SAP Program RNNKOS15 - IS-H: Extend Insurance Verification Requests

Description
The Extend IV Request function enables you to create extensionrequests for insurance verification.
Such extension requests always relate to an insurance verificationrequest already saved in the system. They are flagged as anextension request, and reference the existing request.
In the insurance verification transaction, the Ext. Req.indicator is located in the header data of the IV document.
When the IV extension requests are printed, this indicator can be usedto select a different text or a new layout (see below).
Extension requests usually contain all items of the reference IV requestthat have not been canceled or rejected.
In the Processing Mode group box on the selection screen, you canspecify which IV requests you want to extend:

  • Confirmed Items Only

    • If you set this indicator, the program only takes into account IV itemswith the status Confirmed when creating the extension request.All other items are ignored.
    • Extended Svce Only

      • This indicator enables you to prevent extended service items from beingextended. If the IV item in question relates to a service group, theExtended Svce indicator in the service master is evaluated as forindividual services. This means that the group is not expanded to carryout the check (important for service groups that contain immediateservices and extended services).
      • Include Rej.

        • This indicator enables you to specify whether the extension programshould also generate an IV extension if a rejected request exists forthe period following the limited IV request. Set this indicator is youwant to prevent the system from extending an IV request, although arejected IV request exists for the subsequent period. Note that thesystem only checks the header status of the rejected IV requests.
        • Following Services Only

          • This option enables you to explicitly specify the items the extensionprogram is to take into account when creating the IV extension request.If you do not want to restrict the items, leave these fields blank.
          The items start on the day after the corresponding item of the referenceIV request, and end in accordance with the settings in the insuranceprovider master (IVR Extension field).

          Precondition
          The Extend IV Request function checks whether there are limitedIV requests for one or more cases. In executing this function, thesystem only takes into account the validity period from the header data.The validity specification in the IV header always covers the completeperiod of all individual items.
          If the system detects a gap in coverage (see below) with regard to thekey date, it proposes to extend this IV request. The key dateshould normally be the current date. A future date can also be set todetect limited coverage in good time. You should never enter 12/31/9999as the key date, since all IV requests are limited with regard to thisdate.
          The system checks whether the patient has changed insurance provider, inother words, whether the insurance relationship is still valid for theextension period.
          For the proposal list, it is irrelevant whether services have alreadybeen assigned to an insurance verification item (exceptions to this ruleare listed under Special Features for Country Version Germany).
          Special Features for Country Version Germany
          For leading cases of a readmission sequence, the report takes intoaccount the perod of the entire readmission case.A
          Example:
          Case 1: Admission 01/15//04
          Discharge 01/20/04
          Coverage from 01/15/04 through 01/21/04.
          Case 2: Admission 01/22/04 Discharge 02/05/04
          Case 1 and case 2 comprise a readmission sequence. Case 1 is the leadingcase.
          You run the report for case 1. It takes into account the period of theentire readmission case. Thus in this example, the report proposes toextend the IV request, although coverage for case 1 already exceeds theperiod of the individual case.
          For all cases of a readmission sequence except for the leading case, thesystem only takes into IV requests with assigned services for extension.This prevents the system from unnecessarily extending IV requests towhich services are no longer assigned, since the merging of cases hascaused the services to be reassigned to a different case.

          Output
          The program can be executed in three modes:

          • Interactive mode

            • This is the default mode. Note that all cases of the IV requests to beextended are locked against processing by other users until theExtend IV Request was executed for the case, or the list isexited.
            • Without Dialog

              • You enable this mode by setting the Extend Immediately indicatoron the selection screen.
              • Proposal List

                • You enable this mode by setting the Output List Only indicator.
                In interactive mode, the system outputs a list of limited insurancecoverage. You can process this list using the following functions:
                • Extend IV Request

                  • This function extends the selected IV requests. The data is saved.
                  • Simulate

                    • This function enables you simulate extensions. A dialog box containingthe data of the extension request appears. Data is not modified.
                    • Display Document

                      • This function displays the IV request to be extended.
                      When you execute the program without dialog, the system immediatelyextends the IV requests found.
                      The proposal list is particularly suited for checking IV requests. TheExtend function is disabled in this mode. The cases found are notlocked against processing by other users.
                      You can call the list online, or choose to print it in the background.

                      Note
                      When printing forms, the field RNF12-VRLNG tells you whether you aredealing with an IV extension request.
                      The current diagnoses of the case are located in the structure RNF17.
                      The structure RNF38 contains the header data of the reference IVrequest.

                      Gaps in Coverage
                      When searching for imited IV requests, the program proceeds as follows:

                      • It sorts all of the IV requests for the case according to insurance
                        • provider, and start and end date.
                        • It processes all IV requests for each insurance provider. Gaps at the
                          • start of requests or between requests are reported as messages. If themost recent request to the insurance provider does not fully cover theperiod being checked, this request is included in the list of IVrequests to be extended.

                          Example
                          Check period |-------------------------------------|
                          IV requests |-(a)-|-(b)-| |---(c)---|
                          Gaps in cover.|-1-| |-2-| |---3---|
                          The check period starts with the admission date and ends with thedischarge date, or with the key date you specify on the selectionscreen.
                          The insurance verification requests (a), (b), and (c), result in threegaps in coverage (1, 2, and 3) within the check period.
                          Gap 1 occurs at the start of the check period. The system reacts to itbe issuing a message. An extension is not proposed since the limitationdoes not relate to the period following the end date of the IV request.
                          Gap 2 occurs between the two requests (b) and (C). Once again, thesystem issues a message. An extension to IV request (b) is not proposed,since a request relating to the following period has been made to thesame insurance provider. If IV request (b) were extended, excesscoverage could result.
                          Gap 3 occurs after the last UV request (c) before the end of the checkperiod. This is why IV request (c) is included in the list of IVrequests to be extended.