Patient Details tab (claim)

Control Name

Type

Description

Find Patient

text field + [...] selection button

Patient information used to search for a patient.

The user can type it manually (e.g. a part of patient name, Member ID, Patient ID) and press Enter key or they can select it from the list which opens by pressing […] button. Patient details load to Patient Details tab.

Patient ID

text field

The indicator that shows whether this is an insurance claim or not. If checked, Self-Pay drop-down appears.

The type of a patient that pays directly for the services/medication provided. The field becomes visible and mandatory when Self-Pay checkbox is selected.

Possible values:

• Self-Pay;
• Pro Forma Payer;
• Medical Tourism Self-Pay;
• Medical Tourism Other.

Payer ID

text field + [...] selection button

The insurance company that pays the claim.

Format: code: company name.

The user can type it manually (e.g. a code) and press Enter key or they can select it from the list which opens by pressing […] button. 

The field and button become disabled when Self-Pay checkbox is selected.

TPA ID

text field + [...] selection button

The third-party administrator that processes the claim.

Format: code: company name.

The user can type it manually (e.g. a code) and press Enter key or they can select it from the list which opens by pressing […] button.

The field and button become disabled when Self-Pay checkbox is selected.

The filed becomes mandatory when Payer ID = @value.

Member ID

text field

Patient insurance card number for the specified payer.

Becomes disabled when Self-Pay checkbox is selected.

Cover Plan

drop-down

Cover plan for the specified payer.

When the user sets Payer, Cover Plan drop-down fills automatically with custom values for this payer. The user can select a plan from the list or type another one – the new plan will be added to the list.

Becomes disabled when Self-Pay checkbox is selected.

First Name

text field

Patient first name, free text.

Last Name

text field

Patient last name, free text.

Gender

drop-down list

Patient gender.

Possible values:

• Male;
• Female.

Birth Date

date picker

Patient birth date.

Emirates ID

drop-down list

Patient Emirates ID.

Possible values:

• National without a card;
• Expatriate resident without a card;
• Not national, not expatriate resident without a card;
• Unknown status, without a card;
• a value in the format NNN-NNNN-NNNNNNN-N entered manually.

Nationality

text field + [...] selection button

Patient nationality.

Format: nationality: country.

The user can type it manually (e.g. a code) and press Enter key or they can select it from the list which opens by pressing […] button.

Mobile

text field

Patient mobile number.

Work Tel.

text field

Patient work phone number.

Home Tel.

text field

Patient home phone number.

Address

text field

Patient address or addresses, free text.