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RNNKOS15 - IS-H: Extend Insurance Verification Requests

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Description

The Extend IV Request function enables you to create extension requests for insurance verification.

Such extension requests always relate to an insurance verification request already saved in the system. They are flagged as an extension request, and reference the existing request.

In the insurance verification transaction, the Ext. Req. indicator is located in the header data of the IV document.

When the IV extension requests are printed, this indicator can be used to select a different text or a new layout (see below).

Extension requests usually contain all items of the reference IV request that have not been canceled or rejected.
In the Processing Mode group box on the selection screen, you can specify which IV requests you want to extend:

• Confirmed Items Only

If you set this indicator, the program only takes into account IV items with the status Confirmed when creating the extension request. All other items are ignored.

• Extended Svce Only

This indicator enables you to prevent extended service items from being extended. If the IV item in question relates to a service group, the Extended Svce indicator in the service master is evaluated as for individual services. This means that the group is not expanded to carry out the check (important for service groups that contain immediate services and extended services).

• Include Rej.

This indicator enables you to specify whether the extension program should also generate an IV extension if a rejected request exists for the period following the limited IV request. Set this indicator is you want to prevent the system from extending an IV request, although a rejected IV request exists for the subsequent period. Note that the system only checks the header status of the rejected IV requests.

• Following Services Only

This option enables you to explicitly specify the items the extension program is to take into account when creating the IV extension request. If you do not want to restrict the items, leave these fields blank.

The items start on the day after the corresponding item of the reference IV request, and end in accordance with the settings in the insurance provider master (IVR Extension field).

Requirements

The Extend IV Request function checks whether there are limited IV requests for one or more cases. In executing this function, the system only takes into account the validity period from the header data. The validity specification in the IV header always covers the complete period of all individual items.

If the system detects a gap in coverage (see below) with regard to the key date, it proposes to extend this IV request. The key date should normally be the current date. A future date can also be set to detect limited coverage in good time. You should never enter 12/31/9999 as the key date, since all IV requests are limited with regard to this date.

The system checks whether the patient has changed insurance provider, in other words, whether the insurance relationship is still valid for the extension period.

For the proposal list, it is irrelevant whether services have already been assigned to an insurance verification item (exceptions to this rule are listed under Special Features for Country Version Germany).

Special Features for Country Version Germany

For leading cases of a readmission sequence, the report takes into account the perod of the entire readmission case.A

Example:

Case 1: Admission 01/15//04

Discharge 01/20/04

Coverage from 01/15/04 through 01/21/04.

Case 2: Admission 01/22/04 Discharge 02/05/04

Case 1 and case 2 comprise a readmission sequence. Case 1 is the leading case.

You run the report for case 1. It takes into account the period of the entire readmission case. Thus in this example, the report proposes to extend the IV request, although coverage for case 1 already exceeds the period of the individual case.

For all cases of a readmission sequence except for the leading case, the system only takes into IV requests with assigned services for extension. This prevents the system from unnecessarily extending IV requests to which services are no longer assigned, since the merging of cases has caused the services to be reassigned to a different case.

Output

The program can be executed in three modes:

• Interactive mode

This is the default mode. Note that all cases of the IV requests to be extended are locked against processing by other users until the Extend IV Request was executed for the case, or the list is exited.

• Without Dialog

You enable this mode by setting the Extend Immediately indicator on the selection screen.

• Proposal List

You enable this mode by setting the Output List Only indicator.

In interactive mode, the system outputs a list of limited insurance coverage. You can process this list using the following functions:

• Extend IV Request

This function extends the selected IV requests. The data is saved.

• Simulate

This function enables you simulate extensions. A dialog box containing the data of the extension request appears. Data is not modified.

• Display Document

This function displays the IV request to be extended.

When you execute the program without dialog, the system immediately extends the IV requests found.

The proposal list is particularly suited for checking IV requests. The Extend function is disabled in this mode. The cases found are not locked against processing by other users.

You can call the list online, or choose to print it in the background.

Note

When printing forms, the field RNF12-VRLNG tells you whether you are dealing with an IV extension request.

The current diagnoses of the case are located in the structure RNF17.

The structure RNF38 contains the header data of the reference IV request.

Gaps in Coverage

When searching for imited IV requests, the program proceeds as follows:

• It sorts all of the IV requests for the case according to insurance provider, and start and end date.

• It processes all IV requests for each insurance provider. Gaps at the start of requests or between requests are reported as messages. If the most recent request to the insurance provider does not fully cover the period being checked, this request is included in the list of IV requests to be extended.

Example

Check period |-------------------------------------|

IV requests |-(a)-|-(b)-| |---(c)---|

Gaps in cover.|-1-| |-2-| |---3---|

The check period starts with the admission date and ends with the discharge date, or with the key date you specify on the selection screen.

The insurance verification requests (a), (b), and (c), result in three gaps in coverage (1, 2, and 3) within the check period.

Gap 1 occurs at the start of the check period. The system reacts to it be issuing a message. An extension is not proposed since the limitation does not relate to the period following the end date of the IV request.

Gap 2 occurs between the two requests (b) and (C). Once again, the system issues a message. An extension to IV request (b) is not proposed, since a request relating to the following period has been made to the same insurance provider. If IV request (b) were extended, excess coverage could result.

Gap 3 occurs after the last UV request (c) before the end of the check period. This is why IV request (c) is included in the list of IV requests to be extended.

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This documentation is copyright by SAP AG.

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