Description
This report lets you monitor cases with regard to insuranceverification. It is primarily intended for evaluating inpatient cases(selection by admission or discharge date), but can also be used foroutpatient cases (only possible with selection by case number).
The following checks are carried out:

• Have (billable) services already been entered for a case?


• Do insurance verification requests already exist for a case?


• Does an assignment to an insurance verification requests exist for all
billable services ?

• Is confirmation of coverage a prerequisite for interim billing?


• Is confirmation of coverage a prerequisite for final billing?


• Is the service period covered completely (that is, up to the key date)
by insurance verification requests (gap test) ?

• Is service is covered to 100 % (currently only excess coverage check or
insufficient coverage check in percent) ?

• Does the self-payer customer or the insurance provider customer exist ?


• Does an admission diagnosis or a referral diagnosis exist if a
prerequisite to sending the insurance verification request?

• Has the request already been printed, sent or the object of a reminder,
or could a reminder be sent for it ?

Precondition
The report only selects finally billed cases.
On the program selection screen you must decide on a criterionaccording to which cases are to be selected:


• Selection by Admission date


• Selection by Discharge date


• Selection by Case selection

Select the appropriate radio button, and then enter the selectioncriteria.
In the Output Control group box, you can maintain parametersthat control the output of the evaluation:

• If the messages should be filtered using message control, select
Message Control.

• If the list is only to contain cases for which at least one message was
generated, select Hide Cases w/o Message.

• The Output Errors, Output Warnings and Output
Information options let you to stipulate which message types are toappear in the list. Select the types you want to see in the list. Notethat the Filter function is available to you from the list,enabling you to subsequently hide one or more message types.
INCLUDE ISH_EXTRACT_REP OBJECT DOKU ID TX

Output
The reports outputs a list with messages pertaining to the insuranceverification situation.
Each message can be classified into the categories error,warning or information in Customizing for IS-H.
Message output can also be suppressed. For more information about this,see the IMG activity Maintain Messages.

Example
The program generates a number of informational messages including themessage NE027:


• Requests for insurance verification do not exist

If you want to prevent this message from being output, proceed asfollows:

• Maintain an entry for your institution in the message control table
(function NKO1, application area NE, message 027,default type I).

• Select Suppress.


• Run the insurance verification monitoring program with the Message
Control option selected.