List of functions of the module "Assistance. Medical Assistance" for configurations "1C:Підприємство" on managed forms:
- Accounting for contracts and insurance policies:
- Accounting for insurance programs and options;
- Accounting for insurance packages;
- Accounting for exceptions;
- Accounting for authorized counterparties, franchises, limits;
- Tracking the levels of clinics;
- Control of limits and insurance amounts;
- Automation of import of insurance policies;
- Automation of loading insurance programs, exceptions.
- Insured persons accounting:
- Automatic identification on incoming call;
- Auto-creation and identification when loading policies;
- Analysis of limits, reports on expenses.
- Accounting for insured events:
- Automation of the process of resolving cases;
- Registration of service quality assessment and denials of service.
- Conducting settlements with counterparties:
- Settlements with providers of services and medicines;
- Automatic posting of reports from contractors on the services performed and the supply of medicines;
- Mutual settlements with insurance companies: generating reports, issuing invoices, registering acts. Control of mutual settlements at all stages.
- Accounting for internal tasks: addressing tasks to users, monitoring performance;
- Business process "Insured event", automatic formation of tasks for users to settle insurance claims (as an additional solution);
The configuration is implemented on the basis of the standard configuration "BAS Accounting, revision 2.1".
More about features
1. Document "Insurance contract".
The document is intended to record all contractual conditions of insurance in the "1C:Підприємство" database, namely:
- Contract period, policyholder, insurance company;
- Policy for insured persons;
- Insurance contract exceptions;
Insurance program - groups of services, categories of services, limits on them;
List of counterparties who are allowed to carry out the settlement of insurance cases;
Information materials - physical files: list of insured, insurance program, insurance contract itself;
Series under an insurance contract, example: individuals, law firms.
Fig. 1. The document "Insurance contract". The main form of the document. List of exceptions to the insurance contract.
Fig. 2. Insurance contract. Insurance program: types of services, groups of services, limits on them.
Fig. 3. Insurance contract. Insurance programs (insurance packages), insurance amounts by programs.
2. "Insurance policy" document.
Document contains information on the insured person:
Fig. 4. "Insurance policy" document. Main form.
orders to the supplier;
denials of services.
3. "Coverage Analysis" report.
The report makes it possible to check the volumes of services already ordered for the insured at the moment by various groups and options, as well as to see the rest of the limit.
Fig. 5. "Coverage Analysis" report. Performed from an insurance policy.
Shows all information on the policy: insurance program, limits, allowed hospitals, deductibles, clinic levels.
Fig. 6. "Coverage Analysis" report. Data on coverage of the insurance program by individual and aggregate (total) limits.
4. The document "Assistance business".
The document registers an insured event when the insured person applies.
Fig. 7. Document "Assistance Delo". The main dialog form. Data on the insured event. Monitoring (diary) of an insured event.
The printed form of the Assistance Case Monitoring reflects the entire chronology of events of this insured event.
Fig. 8. Assistance business. Print form "Monitoring".
5. "Supplier order" document.
The document fixes the list of services or goods ordered for the insured person in the assistance case in a medical institution.
Fig. 9. Supplier order document. Pre-ordering services in medical institutions, ordering medicines in pharmacies.
In the document order to the supplier there are printable forms:
Letter of guarantee.
Fig. 10. Supplier order document. Printed form "Letter of guarantee" for medical institutions for ordered services for insured persons.
5. "Statement of expenses" report.
The report analyzes the correspondence of the invoiced amounts in the documents "Order to the supplier" and the reflected amounts in the documents "Fixing the expenses" received from the providers of medical services/goods.
Fig. 11. "Statement of expenses" report.
6. Document "Reported to IC (insurance company)".
In the document Reported to the IC, the list of amounts to be reimbursed by the insurance company is filled in (expenses incurred for assistance cases).
Fig. 12. Document "Reported to the IC". Basic form. The tabular section is filled in with a list of expenses incurred.
A printed form is sent to the insurance company to cover the costs.
7. "Insurance Company Indemnity" Report.
The report shows the accrual of the insurance company for compensation and what is closed by payment.
Fig. 13. Appearance of the report "Indemnity from the insurance company".
8. Business processes.
BP provide an opportunity to move to process management and qualitatively improve the activities of an enterprise by automating business processes. Business processes in the system are designed to combine individual operations (tasks) into chains of related actions, which will lead to the achievement of a specific goal.
Fig. 14. An example of a business process "Outpatient treatment".
User tasks in the system allow you to keep track of tasks by performer and serve as a reflection of the progress of business processes along the route points. At the same time, User Tasks can be created not only by business processes, but also directly by users.
Fig. 15. User tasks on the start page "1C:Підприємство".
The rights to the module are reserved (certificate No. 36092). We provide favorable terms of cooperation for partners.
Configuration cost: from 200000 UAH
Contract No. 1: Subsystem "Assistance. Medical Assistance": UAH 200,000, where 130,000 is the cost of the subsystem "Assistance. Medical Assistance" and 70,000 is the cost of deploying the system, setting access rights. Within the framework of this agreement, we achieve that the functionality of the "Assistance. Medical Assistance" subsystem works.
Contract No. 2: (implementation and maintenance). Within the framework of this agreement - consultations on the use of the module, as well as additional settings. Minimum contract term: 6 months at UAH 36,000 (60 hours per month at UAH 600).
Developer: Company "NCT"