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ISH_ZUZ_BETRAG_PRO_T - Maintain Copayment Amount per Day by Insurance Provider

ISH_ZUZ_BETRAG_PRO_T - Maintain Copayment Amount per Day by Insurance Provider

SUBST_MERGE_LIST - merge external lists to one complete list with #if... logic for R3up   General Data in Customer Master  
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In this IMG activity, you define the copayment amount per day. You need the copayment amount per day in the copayment transaction to enable the system to automatically convert the specified copayment days into an amount. Alternatively, you can also enter an amount in the copayment transaction directly (e.g. if a patient only makes a partial payment).

You can define the copayment amount per day in relation to the insurance provider type or a particular insurance provider. The table is institution-specific in order to support different copayment amounts in different institutions, if required.

  • Check which copayment amounts per day apply to which insurance providers requiring copayment and the corresponding validity periods.
  • If different copayment amounts exist for insurance providers, consider which amounts you have to maintain in relation to the insurance provider type and in relation to the individual insurance providers.
  • The table contains two fields for the copayment amount. The first field (Amount 1) is always relevant.
  • Specify for what purpose the copayment is used in the U field (Usage). Enter D1 if the copayment corresponds to the statutory requirement for inpatient cases in Germany. You can define your own usage by means of SAP enhancement NZUZ0001.
  • The copayment amount is also time-dependent. When maintaining the table, make sure that the periods you define do not overlap.

Access Sequence

Specific entries take precedence over general rules. Thus, an entry for a particular insurance provider takes precedence over an entry for the corresponding insurance provider type.

An entry with insurance provider "*" and insurance provider type "*" defines the copayment amount for all insurance providers and insurance provider types for which no specific entry has been made.

The table contains the following (simplified) entries:

Ins.Prov.   IPT   Amount 1   Amount 2   Currency
AOK Berlin   *   7   5   EUR
*     AOK   6   5   EUR
*     *   8   4   EUR

  • The system determines a copayment amount of 7 euro for a case with insurance provider AOK Berlin.
  • The system determines a copayment amount of 6 euros for all other insurance providers of insurance provider type AOK.
  • The system determines an amount of 8 euros or all remaining insurance providers.

You can stipulate a currency for each interval. Note that it does not make sense to create identical periods in the same currency. Since the currency in this table is used for the automatic generation of copayment requests, only one currency must be stipulated for each interval.

For more information on customer-specific usage, see the documentation on SAP enhancement NZUZ0001.






ABAP Short Reference   RFUMSV00 - Advance Return for Tax on Sales/Purchases  
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