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SIMG_CFMENUNMOHNK30 - Maintain Preapproved Insurance

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In this IMG activity, you enter institution-specific pr-approved insurance for the insurance verification process. This time-dependent information indicates that certain insurance providers reimburse a given percentage or cost of a particular service without a request for insurance verification having to be submitted beforehand.

Pre-approved insurance results in the automatic creation of items in insurance verification documents that are assigned the status confirmed.

Pre-approved insurance takes precedence over default values.

You can specify an insurance provider type

instead of an insurance provider. In this way, the pre-approved insurance applies to all insurance providers of this type. You can also specify pre-approved insurance for self-payers.

The same applies for services. You can specify service groups instead of individual services. In this way, the pre-approved insurance applies for all services in this group, regardless of whether they were actually performed.

You must have already created:

• The institution

• The insurance providers or insurance provider types

• The services you want to use in pre-approved insurance

The pre-approved insurance must relate to services in a billing catalog.

You enter a pre-approved insurance by specifying:

• An institution (under a four-character key) in the Inst. field

• The insurance provider type in the IPT field and the insurance provider in the Ins.Prov. field, or by selecting Self-Payer (S)

• The in-house service catalog in the SC field

• The service or service group in the Service field

• The extent of coverage either as

• A percentage in the Rate field or

• A maximum price in the Max. Price field.

• Pre-approved insurance for individual insurance providers takes precedence over pre-approved insurance for insurance provider types.

• Pre-approved insurance for an individual service takes precedence over pre-approved insurance for a service group.

You should only transport pre-approved insurance from one system to another after consultation with SAP.

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This documentation is copyright by SAP AG.

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