
Filename: OE_D_<DistrictID>_<Sequence>.RAR (e.g. OE_F_1_8_Photos.RAR)
After clicking the desired extract download button, the file download dialog box appears to select the destination folder for the extract file as shown below:
In case the extract file is not available (anymore) on the server, the following dialog box might appear:
The reason for this box to appear could be that the file to be downloaded has been removed from the server or that you have attempted the download a full extract but no full extract was generated (only the differential extracts exist). It is also possible that you have attempted to download a photo extract but no photos were added since the last extract.
Checking the checkbox
In background
means that the off-line extract will be created in background and the user will be notified by e-mail (provided his/her e-mail is entered in the register of users) as shown below:In case the extract is created in the background, the following dialog box appears:
D - Upload Claims section
Browse
Browse for the file from the IMIS-Offline or IMIS (Claims ) application containing claims to be uploaded.
Upload
Upload claims contained in the selected file.
E - Upload Enrolment section
Browse
Browse for the file from the IMIS-Offline or IMIS (Policies )application containing newly enrolled or renewed policies to be uploaded.
Upload
Upload policies contained in the selected file.
F - Upload Feedback section
Browse
Browse for the file from the IMIS-Offline or IMIS (Policies )application containing feedbacks to be uploaded.
Upload
Upload feedbacks contained in the selected file.
G - Button section
The
Cancel
button brings the operator back to the Home Page.H - Information panel
The Information Panel is used to display messages back to the user. Messages will occur once an action has completed or if there was an error at any time during the process of these actions.
IMIS Extracts (OFFLINE MODE)¶
Offline HF
A - Import Extract
Used to extract photos obtained from online IMIS
B - Import Photos
Used to upload photos obtained from online IMIS
C - Download Claim XMLs
Used to download claims made in the offline health facility prior to be sent to online IMIS
Offline Insurer
A - Import Extract
Used to upload extract obtained from online IMIS
B - Import Photos
Used to upload photos obtained from online IMIS
C - Import Extract
The Choose file section should be clicked to select an extract file to upload/import. The following file selector appears for Internet explorer (the appearance might differ for different internet browsers):
On clicking the
Choose File
button, the file selector dialog appears as shown below:With the import/upload of an extract it is important to understand that each extract has its sequence number. This sequence number is found in the filename of the extract. We would in case of differential imports/uploads have to follow the sequence. In the example screen above, it shows in the status bar, that the last import was number 6. Therefore we should select in this case the differential extract number 7 as highlighted in the file selection dialog.
Alternatively the operator could select any full extract with a sequence number higher than 6. In case a wrong extract is selected, warning messages will appear as shown below:
In case you are missing extract sequences, additional extracts are needed to be uploaded before the extract selected. The extract selected, in this case, does not directly follow the last sequence as indicated in the status bar of the screen. The additional extracts are to be provided by NSHIP district office.
In case the extract file selected is valid, the system will import the data. New data will be added and existing data might be modified. After a successful import of an extract (Differential and FULL), a form is displayed with the statistics of the import as shown below:
The above statistics are provided to give some quick overview of how many records were inserted or updated during the import process. In case we would for example update the phone number of an enrolment officer, it would result in one update and one insert as we always keep historical records. The photos inserts and updates are related to information on the photos, but are not the actual photographs. The actual photographs (\*.jpg) are uploaded separately.
D - Import Photos
The import of photos is optional and will have no further checking on sequence numbers. NSHIP should provide (if available) with each extract the photo extract as well.
E.g. (for Differential extract)
OR (for FULL extract)
The photo extract will contain all photographs associated with the actual extract in a zipped format. The Upload procedure will simply unzip the extract and copy the image files to the photo folder of IMIS.
After successful upload of the photographs the following message appears:
E - Button panel
The ‘Cancel’ button brings the operator back to the main page of IMIS.
F - Information panel
The Information Panel is used to display messages back to the user. Messages will occur once an action has completed or if there was an error at any time during the process of these actions. If the user opens the openIMIS extracts page (in offline mode only), the status bar will show the last sequence number uploaded.
Reports¶
Access to the reports is generally restricted to the users with the role of Manager, Accountant, Scheme Administrator and openIMIS Administrator. By having access to theReports Page
, it is possible to generate several operational reports. Each report can be generated by users with a specific role (Manager, Accountant, Scheme Administrator and openIMIS Administrator) only.
Pre-Conditions¶
Navigation¶
Select Criteria
The Select Criteria panel or the filter panel allows a user to select specific criteria determining the scope of data included in the report. The criteria (Image 205 – Image 222) will change depending on the selected type of the report.
- Primary Operational Indicators - Policies Report.
- Primary Operational Indicators - Claims Report.
- Derived Operational Indicators Report.
- Contribution Collection Report.
- Product Sales Report.
- Contribution Distribution Report.
- User Activity Report.
- Enrolment Performance Indicator Report.
- Status of Registers Report.
- Insurees without Photos Report.
- Payment Category Overview Report.
- Matching Funds Report.
- Claim Overview Report.
- Percentage of Referrals Report.
- Families and Insurees Overview Report.
- Pending Insurees Report.
- Renewals Report.
- Capitation Payment Report
The general meaning of selection criteria for creating of a report is as follows:
Date From
Type in a date; or use the Date Selector Button, to enter the beginning of a period, in which policies have their enrolment, effective, expire or renewal days, contributions were paid or in claimed health care was provided. If used with a report, it is mandatory. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Date To
Type in a date; or use the Date Selector Button, to enter the end of a period, in which policies have their enrolment, effective, expire or renewal days or in which claimed health care was provided. If used with a report, it is mandatory. Note. To clear the date entry box; use the mouse to highlight the full date and then press the space key.
Payment Type
Select the
Payment Type
from the drop down list by clicking on the right arrow. By selecting any of the options a user can filter the report on a particular type of the payment. This filter is not mandatory, leave it blank to preview the report on all the payment modes.
Region
Select the
Region
; from the list of regions by clicking on the arrow on the right of the selector to select a region, data of which should be included for the report. Note: The list will only be filled with the regions assigned to the current logged in user. If this is only one then the region will be automatically selected.
District
Select the
District
; from the list of districts by clicking on the arrow on the right of the selector to select a district, data of which should be included for the report. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user. If this is only one then the district will be automatically selected.
Product
Select the
Product
; from the list of products by clicking on the arrow on the right of the selector to include in the report data for the specific product. Note: The list will only be filled with the products belong to the districts assigned to the current logged in user. If this is only one then the product will be automatically selected.
Month
Select the
Month
from the list of months by clicking on the arrow on the right of the selector to include in the report data relating to that month selected.
Year
Select the
year
from the list of years by clicking on the arrow on the right of the selector to include in the report data relating to that year selected.
Quarter
Select the
quarter
from the list of quarters by clicking on the arrow on the right of the selector to include in the report data relating to that quarter selected.
HF Code
Select the
HF Code
; from the list of heath facility codes by clicking on the arrow on the right of the selector to create the report for the specific health facility. Note: The list will only be filled with health facility codes of health facilities belonging to the districts assigned to the current logged in user. If this is only one then the health facility code will be automatically selected.
Enrolment Officer
Select the enrolment officer; from the list of enrolment officers by clicking on the arrow on the right of the selector to select enrolment officer data of whom should be included in the report. Note: The list will only be filled with the enrolment officers assigned to the current selected district. If this is no district selected the enrolment officers list will be filled by all districts’ enrolment officers
Payer
Select the payer from the drop down list by clicking on the right arrow. By selecting any of the options a user can filter the report on a particular payer. This filter is not mandatory; leave it blank to preview the report on all the payers.
Claim Status
Select the claim status from the drop down list by clicking on the right arrow. By selecting any of the options a user can filter the report on a particular claim status. This filter is not mandatory, leave it blank to preview the report on all the claim statuses.
Sorting
Select the way of sorting of records in the report from the list of available ways of sorting (Renewal Date, Receipt Number, Enrolment Officer).
Previous
Select the previous reports from the drop down list by clicking on the right arrow. By selecting any of the options a user can fetch a report which was produced before. Note: This filter is available only for Matching Funds Report.
Date Selector Button
Clicking on the
Date Selector Button
will pop-up an easy to use, calendar selector (Image 223) by default the calendar will show the current month, or the month of the currently selected date, with the current day highlighted.
- At anytime during the use of the pop-up, the user can see the date of today.
- Clicking on today will close the pop-up and display the today’s date in the corresponding date entry box.
- Clicking on any day of the month will close the pop-up and display the date selected in the corresponding date entry box.
- Clicking on the arrow to the left displays the previous month.
- Clicking on the arrow on the right will displays the following month.
- Clicking on the month will display all the months for the year.
- Clicking on the year will display a year selector.
Image 223 - Calendar Selector - Search Panel
Report Type Selector
This panel contains a list of available report types. A user can select to create a desired report by clicking on the report type list item (Image 224) and narrow the report using the criteria being shown on the panel above, and then click the preview button to create the report. Available report types are:
- Primary Operational Indicators Report.
- Derived Operational Indicators Report.
- Contribution Collection Report.
- Product Sales Report.
- Contribution Distribution.
- User Activity Report.
- Enrolment Performance Indicators
- Status of Registers
- Insures without Photos.
- Matching Funds.
- Claim Overview.
- Payment Category Overview.
- Families and Insurees Overview.
- Pending Insurees.
- Percentage of Referrals.
- Capitation Payment
Button Panel
Preview button
By clicking on this button, the system will process the selected report type basic on the corresponding criteria submitted and re-direct current user to Report Page, for previewing the processed report. At any time the user clicks on the preview button, the current criteria will be saved in the session and can be reused later in the same session and for other report types where the same criteria are found.
Cancel button
By clicking on this button, the current user will be re-directed to the Home Page.
Information Panel
The Information Panel is used to display messages back to the user. Messages will occur if there was an error at any time during the processing of the reports.
Report Preview¶
The report viewer offers the facility to navigate through the report either by using the arrows or by typing in a page number at the top of the report. Another feature of the report viewer is to export the report in different formats. Currently system supports three formats; Word, Excel and PDF. Select the desired format from the list by clicking on the Export link. Use the
Go Back to Selector
link to go back to the previous selection page.Below are the types of reports as they can be seen in the report page.
primary operational indicators - policies report
The report provides aggregate data relating to policies and insurees according to insurance products. The report can be run by users with the role Manager. The table below will provide an overview on primary indicators of the report.
¶ Code Primary indicators Dimension Description P1 Number of policies Time, Insurance product The number of policies of given insurance product on the last day of a respective period (Status of the policy is Active, the last day of period is within <Effective date, Expiry day>) P2 Number of new policies Time, Insurance product The number of new policies of given insurance product during a respective period (Enrolment date is within the respective period, there is no
preceding policy with the same (or before converted) insurance product forgiven policy)P3 Number of suspended policies Time, Insurance product The number of policies for given insurance product that were suspended during a respective period (Status of the policy is Suspended, suspension took place within the respective period) P4 Number of expired policies Time, Insurance product The number of policies for given insurance product that expired during a respective period (Status of the policy is Expired,expiration took place within the respective period) P5 Number of renewals Time, Insurance product The number of policies that were renewed forgiven insurance product (or a converte done) during a respective period ( Enrolment date is within the respective period, there is a preceding policy with the same (or before converted) product forgiven P6 Number of insurees Time, Insurance product The number of insurees covered by policies of given insurance product on the last day of a respective period (An insuree belongs to a family with an active coverage on the last day of the respective period-see P1 ) P7 Number of newly insured insurees Time, Insurance product The number of insurees covered by new policies of given insurance product during a respective period (An insuree belongs to a family with newly acquired policy during the respective period-see P2 ) P8 Newly collected Contributions Time, Insurance product Amount of acquired Contributions (for policies of given insurance product) during a respective period ( Date of payment of a Contribution is within the respective period) P9 Available Contributions Time, Insurance product Amount of Contributions that should be allocated for policies of given insurance product for a respective period provided a uniform distribution throughout the insurance period takes place. (If the respective period overlaps with <Effective date, Expiry day> of a policy then a proportional part of corresponding Contributions relating to the respective period is included in available Contributions) Below is an example of the report:
primary operational indicators - claims report
The report provides aggregate data relating to policies and insurees according to insurance products. The report can be run by users with the role Manager. The table below will provide an overview on primary indicators of the report.
¶ Code Primary indicators Dimension Description P10 Number of claims Time, Health facility, Insurance product The number of claims for given insurance product that emerged during a respective period (Start dateof a claim is within the respective period) P11 Amount remunerated Time, Health facility, Insurance product Amount remuneratedfor claims for given insurance product that emerged during a respective period (Start dateof a claim is within the respective period) P12 Number of rejected claims Time, Health facility, Insurance product The number of claims for given insurance product that emerged during a respective period and were rejected (Start dateof a claim is within the respective period and the Status approval ofthe claim is Rejected) Below is an example of the report:
derived operational indicators report
The report provides operational indicators derived from primary operational indicators. The report can be run by users with the role Manager. The table below will provide an overview on the actual derived indicators provided by the report.
¶ Code Derived Dimension Description D1 Incurred claims ratio Time, Insurance product It is the ratio P11/P9 D2 Renewal ratio Time, Insurance product It is the ratio P5/P4 D3 Growth ratio Time, Insurance product It is the ratio P2/P1-for immediately preceding period D4 Promptness of claims settlement Time, Insurance product It is the average (date of sending to payment- Date of submission of the claim) for all claims relating to given insurance product and emerging in a respective period Date of sending of payment is not in the structure of Claim, it has to be retrieved from a journal-can be?) D5 Claims settlement ratio Time, Health facility, Insurance product It is the ratio (P10-P12)/P10 D6 Number of claims per insuree Time, Insurance product It is the ratio P10/P6 D7 Average cost per claim Time, Health facility, Insurance product It is the ratio P11/P10 D8 Satisfaction level TimeDistrict, Health facility The average mark from feedbacks received in a respective period D9 Feedback response ratio Time, District, Health facility The ratio of number of feedbacks received (up to time of creation of the report) and number of feedbacks asked for in a respective period Below is an example of the report:
Contribution collection report
The report lists all actual payments of contributions according to insurance products in the defined period. The report can be used as input to an accounting system. The report can be run by users with the role Accountant. Payments are assigned to the specified period according to the actual date of payment.
Below is an example of the report:
product sales report
The report provides overview of selling of policies according to insurance products in terms of calculated contributions (not necessarily actually paid). The report can be run by users with the role Accountant. Policies are assigned to the specified period according to their effective days.
Below is an example of the report:
Contribution distribution report
The report provides proportional amount of actually paid contributions allocated by openIMIS to specific months according to insurance products. The report can be run by users with the role Accountant. This report shows the information about the Total collection, Allocated amount and Not allocated amount for contributions in the specified period.
Allocated amount is the proportionally calculated amounts of contributions paid covering the month. Not Allocated amount is the amount collected for contributions that have a start date in the future (after the month in question).
Below is an example of the report:
user activity report
The report shows activities of users according to types of activities and types of entities to which the activities relate. The report can be run by users with the role openIMIS Administrator. Below is an example of the report:
enrolment performance indicator report
The report provides overview of activity of enrolment officers. The report can be run by users with the role Manager. Below is an example of the report:
status of registers report
The report provides an overview of the number of items in registers according to districts. The report can be run by users with the role Scheme Administrator. Below is an example of the report:
insurees without photos
The report lists all insurees according to enrolment officers that have not assigned a photo. The report can be run by users with the role Accountant. Below is an example of the report:
matching funds
The report lists all families/groups according to insurance products and (institutional) payers that paid contributions in the specified period. This report is useful for claiming of subsidies for running of health insurance schemes. The report can be run by users with the role Accountant. Below is an example of the report:
claim overview
The report provides detailed data about results of processing of claims in openIMIS according to insurance products and health facilities. The report can be used as a tool for communication between a health insurance scheme and its contractual health facilities. The report can be run by users with the role Accountant. Claims are assigned to the specified period according to date of provision of health care (in case of in-patient care according to the date of discharge). Below is an example of the report:
payment category overview
The report provides split of total contributions according to their categories. The report can be run by users with the role Accountant. Contributions are assigned to the specified period according to actual payment date. Below is an example of the report:
Families and Insurees Overview report
The report provides an overview of enrolled families/groups and their members in specified location within the specified period. The report can be run by users with the role Accountant. Below is an example of the report:
Percentage of Referrals report
The report lists all primary health care facilities (the category is Dispensary and Health Centre) in the selected district and for each such health facilities provides the following indicators:
- The number of visits (claims) of the primary health care facility in the selected period.
- The number of out-patient visits that have Visit Type equal to Referral in all other health facilities (irrespective of the district) for insurees with the First Service Point in the respective primary health care facility.
- The number of in-patient stays that have Visit Type equal to Referral in all health facilities-hospitals (irrespective of the district) for insurees with the First Service Point in the respective primary health care facility.
The report can be run by users with the role Accountant. Below is an example of the report:
Pending Insurees report
The report lists all insurees whose photos have been sent to openIMIS but who has no record in openIMIS yet. The report can be run by users with the role Accountant. Below is an example of the report:
Renewals report
The report lists all renewed policies in given period for given insurance product and optionally for given enrolment officer. The families that have at least one payment of contributions in given period of time are included in the report. The report can be run by users with the role Accountant. Below is an example of the report:
Capitation Payment Report
The report lists capitation payments for all health facilities specified in the capitation formula for specified month and for given insurance product. The report can be run by users with the role Accountant. Below is an example of the report:
Utilities¶
Access to the
Utilities
is restricted to the users with the role of openIMIS Administrator.The
Utilities
is the place for database administration. By having access to this page, it is possible to backup and restore the openIMIS operational database and also to execute SQL Scripts (patches provided for maintenance or update of the database). At the top of the page, the current “Backend” version is displayed for reference.
Navigation¶
All functionality for use with the administration of utilities can be found under the main menu
Tools
, sub menuUtilities
Clicking on the sub menu
Utilities
re-directs the current user to the Utilities Page.
Backup¶
Backup utility can be found in the top panel of the Utilities Page. By default the path of the backup folder will be populated from the default table. User can change the path according to the requirement. Next to the textbox user can see one heck box called
Save Path
. If user wants to update the backup folder in default table then this check box should be in checked state. Otherwise system will take the backup on the folder assigned by the user but it will not be updated in database. So next time when user comes on the Utilities Page, the textbox will be populated with the original path. After the path has been entered user can just click on theBackup button
to start the process and a progress bar will be appeared on the screen. Users are requested to be patient while the system performs the task.
Restore¶
Restore utility can be found in the second panel of the Utilities Page. User will have to put the path of the backup file to be restored. After the path has been entered user can just click on the
Restore
button to start the process and a progress bar will be appeared on the screen. Users are requested to be patient while the system performs the task.
Execute script¶
Execute script can be found in the third panel of the Utilities Page. User will have to choose the script by clicking on the browse button. User will have to select the file only with the “.isf” extension. After the file has been chosen, user can just click on theExecute
button to run the script. Users are requested to be patient while the system is executing the script. After the script is executed successfully, backed version will be updated to the latest version. If user will try to run the lower or the equal version’s script then system will prompt the user with the appropriate message.
Funding¶
Access to the
Funding
is restricted to the users with the role of Accountant.The
Funding
is the place where funding from external authorities (payers) can be for entered. openIMIS creates internally one fictive family/group (the insurance number of the head of the fictive family/group is 999999999, the name is Funding and the other name is Funding as well) for the district for which a funding is done. Each entering of a fund results in creation of a fictive policy for the corresponding fictive family/group with paid contribution in the amount of the funding. The fictive policy is active since the date of payment of the corresponding fund. These fictive policies are overpaid as these funds are usually much higher than the contribution rate for a single family/member of the group but it doesn’t matter. External funding corresponds to payment of contributions for many families/members of the group in some period. openIMIS can regard funds as standard contributions and its standard functionality can be used for handling of funds. One distinctive feature of payment of funds by means of the fictive policies is that the payments of funds don’t appear in the reports on matching funds generated for funding authorities. So, there is no danger that offices of the scheme administration would acquire new funds based on funding already acquired.
Navigation¶
The functionality for entering of funds can be found under the main menu
Tools
, sub menuFunding
Clicking on the sub menu
Funding
re-directs the current user to the Funding Page.
Funding Page¶
Data Entry
Region
Select the region from the list of regions for which the funding is designated by clicking on the arrow on the right of the selector. Note: The list will only be filled with the regions assigned to the current logged in user.
District
Select the district from the list of districts for which the funding is designated. by clicking on the arrow on the right of the selector. Note: The list will only be filled with the districts belonging to the selected region and assigned to the current logged in user.
Product
Select an insurance product from the list of insurance products purchased in the selected district (including national insurance products) for which the funding is designated.
Payer
Select from the list of institutional payers the funding authority/agency.
Payment Date
Enter the date of receiving of the funding.
Contribution Paid
Enter the amount of the funding.
Receipt Number
Enter an identification of the document accompanying the funding.
Saving
Once all mandatory data is entered, clicking on the
Save
button will save the record. A message confirming that the new password has been saved will appear. The user will be re-directed back to the Home Page.Mandatory data
If mandatory data is not entered at the time the user clicks the
Save
button, a message will appear in the Information Panel, and the data field will take the focus (by an asterisk on the right side of the corresponding field). The user will be re-directed to the Home Page.Cancel
By clicking on the Cancel button, the user will be re-directed to the Home Page.
Email Settings¶
Access to the
Email Settigns
is restricted to the users with the role of Accountant.The
Email Settigns
is the page where the setting of the outbound email server are entered.
Navigation¶
The functionality for entering of funds can be found under the main menu
Tools
, sub menuEmail Settigns
Clicking on the sub menu
Email Settigns
re-directs the current user to the Email settings Page.
Email settings page¶
Data Entry
SMTP Login to be used on the email server in order to send email
Password
SMTP password to be used on the email server in order to send email.
SMTP Host
SMTP email server address or IP
Port
SMTP email server IP port, standard port are
- 25 when no encryption is used
- 465 when implicit encryption is used(depreciated)
- 587 when explicit encryption is used, see
Enable SSL
Enable SSL
Check to box if the SMTP mail server require encryption
Offline mode¶
Introduction¶
IMIS system can be used in offline mode, which makes it possible for usage by health facilities (HF) and scheme administration offices with low/no internet connectivity.
OFFLINE FACILITIES¶
Facilities available while offline and online in IMIS, are similar with some few differences. The following are the feature wise differences found while using openIMIS in offline mode.
Login
If a user who is logging in is having user role HF Administrator or offline Scheme Administrator and if Heath Facility ID/Scheme Office ID is not set yet, just after clicking login button on the login screen/page, the user will be prompted to enter Health Facility/Scheme Office ID (Image 251), (Image 252), only once for that very first time of logging in.
Information bar
Menu Access
For all users with roles other than HF Administrator and Offline Scheme Administrator , will have the menus available to them as per normal roles’ rights in online openIMIS version. Menu access in the offline version is different in following scenarios:
User with roles HF Administrator and Offline Scheme Administrator can access only
Users
,IMIS Extracts
andUtilities
menus, while all other users with different roles can access menus just as they would do in the online openIMIS version.
Extracts
Extracts Menu leads an offline user to Extracts control panel. Using this panel, an offline user with rights to this panel can import data from online openIMIS to the local offline IMIS, and can also download claims and enrolments prior to upload them to the online IMIS. This panel is divided into five sections (Image 255), (Image 256) If an offline user is HF Administrator, section C will contain facility to
Download Claims
. If an offline user is Offline Scheme Administrator, section C will contain facility toDownload Enrolments
section a - import extract
This section has a facility to enable synchronization of online openIMIS data with that offline openIMIS data. When online data in a zipped file is obtained (downloaded extraction) from online openIMIS to user local computer, user will use this section to put that data into offline IMIS.
User has to select a file from a local computer by clicking the ‘select file’ button on the left side of the section, and in the popup window which appears (Image 256) user can navigate to the required file and select the file.
After clicking the upload button on the very end of right hand side in this section, data in the file will be imported to the offline openIMIS and confirmation will be given as popup messages (Image 257), (Image 258).
User cannot import an extract whose sequence number is same as last one imported; if done so, a popup message (Image 260) will be shown.
section b - import photos
Just as the section name implies, this is a section with facility to enable a user synchronize insurees’ photos in online IMIS, with insurees’ photos in offline IMIS. When online insurees’ photos in a zipped file is obtained from online openIMIS to user local computer, user will use this section to put those photos into offline IMIS.
User has to select a file from a local computer by clicking the ‘select file’ button on the left side of the section, and in the popup window which appears (Image 261), user can navigate to the required file and select the file.
After clicking the upload button on the very end of right hand side in this section, data in the file will be imported to the offline openIMIS and confirmation will be given as popup messages (Image 261).
If importation of photo is not done due to some reason, the above popup message will not be shown, instead system will issue proper popup message to notify a user what went wrong and what is to be done.
section c - download claim xmls
This section has facility to enable offline HF Administrator download to a zipped file all offline claims. By clicking the download button on the right hand side, the user initiate download process and all offline claims will be downloaded to a default downloads folder in user’s local computer or a prompt of ‘where to save file’ will be displayed by browser’. User can navigate through folder in his/her local computer to find the file downloaded. If no new claims found, a message will be displayed.
download enrolment xmls
This section has facility to enable Offline Scheme Administrator download to a zipped file all offline enrollments of families, insurees, policies and contributions. By clicking the download button on the right hand side, the user initiate download process. If no enrolment found, a popup message box (Image 262) will appear, notifying the user. Otherwise enrollments will be downloaded in a zipped file and a confirmation popup message (Image 264) will appear
section d - buttons
This section has a cancel button, which when clicked will take the current user to the Home page.
section e - information bar
Information bar at the bottom will show different notification messages in blue color depending on the actions of the user. Such actions and messages may be:
- No Previous Extract Found
This message is seen at the first time when using the system and no any extract has been imported into the offline IMIS
- Last Extract Sequence: <Sequence Number>
This message is seen, after a single / series of extract importation have been made to the offline openIMIS and that much times will be shown as a sequence number at the end of the message. This enables proper tracking of right extracts to import and use.
- No claims Found
When HF offline openIMIS user is downloading offline claims and no new offline claims is found, this message is displayed.
User
data access
Search / Find
In all pages in
Insurees
andPolicies
menus with search / find acility, there will be an extra search criteria (image 270) to enable search for offline data only. This feature is available if a user is in Offline IMIS.Create / Edit
Only families, insurees, policies and contributions created/edited while offline, will be available for further manipulation. An online data is available for viewing purposes.
For an offline user with a right to open
Insurees
andPolicies
menus, he/she can access all data but can manipulate only that data which was created offline. The rest of the data will be available in read-only mode