Import claims

There is a possibility to import claims to the Greenrain Facility database instead of manual entering. Greenrain Facility validates an input Excel file and inserts claims into the database pending upload (Status = Ready for Submission).

To import claims, follow the below steps.

Step 0. Prepare Excel file with claims for import. The expected format is provided below.

Step 1. Select Claims > Import claims from the menu.
The file explorer opens.

Step 2. Select the necessary Excel file and click Open.
Either Success or Validation Failed dialog appears.

SUCCESS: The parsing is successful.

Step 3a. Click Yes.

Once the claims are imported, the information dialog appears showing the total number of the claims imported into the database along with the total Net of these claims.

Step 4a. Select Claims > Find Claims from the menu.
Find Claims form opens.

Step 5a. Set a search value to find just imported claims and click Search.
The search results grid appears. The imported claims have Status = Ready for Submission.

FAILED: The Excel sheet contains validation errors or has an inappropriate format.

Step 3b. Click Yes.

Validation Report dialog appears showing the description of all errors found.

You need to resolve the errors according to their location and try uploading again.

Template

Use the following template to fill in claims:

The table below describes each column in the expected Excel file.

Worksheet	Column	Mandatory	Description	Possible Values

Worksheet	Column	Mandatory	Description	Possible Values
Claims	Sender ID	No	The license number of a healthcare entity that is the sender of the transaction. The column is ignored until multiple facilities support in Greenrain Facility.	https://www.haad.ae/shafafiya > Dictionary > Licenses > Facilities
	Receiver ID	Yes	The license number of a healthcare entity that is the receiver of the transaction.	https://www.haad.ae/shafafiya > Dictionary > Licenses > Insurers
	Claim ID	Yes	A unique number assigned by a healthcare provider to identify the claim. This is also known as the provider’s claim reference number. If the patient is not insured and pays out of pocket, this is the external invoice reference number. Greenrain Facility uses Claim ID value from the Excel file instead of generating it automatically specified in Settings.
	Member ID	Yes	The patient’s insurance member number, if the patient is claiming insurance. Otherwise, it equals to Facility ID#Patient ID.
	Payer ID	Yes	If the patient is claiming insurance cover, this is the Insurer's license number.	https://www.haad.ae/shafafiya > Dictionary > Licenses > Insurers Other values: If the patient is claiming insurance from an Insurer not included in the list of valid licenses - '@' followed by the name of the Insurer; If the patient is a resident of the Emirate of Abu Dhabi and is paying directly for services provided - SelfPay; If the patient is a resident of the Emirate of Abu Dhabi and neither claims insurance nor pays directly for services provided - ProFormaPayer; If the patient is not a resident of the Emirate of Abu Dhabi and is paying directly for services provided -MedicalTourismSelfPay; If the patient is not a resident of the Emirate of Abu Dhabi and neither claims insurance nor pays directly for services provided - MedicalTourismOther.
	Provider ID	No	The facility license number of the healthcare provider claiming from the payer. Greenrain Facility uses the Healthcare Provider License linked to the license key. The column is ignored until multiple facilities support in Greenrain Facility.	https://www.haad.ae/shafafiya > Dictionary > Licenses > Facilities
	Emirates ID Number	Yes	The unique number the government assigns to a citizen.	NNN-NNNN-NNNNNNN-N When Emirates ID is not available: 000-0000-0000000-0 - National without card; 111-1111-1111111-1 - Expatriate resident without a card; 222-2222-2222222-2 - Non-national, non-expat resident without a card; 999-9999-9999999-9 - Unknown status, without a card.
	Encounter Type	Yes	The type of encounter (inpatients, daycases, emergencies and outpatients). They vary according to whether the encounter went past midnight, lasted for more than 24 hours, involved a hospital bed and whether they involved an emergency room.	1 = No bed + No emergency room 2 = No bed + Emergency room 3 = Inpatient bed + No emergency room 4 = Inpatient bed + Emergency room 5 = Daycase bed + No emergency room 6 = Daycase bed + Emergency room 7 = Nationals screening 8 = New visa screening 9 = Renewal visa screening 12 = Home 13 = Assisted living facility 15 = Mobile unit 41 = Ambulance - land 42 = Ambulance - air or water
	Patient ID	Yes	The unique number a healthcare provider assigns to a patient. This is often known as the medical record number.
	Encounter Start	Yes	The date and time at which the patient comes under the care of a responsible clinician. For Elective patients, this will typically be the date and time of the visit registration/admission on arrival of the patient at the healthcare facility. For Emergency patients, this will typically be the date and time of the registration and admission on arrival of the patient at the healthcare facility. For Transfer patients between facilities (i.e. inter-hospital transfers), this will typically be the date and time of the visit registration and admission on arrival of the patient at the receiving healthcare facility. For Livebirth this will typically be the date and time of the registration and admission of the newborn at the healthcare facility. The Encounter start will also be the date and time of birth. For Stillbirth this will typically be the date and time of the registration of the stillborn at the healthcare facility. The Encounter start will also be the date and time of stillbirth. For Death on arrival, this will typically be the date and time of the visit registration on arrival of the patient at the healthcare facility for pronouncement.	dd/mm/yyyy hh:mm
	Encounter End	No	The time the patient ceases to be under the direct care of a responsible clinician. For inpatients and day patients this would be the discharge date and time. For emergency patients this would be the time that the patient was released from the ER.	dd/mm/yyyy hh:mm
	Encounter Start Type	No	The type which defines how the encounter started.	1 = Elective 2 = Emergency 3 = Transfer admission from acute care 4 = Live birth 5 = Still birth 6 = Dead on arrival 7 = Continuing encounter 8 = Transfer admission from non-acute care
	Encounter End Type	No	The type which defines how the patient was discharged.	1 = Discharged with approval 2 = Discharged against advice 3 = Discharged absent without leave 4 = Discharge transfer to acute care 5 = Deceased 6 = Not discharged 7 = Discharge transfer to non-acute care.
	Transfer Source	No	The license number of a healthcare facility from where a hospital transfer originated (Encounter Start Type = 3 Transfer). If the facility is not in the list of licensed providers, it equals to '@' followed by the name of the facility.
	Transfer Destination	No	The license number of a healthcare facility to which a hospital transfer is made at the end of an encounter (Encounter End Type = 4 Transfer). If the facility is not in the list of licensed providers, it equals to '@' followed by the name of the facility.
	Package Name	No	The name of the insurance package.	https://www.haad.ae/shafafiya > Dictionary > Codes > Benefit Packages
Diagnoses	Claim ID	Yes	Reference to Claim ID on Claims worksheet
	Diagnosis Type	Yes	The type of diagnosis being recorded. Principal Identifies the principal diagnosis for the condition established after examination, the nature of a disease or illness. Secondary All conditions that co-exist at the time of admission, or develop subsequently, which affect the treatment received and/or the length of stay. Admitting The diagnosis that the physician identifies at the time of admission. Reason For Visit	Principal Secondary Admitting ReasonForVisit
	Diagnosis Code	Yes	The value for the diagnosis code as per the coding manual.	ICD10-CM
	Dx Info Type	No	The type of additional information for the diagnosis.	POA Year of Onset
	Dx Info Code	No	The code value related to the DxInfoType.	Y, N, U, W or 1
Activities	Claim ID	Yes	Reference to Claim ID on Claims worksheet
	Activity Start	Yes	The date and time at which an activity started. For a DRG code, it is the date and time of discharge. If the date, but not the time is recorded, the time is assumed to be 00:00.	dd/mm/yyyy hh:mm
	Activity Type	Yes	The type of activity/procedure.	3 = CPT 4 = HCPCS 5 = Trade Drug 6 = Dental 8 = Service Code 9 = DRG
	Activity Code	Yes	An activity code, specified by its type for the activity performed.
	Quantity	Yes	The number of units for an activity.	NNN.DDDD
	Net	Yes	The net charges billed by the provider to the payer for an activity.
	Patient Share	No	Any fee that payer is expecting the provider to collect from the patient.
	Ordering Clinician	Yes	The license number of the clinician who ordered the service or referred the patient for the service.	https://www.haad.ae/shafafiya > Dictionary > Licenses > Clinicians
	Clinician	Yes	The license number of the clinician responsible for the activity. In general, this is the person providing the treatment or care for the patient.	https://www.haad.ae/shafafiya > Dictionary > Licenses > Clinicians
	Prior Authorization ID	No	The corresponding prior authorization number.
	VAT	No	The Value Added Tax amount appropriated for the activity. If the value in the Excel file is empty, it is set to 0.	number, two decimals
	VAT Percent	No	The Value Added Tax rate. If the value in the Excel file is empty, it is set to 0.	[0...100], one decimal

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