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 need to be met. They are listed below-
i. For the Organisation generating claims should Switch On the preference Allow billing to External Practitioners. To do this, you simply need to go to Tools | Organisation |Select the Organisation | Scroll down to Preference: Financial |Under Integrated Billing | Switch ON, Allow billing to External Practitioners.
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 Finance 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 Billed to Corporate and Add the Corporate Policy that the patient is enrolled with.
Let us take a look at how to generate this Claim in Clinicea.
Example: A Patient Hermione subscribes to an Insurance Policy called Startup from the Insurance Company called Lloyds. The Policy has few rules which cover the cost of all the Consultations, Medications, Lab Tests etc. done at the clinic or with an external doctor up to $20,000/patient.
The patient Hermione while traveling had to visit an external doctor, Dr. Raman Kumar who charged her $495 for Medical Consultation and $90 for 5 capsules of Alprax 0.25. Now Hermione is back in town and wants to claim for the expenses through his insurance provider.
1. Go to Financials | New Bill | Search and Select a patient.
2. Once you are done selecting the patient a New Bill window will open up | Add the Bill Items Ex: Medical Consultation and Alprax 0.25 and change the price of the item as per what Hermione was charged by Dr. Raman Kumar.
Click on Practitioner which will populate a dropdown list, and select Dr. Raman Kumar.
3. Once you have selected the practitioner that Hermione visited, you can click on the bill amount as shown in the screenshot below to see the payment details.
4. 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 Hermione is linked to.
5. 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 Lloyds.