Control Name | Type | Default Value / State | Mandatory | Description | |||||
Type | drop-down list | preselected (3 - CPT code) / enabled | Yes | Procedure type. Possible values:
The latest saved Type will be preselected by default in new requests and claims. | |||||
Procedure | text field + [...] selection button | empty / enabled | Yes | Procedure (or activity) from the list of the specified type. Format: code: description. The user can type it manually (e.g. a trade drug code) and press Enter key or they can select it from the list which opens by pressing […] button. | |||||
Rx number | text field | empty / enabled | Yes | Prescription number. Visible for an activity with Type = 5 - Trade Drug code if setting IsRxNumberMandatorySetting = true. | |||||
Fill counter | text field | empty / enabled | Yes | Fill Counter. Visible for an activity with Type = 5 - Trade Drug code if setting IsRxNumberMandatorySetting = true. Possible values: >=0, integer. | |||||
Ordering clinician | text field + [...] selection button | empty / enabled | Yes | The doctor who ordered a procedure or prescribed a drug. Format: clinician license: clinician name (Clinicians list). The user can type it manually (e.g. a clinician license) and press Enter key or they can select it from the list which opens by pressing […] button. The latest saved Ordering clinician will be preselected by default in new requests and claims. Ordering clinician is mandatory if Encounter start >= 1-Jun-2014. Ordering clinician must be empty if Encounter start < 1-Jun-2014. | |||||
Performing clinician | text field + [...] selection button | empty / enabled | Yes | The doctor who performed a procedure or dispensed a drug. Format: clinician license: clinician name (Clinicians list). The user can type it manually (e.g. a part of clinician name) and press Enter key or they can select it from the list which opens by pressing […] button. The latest saved Performing clinician will be preselected by default in new requests and claims. Performing clinician is optional if Encounter start >= 1-Jun-2014. Performing clinician is mandatory if Encounter start < 1-Jun-2014. | |||||
Start date | date picker | checked (today) / enabled | Yes | Activity start date. The latest saved Start Date will be preselected by default in new requests and e-claims. Possible values: between Encounter start and Encounter end. If the user changes the visit period and the activity Start date becomes outside its boundaries, it adjusts to the new value of Encounter start / Encounter end. | |||||
Quantity | text field | empty / enabled | Yes | How many items of selected procedure clinician prescribes. Possible values: 0.0001-999.9999. | |||||
Pre-Auth. No | text field | empty / enabled | No | Authorization number. | Comments | text field | empty / enabled | No | Comments on the activity left by the provider. |
Add PDF attachment | link | enabled | - | On clicking Add PDF attachment a window opens to search for the necessary file. After the file is selected, the link label changes to View PDF attachment. On clicking View PDF attachment link attached file opens for viewing. | |||||
View PDF attachment | link | hidden | - | ||||||
Update observations | link | enabled | - | On clicking Update observations Observations form opens where the user can set observations of LOINC or Text type. For a sent claim (that cannot be edited) the link name is View observations. | |||||
View observations | link | hidden | - | ||||||
Discount | text field | empty / enabled | No | Price discount in percent. Possible values: 0-100%. | |||||
Copay | text field | empty / enabled | No | Patient copay in percent. Possible values: 0-100%. If the user enters/modifies Copay, then Patient share recalculates: Patient share = Gross price x Copay / 100. If the user modifies Patient share, Copay value clears. | |||||
Deductible | text field | empty / enabled | No | The amount the patient has to pay out-of-pocket for expenses before the payer will cover the remaining costs. | |||||
Gross price | text field | empty / enabled | Yes | Gross price for one unit of the procedure. If the user sets Type = 5 - Trade Drug Code and selects any trade drug in Procedure, Gross price fills with Price value for this drug but still can be changed to another value. | |||||
Patient share | text field | empty / enabled | No | Patient share for one unit of the procedure. Patient share = Gross price x Copay / 100. | |||||
Net price | text field | empty / enabled | Yes | Net price for one unit of the procedure. Net price = Gross price - Patient share. If the user modifies Net price, then Gross price adjusts. If the user modifies Gross price or Patient share, then Net price adjusts. | |||||
VAT percent | text field | 0 / enabled | No | The value-added tax for a procedure in percent. Possible values: 0-100%. | |||||
VAT amount | text field | empty / disabled | No | The value-added tax for a procedure (money value). VAT amount = Net price x VAT percent / 100. | |||||
Comments | text field | empty / enabled | No | Comments on the activity left by the provider. It is sent as an observation. | |||||
Patient instructions | text field | empty / enabled | No | Instructions to the patient left by the provider. It is sent as an observation. | |||||
Selected procedures | grid | empty / disabled | - | All procedures for a claim, one procedure per line. The grid contains the following columns:
The grid is not editable. | |||||
Add new procedure (Ctrl + N) | link | enabled | - | On clicking the link (or pressing Ctrl + N), an empty row adds to the Selected procedures grid. | |||||
Remove this procedure (Ctrl + D) | link | enabled | - | On clicking the link (or pressing Ctrl + D), the highlighted row removes from the Selected procedures grid. | |||||
Total gross | text field | empty / disabled | Total gross price for all procedures (activities) in the claim. The field is not editable. | ||||||
Total patient share | text field | empty / disabled | Total patient share for all procedures (activities) in the claim. The field is not editable. | ||||||
Total net | text field | empty / disabled | Total net price for all procedures (activities) in the claim. The field is not editable. | ||||||
Total VAT | text field | empty / disabled | Total VAT for all procedures (activities) in the claim. The field is not editable. |
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