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SIMG_CFMENUNMOHNK35 - Maintain Default Values

SIMG_CFMENUNMOHNK35 - Maintain Default Values

rdisp/max_wprun_time - Maximum work process run time   ABAP Short Reference  
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In this IMG activity, you enter institution-specific default values for the insurance verification process. This time-dependent information indicates that certain insurance providers require claims to be submitted for the reimbursement of a given percentage or cost of a service. Default values result in the automatic creation of items in insurance verification documents that are assigned the status request.

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

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

You can further restrict the default values by means of the contract scheme for the insurance provider (type).

If you want an insurance provider or insurance provider type not to cover certain services, select No Cover. and the services in question will never be included in an insurance verification document for specific insurance providers or insurance provider types (for example, a private room surcharge when the patient has statutory health insurance).

You must have already created:

  • The institution
  • The insurance providers or insurance provider types
  • The services you want to use in the default values

The default values must relate to services in a billing catalog.

You enter a default value by specifying

  • An institution (under a four-character key) in the Inst. field
  • The insurance provider type in the IPT field or the insurance provider in the Ins.prov field or by selecting Self-payer (S).
  • The service catalog in the SC field
  • The service or service group in the Service field
  • The extent of either as
  • A percentage in the Rate field or

  • A maximum price in the Max. Price field

  • The indicator for the type of default value (not selected = normal, selected = not covered) in the No. Cover. field

The easiest way to enter new default values is use the Copy as... function to copy existing rules, and then to modify this copy to satisfy your requirements.

If you wish to use the default value for the reception of the "insurance verification" segment, you must set the §301 indicator.

  • Default values for individual insurance providers take precedence over default values for an insurance provider type.
  • Default values for an individual service take precedence over default values for a service group.
  • You should only transport default values from one system to another after consultation with SAP.





CL_GUI_FRONTEND_SERVICES - Frontend Services   Vendor Master (General Section)  
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Length: 4039 Date: 20240523 Time: 170056     sap01-206 ( 60 ms )