You can now claim for consultations done with an External Doctor. This will assist you in running micro-TPA services. In order to do so there are few pre-requisites that needs to be met. They are listed below
i. For the Organisation generating claims should Check On the preference Allow selecting an External Doctor while creating a Bill. To do this, you simply need to go to Tools | Organisation |Select the Organisation | Scroll down to Preference: Financial |Under Integrated Billing Check ON Allow selecting External Doctor while creating a Bill.
ii. Staff who are responsible for managing Claims, should have permission to Change Bill Item Price. To do so you simply need to go Tools | Permissions | Select the Role the Staff Belongs to |Under Financial and Inventory section select Change Bill Item Price.
iii. Add the Corporate (Insurance Company) through Tools | Address Book and define the policy as per the corporate norms.
iv. In the Patient details page set By default patient is billed to: Corporate and Add the Corporate Policy that Dilip is enrolled with.
Let us take a look on how to generate this Claim in Clinicea.
Example: A Patient Dilip subscribes to an Insurance Policy called Basic from the Insurance Company called Axa Health. The Policy has few rules which covers the cost of all the Consultations, Medications, Lab Tests etc. done at the clinic or with an external doctor upto $20,000/patient.
The patient Dilip while traveling had to visit an external doctor, Dr. George who charged Dilip $500 for Consultation and $200 for 10 capsules of Oflomac TZ 200mg. Now Dilip is back in town and wants to claim for the expenses through his insurance provider.
1. Go to Financials | New Bill | Search and Select the patient Dilip
2. Once you are done selecting the patient a New Bill window will open up | Add the Bill Items Ex: Initial Consultation and Oflomac TZ 200mg and change the price of the item as per what Dilip was charged by Dr. George.
Click on Practitioner which will populate a dropdown list. Now click on Practitioner: Select from Contacts…
3. Once done a fly out will appear on the right-hand side with a list of all external practitioners listed. If the doctor Dilip has consulted is not listed you can quickly add by just typing in the Practioner name and clicking on the plus “+” icon to add it on. Please take a look at the screenshot below
4. Once the External Practitioner is added click on the “+” button to select the Practitioner as shown in the screenshot below
5. Once you have selected the practitioner that Dilip visited, you can click on the bill amount as shown in the screenshot below to see the payment details.
6. Once you have clicked on the bill amount a fly out, Payment Details opens as shown in the screenshot below which lists out information like total amount covered, annual/daily limit etc depending on the policy that Dilip is linked to.
7. Once you have checked everything, click Save. This will create a Claim against the Corporate to which the Patient belongs to. In this case against Axa Health.