Claim Dispatch

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Claim Dispatch / Visit End Process Overview: Finalizing Patient Claims and Encounters

1. Introduction: Understanding Claim Dispatch / Visit End

This comprehensive guide provides a high-level overview of how our system manages the crucial final steps of a patient's visit and the associated billing. This process is the formal conclusion of a healthcare encounter.

The Claim Dispatch / Visit End is a series of interconnected steps designed to ensure that all services are accounted for, the patient's record is properly closed, and the claim is ready for submission to the Social Health Authority (SHA). It's about moving from an active, open visit to a finalised, dispatched claim.

1.1. Why This Full Process Matters

A robust and accurate Claim Dispatch / Visit End process is fundamental to efficient, fair, and compliant healthcare delivery. It is crucial because it:

• Ensures Financial Accuracy: Verifies that a claim is complete and accurate before it is dispatched, which reduces the risk of payment delays or denials.
• Maintains Record Integrity: Guarantees that a patient's visit record is officially and correctly closed, preventing future administrative confusion and ensuring accurate health records.
• Adheres to Regulatory Compliance: Follows all necessary procedures, such as getting patient confirmation via OTP for outpatient visits or setting next-of-kin contacts in specific inpatient scenarios.
• Streamlines Operations: Automates the finalisation of claims, reducing the administrative burden on providers and enabling more efficient payment processing.

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2. The Full Claim Dispatch / Visit End Journey: Step-by-Step Encounter Closure

The complete Claim Dispatch / Visit End is a multi-step journey, with each workflow building upon the results of the previous one. It consists of a series of workflows, each focused on a different aspect of the claim's finality. The two key workflows diverge based on the type of patient encounter.

Here are the key workflows:

2.1. Step 1: Outpatient claim dispatch

This workflow is all about verifying the patient's consent via a One-Time Password (OTP) before submitting the claim and formally ending the visit.

This specific step is vital for ensuring that the patient acknowledges and consents to the end of their visit, which is an important validation for the claim's integrity and compliance.

2.2. Step 2: Inpatient claim dispatch

This workflow handles the process of an inpatient's discharge. It includes a conditional step to set next-of-kin contacts if the patient's discharge reason is "DECEASED".

This specific step is vital for ensuring that all necessary post-visit actions for an inpatient are completed, which includes data collection and, in sensitive cases, proper handling of next-of-kin information.

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3. Key Success Factors for Overall Claim Dispatch / Visit End Integration

For your integration with the entire Claim Dispatch / Visit End process to be successful and efficient, keep these points in mind:

• Provide Correct consent_token: The consent_token is the key that unlocks all actions in this process. Ensuring its validity and correctness is paramount.

• Accurate Patient Contact Data: For outpatient claims, the process critically depends on having valid beneficiary contacts to send the OTP. Without this, the visit cannot be finalised.

• Precise discharge_reason: For inpatient claims, the discharge_reason field is not just a label; it is a critical trigger for conditional logic. Correctly populating this field ensures that the appropriate subsequent steps (e.g., next-of-kin contacts) are completed.

By understanding and adhering to these key points, you can ensure a smooth, accurate, and effective integration with the Claim Dispatch / Visit End process.