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SIMG_CFMENUNMO3ON32 - Configure Copayment

SIMG_CFMENUNMO3ON32 - Configure Copayment

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This IMG activity tells you the settings you have to make to enable copayments to be posted automatically from the IS-H System.

On the one hand, you have to declare settings you have already made in Financial Accounting (FI) to the IS-H System.

You also have to set parameters that determine how the IS-H System is to make postings in Financial Accounting.

You make a number of settings irrespective of the copayment procedure. These parameters are located in the Global Parameters group box. Other settings refer to the respective copayment procedure. These parameters are located in the Collection Procedure and Receivable Procedure group boxes.

Before proceeding, determine whether the receivable procedure and/or the collection procedure is relevant in your institution.

You should start by making the settings in Financial Accounting.

This involves defining:

  • special G/L transactions
  • posting keys
  • document types
  • reconciliation accounts
  • dunning block reasons
  • dunning areas
  • tax codes
  • reasons for reversal

Note that the transactions defined in Financial Accounting must have the correct properties (e.g. document type and posting key) and should be used exclusively for copayment.

For more information about the settings required in Financial Accounting, refer to the financial accounting part of the Implementation Guide entitled SAP Healthcare - Core Components (FI, CO, MM).

If copayment is to be performed in your institution using the collection procedure, you require two special G/L transactions:

  • One for the copayment request
  • The other for the copayment made

You define a special G/L transaction by

  • Assigning a special G/L indicator
  • Defining an alternative reconciliation account
  • Maintaining properties
  • Maintaining transaction types
  • Maintaining posting keys

To define the copayment special G/L transaction, proceed as follows:

  1. Do not flag any of the checkboxes in the Properties group box.
  2. Select the transaction type Others.
  3. Assign a Debit and Credit Posting Key
  4. Maintain the Alternative Reconciliation Account.

For more information about this, refer to the section entitled Other Special G/L Transactions in the Financial Accounting Implementation Guide.

If copayment is to be performed in your institution using the receivable procedure, you require four posting keys:

  • A debit posting key for posting the receivable
  • A credit posting key for reversing the receivable
  • A credit posting key for the copayment credit memo
  • A debit posting key for reclaiming the copayment credit memo.

Flag the Sales-Relevant checkbox for all posting keys, and choose the account type Customer.

When maintaining the field status, keep in mind that the system cannot post copayment automatically if you

  • Hide fields that are filled by the transaction
  • Define fields that are not filled by the transaction as required entry fields.

Make sure that the posting keys are used exclusively for copayment.

If copayment is to be performed in your institution using the collection procedure, you require the following posting keys:

  • A debit posting key for the copayment request or copayment (special G/L transaction)
  • A credit posting key for reversing the copayment request or copayment (special G/L transaction)
  • A credit posting key for posting a copayment credit memo to the insurance provider's account
  • A debit posting key for reversing the copayment credit memo.

Flag the Special G/L checkbox for the posting keys for posting and reversing a copayment request or copayment. Choose the account type Customer for all posting keys.

When maintaining the field status, keep in mind that system cannot post copayment automatically if you

  • Hide fields that are filled by the transaction
  • Define fields that are not filled by the transaction as required entry fields.

Make sure that the posting keys are used exclusively for copayment.

If possible, do not change the field status.

For more information about this, refer to the section entitled Define Posting Keys in the Financial Accounting Implementation Guide.

The Global Settings group box contains parameters that are independent of the copayment procedure:

  • Value Date
  • Due Date

These date fields are filled by the IS-H System. You can decide which date is to be used from among the following options:

  • Date relative to the admission date
  • Date relative to the discharge date
  • Date relative to the system date

If you do not maintain a rule, the system uses the date from the transaction.

Flagging the No Asgmt to G/L Acct.Line Item checkbox prevents the Assignment field in the G/L account line item being filled with the case number when the copayment made is posted.

This option can be useful if the copayment is posted via a clearing account that is to be cleared automatically.

If you flag this checkbox, the Assignment field in the G/L account line item of the copayment document is filled in accordance with the FI Customizing settings (e.g. with the document date). As regards the customer line item, the Assignment field must be filled with the case number from the IS-H System in order to retain the reference of the copayment to a case.

In the Bank Post. Key field, you enter the posting key that is to be used for the G/L account line item when posting the copayment made (e.g. 40).

If you want to set a particular dunning area for the copayment document, you specify this in the field with the same name.

In the Tax Code field, you specify a tax code that is to be used for the copayment. Since copayment is usually non-taxable, you can also leave this field blank. If the G/L account requires you to specify a tax code, you can enter a tax code that does not calculate any tax (e.g. A0).

You can predefine the document header text by entering the required text in the Doc. Header Txt field.

You can either predefine the document line item text, or control it using formatting variants. If you want to use a constant text, enter it in Line Item Text field.
The following formatting variants exist:

  • =P1 for patient's name and birthdate
  • =P2 for last name, first name, birthdate and admission date
  • =P3 for '*', last name, first name, birthdate and admission date

You can define your own formatting routines as follows:

  • Z_..., for example Z_POSTING_STRING

Note that the function module must use the following interface:

Import Parameters:

  • EINRI reference structure TN01-EINRI - institution
  • FALNR reference structure NFAL-FALNR - case number
  • PATNR reference structure NPAT-PATNR - patient number

Export Parameter:

  • POSTEXT reference structure BSEG-SGTXT - formatted line item text

In the Document Type field, you specify the document type that is to be used for posting the copayment made. You can change this document type during copayment processing and define it on a user basis via user parameter NBZ.

You should define separate document types for the copayment, credit memo and transfer posting. You need a different document type at least for the copayment and the transfer posting, since otherwise the copayment program cannot differentiate between a copayment reversal and a transfer posting.

In the Bank Account field, specify the G/L account the system is to use when posting the copayment, provided you have not specified an alternative bank account in the application. You can maintain settings on a user basis via user parameter NBK.

In the Max. Diff. field, you can decide the maximum difference allowed between the copayment request and the copayment made before a new request with the difference amount is to be posted. If the difference between the copayment request and the copayment made exceeds the value specified in this field, the system displays a dialog box asking you to confirm whether a new request should be posted.

You make settings for the collection procedure in the Collection Procedure group box.

In the Copayment Made group box, enter the special G/L indicator in the Sp. G/L Indic. field and both posting keys in the Debit Post. Key and Cred. Post. Key fields.

In the Transfer Posting group box, set parameters for the transfer posting of copayment made from the patient's account to the insurance provider's account.

To do this, enter the document type of the transfer posting document in the Document Type field.

In the Stnd.Payt.Mthd. and Payt.Mthd a.FB fields, enter the payment methods that are to be used for the transfer posting.

This can be useful if you want copayments made after final billing to be automatically transferred to the insurance provider using the FI payment program. In this case, you would enter different payment methods in the Stnd.Payt.Mthd. and Payt.Mthd a.FB fields.
You can then start the payment program for copayment documents with Payment method after final billing in order to pay out those copayments that were not output on the invoice to the insurance provider.

Copayment Parameters:

  • Institution 1
  • Standard Payment Method A
  • Payment Method after Final Billing B

Case 1

Invoiced amount 1000.- on 10/31/2005

Copayment 120.- trans. posting made on 10/20/2005

Case 2

Invoiced amount 1200.- on 10/20/2005

Copayment 60.- trans. posting made on 10/31/2005

Assuming that you have set Collection Procedure with Invoice Deduction as the copayment procedure for MEDICARE, for case 1, the copayment is output on the invoice form (amount to pay 880.-) and the payment method is not filled in the copayment document.

For case 2, the copayment cannot be output on the invoice, since it was not made before final billing (amount to pay 1200.-). The copayment document is assigned payment method B, and can be paid out automatically to MEDICARE with the payment program.

For insurance providers that use the Collection Procedure Without Invoice Deduction, the copayment is never output on the invoice form. In this case, the system assigns payment method A to the copayment document, provided a transfer posting was made for the copayment before the case was final billed.

If you want to set a dunning block, specify the dunning block reason already created in financial accounting in the first Dunning Block field.

In the second field, decide under which circumstances the transfer program is to set a dunning block:

  • " " - no dunning block
If you leave this field empty, a dunning block is never set for the transfer posting.
  • 1 - only with deduction from invoice
A dunning block is set if the insurance provider uses the collection procedure with invoice deduction and final billing has not yet taken place for the case.
  • 2 - always set dunning block
The dunning block is always set for the transfer posting.

You can control the text in the transfer document using the Doc. Header Txt and Line Item Text fields. You can use the formatting routines mentioned above for the line item text.

The Immediate Transfer checkbox lets you specify when the transfer posting is to be made. You can decide whether posting is to take place

  • immediately when the copayment made is posted in the IS-H System
  • or later by means of the Transfer Copayment function.

If you want to check the posted copayments before creating the copayment credit memo, you should carry out the copayment transfer posting at a later time.

In the Rev. Reason field, enter the a reason for reversal defined in FI. If you reverse a transfer posting in the copayment transaction, this reversal reason is used for reversing the credit memo intended for the insurance provider.

You make the following settings for the receivable procedure in the Receivable Procedure group box:

  • The Posting Keys for bank posting
  • The G/L Account for bank posting
  • The Debit and Credit Posting Keys for the credit memo
  • The Document Type for the credit memo.

Customizing for Financial Accounting often provides set examples that you can use as templates for copayment.

  1. First determine the copayment procedure that is to be used in your institution.
  2. Then make all necessary settings in Customizing for Financial Accounting.
  3. Test the postings in Financial Accounting manually.
  4. Make further settings in Financial Accounting (e.g. for the dunning program, the payment program, the field status groups, etc.), and test the transactions again.
  5. Now transfer the settings into the IS-H System, and maintain the parameters specific to IS-H.
  6. Make sure that you always consult the FI project team before going ahead with subsequent settings or changes.

To be able to use the print function for the copayment transaction, you need to have maintained the form control tables. The standard table entries are delivered in the standard system, so that you are not usually required to make any additional settings.

The following form print events are triggered within copayment:

  • NE1100 - maintain copayment
  • NE1600 - charge off copayment
  • NE1800 - post back copayment

The following work organizer types are supported:

  • ZUZA - copayment data (maintain copayment)
  • ZUZS - copayment advice note (charge off copayment)
  • ZUZR - copayment advice note (post back copayment)

For more information about this, refer to the section entitled Work Organizer Types in this Implementation Guide.

Since copayment processing is event-driven in Financial Accounting, you are required to make a number of table entries in the configuration tables.

These entries are predefined in client 000.

Check if a configuration is maintained for the following copayment events (function Check Configuration):

  • BEL000 - reverse document
  • BEL001 - display document header
  • BEL002 - read document type
  • BEL003 - change document
  • BEL004 - check if clearing can be reversed
  • BEL005 - check whether reversal can be carried out
  • BEL006 - reverse clearing
  • OP0001 - display open items
  • FI0000 - check periods
  • SKNR01 - display G/L account master record
  • ZUZ001 - change copayment request
  • ZUZ002 - display copayment request
  • ZUZ004 - create copayment
  • ZUZ006 - display copayment
  • ZUZ008 - display reversed copayment
  • ZUZ009 - display reversed copayment request
  • ZUZ010 - transfer copayment
  • ZUZ011 - display transferred copayments
  • ZUZ012 - display transferred and cleared copayments
  • ZUZ013 - display transferred copayments not cleared
  • ZUZ014 - display copayment requests not cleared by reversal
  • ZUZ015 - display ins. prov. copayment credit memo for case
  • ZUZ016 - display dunned copayment requests
  • ZUZ017 - display dunned copayment receivables
  • ZUZ018 - display copayment receivables posted back
  • ZUZ019 - post copayment receivables back

For more information about this, refer to the section entitled Configuration / Systems / Events in this Implementation Guide.






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