Ansicht
Dokumentation

ISH_CV_FR: Ins. Relationships for Statutory Health Ins. Schemes (New) ( RELNISH_604_ISHCVFR_SSHI )

CPI1466 during Backup   Vendor Master (General Section)  
This documentation is copyright by SAP AG.

Short text

ISH_CV_FR: Ins. Relationships for Statutory Health Ins. Schemes (New)

Use

As of SAP ECC 6.0, Industry Extension Healthcare, Enhancement Package 4, Business Function SAP Patient Management Country Version France (ISH_CV_FR), the following new fields are available with the function for entering case-related insurance relationships for entering information on statutory health insurance schemes correctly:

• Billable SI field:

This field indicates the coverage status of the current case in relation to the statutory health insurance scheme. The information is transmitted to the regional health authority (ARH), for example, with the VIDHOSP file. You can define possible values for this field in Customizing.

• Insurance Provider Category field:

You can use this field to specify that the patient in the current case is covered by the national health insurance scheme (AME), the complementary national health insurance scheme (AME-C), or has (complementary) general basic health insurance (CMU and CMUC). The statutory health insurance scheme assumes the role of insurance provider for these forms of coverage.

• Insurance Provider Alsace indicator

In the Alsace-Moselle region, there are patients who belong to the local health insurance scheme "Alsace-Moselle". This local health insurance fund type has its own coverage and billing rules. You can use the new indicator to identify these cases.

• Copayment Waiver field

In this field, you specify the reason why the patient is exempted from paying the patient contribution.

Please note that the system also enters exemption reasons automatically using service rule F05.

Effects on Existing Data

Effects on Data Transfer

Effects on System Administration

If you select the Alsace indicator in the insurance provider's master record, the system automatically selects the indicator as a default value in the insurance relationship with this insurance provider.

Effects on Customizing

Maintain the possible values for the Billable SI field in Customizing under SAP Healthcare - Industry-Specific Components for Hospitals -> Patient Accounting -> Business Partners / Insurance Relationships -> Coverage Status for Social Insurance.

Maintain reasons for patient contribution exemptions in Customizing. Specify whether the exemption reason also constitutes an exemption from the daily hospital rate. To do this, choose SAP Healthcare - Industry-Specific Components for Hospitals -> Patient Accounting -> Business Partners / Insurance Relationships -> Maintain Reasons for Exemption from Fixed Patient Contribution.

Further Information

BAL Application Log Documentation   rdisp/max_wprun_time - Maximum work process run time  
This documentation is copyright by SAP AG.

Length: 3588 Date: 20240602 Time: 134649     sap01-206 ( 66 ms )