H-SPIS v4 User Manual
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Transcript of H-SPIS v4 User Manual
H-SPIS v4.0
Page 1
H-SPIS v4.0 MIS Platform for SHP (Informal Sector)
User Manual
Draft Version
June 2014
H-SPIS v4.0
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Table of Contents
1 Overview ......................................................................................................................................... 5
1.1 Acronyms and Abbreviations .................................................................................................. 5
1.2 Key definitions ........................................................................................................................ 7
2 Accessing the system ...................................................................................................................... 8
2.1 Login ........................................................................................................................................ 8
2.2 User Right for IT Admin ........................................................................................................... 9
2.3 Screen Layout .......................................................................................................................... 9
3 Members ....................................................................................................................................... 10
3.1 Households ........................................................................................................................... 10
3.1.2 Household’s members (Beneficiaries) .......................................................................... 15
3.1.3 Household Contracts/Policies ....................................................................................... 17
3.1.4 Premium Collection ....................................................................................................... 18
3.1.5 Membership Coverage Period ...................................................................................... 21
3.1.6 Medical History ............................................................................................................. 22
3.1.7 Other Benefit ................................................................................................................ 23
3.2 Contracts/Policies ................................................................................................................. 25
3.3 Beneficiaries .......................................................................................................................... 26
3.4 Group Enrollment ................................................................................................................. 27
3.4.1 New Employer ............................................................................................................... 27
3.4.2 Group/Employer Contracts ........................................................................................... 28
4 Utilization/Claims .......................................................................................................................... 28
4.1 Cash-less Claims .................................................................................................................... 29
4.2 Cash-based Claims ................................................................................................................ 33
5 Providers ....................................................................................................................................... 35
5.1 Health Facilities ..................................................................................................................... 35
5.2 HF Services ............................................................................................................................ 36
5.3 Health Facility Transportation .............................................................................................. 38
5.3.1 Health Facility Transportations List ............................................................................... 38
5.3.2 New Health Facility Transportations ............................................................................. 38
5.4 Pharmacies ............................................................................................................................ 38
5.5 Health Facility Contracts ....................................................................................................... 40
5.6 Contracts with Pharmacies ................................................................................................... 40
6 Operators ...................................................................................................................................... 41
H-SPIS v4.0
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6.1 Operators .............................................................................................................................. 42
6.2 System Users ......................................................................................................................... 42
6.3 User Profiles .......................................................................................................................... 44
6.4 Product Types ....................................................................................................................... 47
6.5 Products ................................................................................................................................ 47
6.5.1 Update Premium Info.................................................................................................... 48
6.5.2 Update Contract Info .................................................................................................... 48
6.5.3 Other benefic Info ......................................................................................................... 49
6.6 Other Benefits ....................................................................................................................... 49
6.7 Lumpsum (Case-based) ......................................................................................................... 49
6.8 Claims .................................................................................................................................... 50
6.9 Coupons ................................................................................................................................ 50
7 Tools .............................................................................................................................................. 51
7.1 General Tools ........................................................................................................................ 51
7.1.1 Non Beneficiaries .......................................................................................................... 51
7.1.2 Utilization Validations ................................................................................................... 52
7.1.3 Close Entry .................................................................................................................... 53
7.1.4 Non Payments ............................................................................................................... 55
7.1.5 Households Rollback ..................................................................................................... 55
7.1.6 Household Balance........................................................................................................ 55
7.1.7 Balance Transfer ........................................................................................................... 55
7.2 Complaints ............................................................................................................................ 55
7.3 Surveys .................................................................................................................................. 55
7.4 Integrated Documents Management ................................................................................... 57
7.5 SMS ....................................................................................................................................... 58
8 Reporting....................................................................................................................................... 58
8.1 Operator Reports .................................................................................................................. 59
8.1.1 Active Household .......................................................................................................... 59
8.1.2 Premium Collection Report ........................................................................................... 60
8.1.3 Meeting Report ............................................................................................................. 61
8.1.4 Premium Consolidated Receipt..................................................................................... 62
8.1.5 New Enrollment Summary Report ................................................................................ 62
8.1.6 Household Waiting Report ............................................................................................ 63
8.1.7 Outreach Report ........................................................................................................... 64
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8.1.8 Over Utilization Report ................................................................................................. 64
8.1.9 Utilization Report .......................................................................................................... 65
8.2 MoH Reports ......................................................................................................................... 67
8.3 Query Tools ........................................................................................................................... 67
9 Settings .......................................................................................................................................... 68
9.1 Exchange Rate ....................................................................................................................... 68
9.2 Reference data ...................................................................................................................... 70
9.2.1 General data .................................................................................................................. 70
H-SPIS v4.0
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1 Overview
This user manual focus on how to use H-SPIS v4.0 to manage information on operator
configurations (products, premiums, benefit packages etc.), memberships (enrolment,
renewal, dropout and join-back), premium collections and promotions, system users and
user profiles, tools (daily administration tools, complains surveys, integrated documents
management and SMS), utilizations (medical and non-medical, cash-less and cash-based
claims) at Health facilities, reporting (operators, MoH and custom reports) etc.
1.1 Acronyms and Abbreviations
AF Access Facilitator
AFD Agence Française de Développement
AFH Action for Health
AHC Angkor Hospital for Children
ALOS Average Length of Stay
BfH Buddhism for Health
CAAFW Cambodia Organization for Assistance to Families and Widows
CBHI Community-Based Health Insurance
CHC Cambodian Health Committee
CHO Cambodian Health Organization
CPA Complementary Package of Activities
DBO Database Officer
DEO Data Entry Officer
DPHI Department of Planning and Health Information System
DoB Date of Birth
DRG Diagnosis-Related Group
DVL Delivery
FHD Family Health Development
GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit
GRET Groupe de Recherches et d'Echanges Technologiques
HC Health Centre
HCMC Health Centre Management Committee
HEF Health Equity Fund
HF Health Facility
HIP Health Insurance Project
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HNI Health Net International
H-SPIS Health Social Protection Insurance System
HSSP2 Second Health Sector Support Project
KSFH Khmer-Soviet Friendship Hospital
MIS Management Information System
MoH Ministry of Health
MPA Minimum Package of Activities
SKY Sokaphheap Krousar Yeung
IA Insurance Agent
IPD Inpatient Department
MIA Micro Insurance Academy
MIS Management Information System
NGO Non-Governmental Organization
NSSF National Social Security Fund
OD Operational District
OPD Outpatient Department
PC Personal Computer
PCHSFA Pursat Community Health Support Fund Association
PH Provincial Hospital
PM Project Manager
PMRS Patient Management and Registration System
RACHA Reproductive and Child Health Alliance
RH Referral Hospital
SHP Social Health Protection
SHPA Social Health Protection Association
SOP Standard Operating Procedure
SRS Software Requirement Specification
STSA Angkor Chum OD cooperative Health Insurance
UI User Interface
URC University Research of Cambodia
USAID United States Agency for International Development
VIP Village Insurance Promoter
VIV Village Insurance Volunteer
H-SPIS v4.0
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VM Voluntary Membership
1.2 Key definitions
Table 1: A listing of terms and acronyms used throughout this document.
Term Definition
Benefit Package Services that a VM scheme offers to members.
Capitation A payment mechanism where a fixed rate (per month), whether per
person, family, household or group, is negotiated with a health care
provider who shall be responsible for delivering or arranging for the
delivery of health services required by the covered person under the
conditions of a health care provider contract.
Case Base Payment Lump sum payment made by Operator to a contracted health facility for a
patient treated by the provider.
Cycle A cycle is a minimum period (months) of coverage.
Complementary
Package of Activities
(CPA)
Refers to the activities undertaken at the referral hospital level. Three
levels of CPA packages exist: CPA1, CPA2 and CPA3.
Death certificate Provided by the village chief to the member in order to receive the death
benefit.
Discharge Letter Official document produced by medical staff at hospital to allow the patient
to go back home. Some schemes use it as an evidence for IPD case.
Enrolment The process determined by the VM scheme to enlist households as
members covered by the VM scheme.
Enrolment Period The period during which a scheme accept member enrolments (new,
renewal and join-back). Normally during November and December.
Fee for Service A health care payment system in which health care providers receive a
payment for each unit of service.
Grace Period When a household is not able to pay the premium but still want to continue
the membership, there is a grace period during which the household can
catch up with payments, and is allowed to receive healthcare.
Group Enrolment
HF Receipts Given by health facilities when a member is paid directly. It is used as
evidence for exceptional benefits reimbursement.
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Household A group of persons usually living together under the same roof and
composed of the head and other persons related to the head by blood,
marriage and adoption and depend financially on the head.
Member Any person on whose behalf premium contributions have been regularly
paid to the VM scheme.
Minimum Package of
Activities (MPA)
Refers to activities undertaken at the health centre level.
Operational District
(OD)
Refers to the peripheral sub-unit within the health system closest to the
population. It is composed of health centres and a referral hospital.
Prescription Document issued by a medical staff. Some schemes use it as evidence for
payment of drugs or exceptional benefit.
Referral Slip Document provided by a lower health facility to refer the member to an
upper one.
Waiting period A period during which premiums are paid but without entitlement to
benefits normally referred to (1) pregnancy-related benefits (e.g.
Deliveries) and (2) elective surgeries.
2 Accessing the system
2.1 Login This application is password protected so that any unauthorized persons cannot access the
application and change your data.
So every time you want to use the platform, you have to enter your correct username and
password.
Figure 1. Login Screen
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The first screen of the H-SPIS v4.0 is login screen. This screen requires user to input User
Name and Password fields then press Log In button to verify. If the user exists in the
system, it will go to main screen. Otherwise it will alert Access Denied message.
2.2 User Right for IT Admin
IT Admin can access according to the assigned privilege of “IT Admin” in User Profiles.
Screen Members Claims Providers Operators Tools Reporting Setting
Assigned Privilege
Full Full Full Full Full Full Full
2.3 Screen Layout
After User login successfully Main screen appear as bellow.
Main Screen Left Menu
Top Menu
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3 Members Under Members menu, there are four menu items: Households, Contracts, Beneficiaries
and Groups.
3.1 Households Household List views all Households (active and inactive) at first time or by filtering in
search panel. And Beneficiary List will view the beneficiaries of selected Household (active
and inactive). Search panel allows user to search Household and beneficiary by its Code,
name, Household Coverage starting date, Beneficiary’s code, Beneficiary’s name,
coverage start date, Health Facility then click on Search button to filter data.
Figure 2. List of Households
Household List
Field Description
Household Code Auto generate code by (Operational District code + Health Facility code + Increment number)
Name Full name in Latin
Name (KH) Full name in Khmer
Size of Household Number of active beneficiary
Registered date Date of Household Enrollment
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3.1.1.1 New Household
On Household and Beneficiary List view, when user clicks on New Household button, the
creation screen will appear. User must input the required field (yellow box).
Figure 3 : New Household
Field Name Description Required
Household Code Auto generate code by (Household code + Increment of letter (starting from A to Z))
Yes
Operator Defined Operator Yes
OD Defined Operational District Yes
HF List the defined HF or All HF that is defined in Agent Configuration
Yes
Last name Last name in Latin Yes
First name First name in Latin Yes
Last name (KH) Last name in Khmer Yes
First name (KH) First name in Khmer Yes
Marital status Marital status of Policyholder No
Year of birth Year of birth of Policyholder No
Gender Gender of Policyholder No
ID card no ID card number of Policyholder No
Occupation Occupation No
Size of Household Number of active beneficiary. It will increase or decrease when beneficiary was created, activated or
Yes
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deactivated.
Registered date Date of Enrollment Yes
Sector population List of sector population Yes
Poverty level List of poverty level Yes
Member facilitator
List of Agent of current OD No
Employer List of Contracted Employer No
HEF Is Equity Fund No
Staff Household Is Household of staff No
Coverage staring date
Date of start using product. It will be set automatically when Registered Date was changed. And It will be updated automatically when Household was activated by Renew or Rollback tools
Yes
Coverage ending date
Date of stop using product. It will be updated automatically when Household was deactivated by Non-payment and Household balance tools
No
Status Active or Inactive Household Yes
Province Which province the Household is in? Yes
District Which district the Household is in? Yes
Commune Which commune the Household is in? Yes
Village Which village the Household is in? Yes
Group no Which group number that Household is in? No
Address Extra address information No
Telephone Telephone No
3.1.1.2 Household Detail
On Household and Beneficiary List view, select a Household then click on Detail tab. It will
display the information of as below.
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Figure 4 : Household Detail
3.1.1.3 New Beneficiary
On Household List, Select a Household then click on New Beneficiary button. The
creation screen will appear. User must input the required field (bold label).
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Figure 5. New Household
Field Name Description Required
Code Auto generate code by (Household code + Increment of letter (starting from “A” to “Z”))
Yes
Last name Last name in Latin Yes
First name First name in Latin Yes
Last name (KH) Last name in Khmer Yes
First name (KH) First name in Khmer Yes
Marital status Marital status of beneficiary No
Year of birth Year of birth of beneficiary Yes
Gender Gender of beneficiary Yes
Kinship Relational Household. In one Household must have only one “Head of household”
Yes
ID card no ID card number of Policyholder No
Occupation Occupation No
State Beneficiary It can be “Individual IN”, “New baby born”, “Dead” and “Individual Out”.
- It can be blank when new beneficiary is created immediately after Household is created.
- It must be “Individual In” or “New baby born” (based on rule) when new beneficiary is created while Household is using product.
- It must be “Individual In” when beneficiary is
Yes
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activated.
- It must be “Dead” or “Individual Out” (based on rule) when beneficiary is deactivate
Coverage starting date Date of start using product. It will be updated automatically when Renewing Household and Renewing Beneficiary by setting state beneficiary as “Individual IN”
Yes
Coverage ending date Date of stop using product. No
Status Active or Inactive Beneficiary Yes
Remarks Remarks
3.1.2 Household’s members (Beneficiaries)
On Beneficiary List, select a beneficiary then click on Beneficiary detail tab. It will display
the information as follows:
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Figure 6. Household Detail
Beneficiary List
Field Description
Beneficiary Code Auto generate code by (Household code + Increment of letter (starting from “A” to “Z”))
Full Name Last name and first name in Latin
Full Name (KH) Last name and first name in KHMER
Gender Gender
Age Age of beneficiary
Kinship Relational Household
Action Description
Save Allow user to edit beneficiary info
Upload Image Allow user to upload image to server. When user click on Upload Image, the following dialog appear. Then user can select an image to upload. After selection, the below progressing appear
Tips:
- Name of beneficiary : Left top blue text
- Creation and modification info : Right top text
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3.1.3 Household Contracts/Policies
To manage membership contracts/policies with a household, go to Members >
Households > Households, select the household from the list; then click on Contracts tab.
Figure 7. List of Contracts
Field Name Description
Code Household contract code, It generate automatically by (Product Code + Household Code + Month Year of Start Coverage Date)
Product name Contracted product name
Price Monthly Premium
Start date Date of start using product
End date Date of end using product
Active Status of the record, checked if active.
Action
New Allow user to create new Household contract
Delete Allow user to delete the selected Household contract
Refresh Get current data
Field Name Description Required
Code Auto generated code by (Product Code + Household Code + Month + Year)
Yes
Registered Date Date of Household Enrollment Yes
Size of Household Assign automatically the value that match the real size of Household
Poverty level Inherit from Household
Applied sector price List of sector price
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Type of product List of type product of current Operator
Product name These products are filtered by Size of Household, Poverty level, Applied sector price and Type of product
Yes
Price Monthly premium of selected product Yes
Coupon As month, to encourage the beneficiary that using the selected product. Or It is for the promotion period.
No
Start date Date of start using product Yes
End date Date of end using product No
Active It will be Active when creating new contract, renewing Household or Household rollback. It will be Inactive when Household is dropped-out by Non-Payment or Household Balance tools
Yes
On Household Contract screen, select a contract then click on Detail tab. It will display the
information of beneficiary contract as below screen.
Figure 8. Contract Form
3.1.4 Premium Collection
To manage premium collections, go to Members > Households > Households.
You can record all premium collections from members to insure the contracted product by
month. You can input the several payments for a month.
On Household List, select a Household then click on Premium payment tab. Then it will
display all payments of selected product as below screen.
H-SPIS v4.0
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Figure 9. Premium Collection Form
There are 3 parts: Household contract, Contract Info and Payment List.
Household Contract:
List all active and inactive contracted products. By default, it selects the last contracted
product. When user selects a contracted product, the data in Contract Info and Payment
List will be changed.
Contract Info:
Label Name Label Description
Due date Current coverage period
Due premium Required payment for the Household including coverage for next month missing reserve if needed
Monthly premium Amount of the money to be paid monthly by the Household to be covered for the next month
Reserve balance Amount of money currently available in the reserve
Advanced balance Amount of money currently available in the advanced
Bonus Sum of Advanced Bonus’s amount and Regular Bonus’s amount
Coverage until Period of last coverage date. It bases on Reserve balance, Advanced balance and Bonus
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Payment List:
There are two types of data (lock and unlock). User can’t modify the locked data.
Field Description
Locked Display lock or unlocked payment. The data will be locked after running Close Entry
Due date Date when user paid money during month
Receipt no Receipt number of payment
Total amount Total paid amount that include Discount amount, Coupon amount and Cash paid
Paid date Date of payment
Cash paid Cash amount that beneficiary paid
Discount Discount
Coupon Coupon as month that contract got
Collected by Agent of Operator who collect the money
On Payment List view, select on new button. Then the creation screen will appear.
Figure 10. New Payment
Field Name Description Required
Coverage date Current coverage period Yes
Receipt no Receipt number of payment Yes
Total amount Total paid amount that include Discount amount, Coupon amount and Cash paid
Yes
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Discount Discount as percentage that get from the rule of advanced payment in product configuration. Example, Product configuration defined that if the advanced balance amount greater than 9 months, It will discount 10%
No
Coupon Coupon as month. For the first payment of the selected contract. It inherits from the coupon of contracted product.
No
Cash paid Cash amount that beneficiary paid No
Grand total amount The calculation between Total amount, Coupon amount and Discount amount
No
Paid date Date of payment Yes
Member Facilitator Agent of Operator who collect the money No
3.1.5 Membership Coverage Period
Coverage Info allows user to view the history of coverage premium. It displays by each
Household contract when user select it.
Figure 11. Membership Coverage Period
Field Description
Due date Coverage period of premium
Month of cycle This number will increase one after premium was created. It will set to 1 when cycle is completed. (bases on term of contract)
Monthly premium Contracted product’s price for a month.
Due premium Due premium
Regular pay This number will increase one for regular payment. It will set to one when it equals to Number of Regular Payment that configure in Product
Status Status of premium.
- OK : When premium was paid or used enough advanced balance
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- ReserveCut1: When premium used enough reserve balance at first time.
- ReserveCut2: When premium used enough reserve balance at second time.
- Drop Out: When
Premium does not paid
Reserve balance, Advanced balance or Bonus don’t have enough amount to use
Month of cycle is equal to Term of Contract
- Drop Out In :
Premium does not paid
Reserve balance, Advanced balance or Bonus don’t have enough amount to use
Month of cycle is less than Term of Contract
3.1.6 Medical History
To record the medical history of beneficiary, go to Members > Households > Households,
select the household from the list; then from the list of beneficiaries (individuals), select
the beneficiary.
On Beneficiary List view, Select a beneficiary then click Medical History tab. Then it will
display all medical history of the selected beneficiary as below screen.
Figure 12. Medical History List
Field Description
Code Beneficiary contract code, auto generate code
Product name Contracted product name
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Price Price in KHR / USD
Start date Start coverage date
End date End coverage date
Status Active / Inactive
On Medical History screen, when user clicks on new button, the creation screen will
appear.
Figure 13. Medical History Form
Field Name Description Required
Medical history Medical history Yes
Note Note Yes
Validated It will be checked by Doctor after he validated.
On Medical History screen, select medical history record and click on Detail tab. It will
display the information of selected Medical history as below screen.
3.1.7 Other Benefit
Other Benefit module allow user to manage the payment to the product with type of other
benefit such as: funeral grant, funeral music etc.
On Beneficiary List view, Select a beneficiary then click on Other Benefit tab. Then it will
display all other benefit of the selected beneficiary as below screen.
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Figure 14. Other Benefit List
Field Description
Product name Name of Product
Type of other benefit Type of Other benefit
Receipt no Indicate the number of receipt
Paid amount Paid amount, can be USD or KHR
Paid date Date of payment
Status Active or Inactive
On Other benefit List view, when user clicks on new button, the creation screen will
appear.
Figure 15 : New Other Benefit
Field Name Description Required
Receipt no Indicate the number of receipt No
Product name Contracted product Yes
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Type of benefit Type of other benefit Yes
Paid amount Paid Amount, it can be USD or KHR. Its value base on Product and Type of benefit
Yes
Paid date Date of payment No
Active No
On Other Benefit List view, select other benefit record and click on “Detail” tab. It will
display the information of selected Other Benefit as below screen.
Figure 16. Other Benefit Detail
3.2 Contracts/Policies To access directly the list of all beneficiaries, go to Members > Households > Beneficiaries.
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Figure 17. List of Contracts/Policies
By default, only active records are displayed. To see inactive records, uncheck the Active
field in the search panel above the list.
More detail on the fields, see also 3.1.3 Household Contracts/Policies
3.3 Beneficiaries To access directly the list of all beneficiaries, go to Members > Households > Beneficiaries.
Figure 18. List of Beneficiaries
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By default, only active records are displayed. To see inactive records, uncheck the Active
field in the search panel above the list.
More detail on the fields, see also 3.1.2 Household’s members (Beneficiaries)
3.4 Group Enrollment Manage the employer and configure the contracted between Operator and Employer with
product.
In search panel, user can filter employer by View as (All, Contracted, Non
Contracted, OD, Category Employer, and Description.
Administration Menu > Operator >Employers
Field Description
Code Auto generated code by (“EMP” + OD code + Increment number)
OD Operational District that the employer locates in
Description Name in Latin
Name (KH) Name in Khmer
Number of worker Number of workers are working
Category Employer Category of employer. Example, Employer, Group or Other
Status Active/ Inactive
3.4.1 New Employer
On Employer list, click on New button. The creation will appear.
Field Name Description Required
Code Auto generated code by (“EMP” + OD code + Increment number)
Yes
OD Operational District that the employer locates in Yes
Description Name in Latin Yes
Name (KH) Name in Khmer Yes
Number of workers
Number of workers are working Yes
Category employer
Category of employer. Example: Employer, Group or Other
Yes
Province Which province the employer is in? Yes
District Which district the employer is in? Yes
Commune Which commune the employer is in? Yes
Village Which village the employer is in? Yes
Address Line 1 Address line 1. Example: Building No, Street,
Address Line 2 Address line 2
Telephone Telephone
Email Email
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Comment Any Comments
Active Active/ Inactive
3.4.2 Group/Employer Contracts
It configures the contract between employer and contracts.
On Employer Contracts list, select the group/employer then click on Contracts tab. The
Contract List view will appear.
Field Description
Code Auto generated code by (Product code + Employer code + Month Year of starting date)
Product name List of all products of selected Operator
Premium price Price of contracted product
Sharing cost Percentage that employer will pay for employee. The remaining percentage will be paid by employee.
Start date Date of starting contract
End date Date of ending contract
Active Active / Inactive. When status is inactive, End date is allowed to input.
On Employer Contract list, click on New button. The creation will appear.
Field Name Description Required
Code Auto generated code by (Product code + Employer code + Month Year of starting date)
Yes
Operator Which Operator that employer make contract with product in?
Yes
Product name List of all products of selected Operator Yes
Premium price Price of contracted product No
Sharing cost Percentage that employer will pay for employee. The remaining percentage will be paid by employee.
Yes
Term of contract Is number of months. It is used in Employer Report to define the auto renew member.
No
Start date Date of starting contract Yes
End date Date of ending contract No
Active Active / Inactive. When status is inactive, End date is allowed to input.
Yes
4 Utilization/Claims There are two kinds of claims: (1) Cash-less claims at contracted health facilities and (2)
Cash-based claims that clients access the service at a non-contracted health facility where
s/he need to pay to the facility and then claim for reimbursement from the Operator.
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4.1 Cash-less Claims This module allows user to record the utilization (cash-less) medical and non-medical
benefits such as medical service, drug, transportation (ambulance), etc. at contracted
health facilities.
Cash-less claims - List-view:
On Beneficiary List view, select a beneficiary then click Utilization tab. Then it will display
all utilizations (cash-less claims) of the selected beneficiary. When locked ( icon is
shown in the column Locked), the record is protected from any modification. But user can
modify the information on Drug and Transportation according to his assigned privilege.
Fig 19. Utilization List
Field Name Description Required
Patient dossier Visit number as given by the HF Yes
HF Contracted Health Facility Yes
Category Category of the visit (OPD, IPD, etc.) Yes
Sub Category Sub Category visit, Its value base on Category visit Yes
Entry date Date of entry. It must be before or same as current date
Yes
Discharge date End date of the contact in case of hospitalization. It will automatic fill same as entry date when user select entry date with Category as OPD. It must be not after the current date and after or equal Entry date.
Yes
Hospitalization day Amount of days patience stay at hospital. If Entry date equals Discharge date, it will be 1 day.
Yes
Type visit Type visit Yes
Referral letter A letter which is sent to hospital to confirm patience date.
No
Referred by Who sign the letter for the patience? Yes
Lumpsum name Total of moneys have to pay for each health facility. Its value base on Selected Health Facility and Category Visit. It is enable, if the selected Health Facility has type payment as Lumpsum.
Yes, If it is enable
Type of diagnosis 1 Type of disease Yes
Diagnosis 1 Type of diseases in which person obtain. Note: users are not allowed to choose the same
Yes
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diagnosis/per time. Its value base on Type of diagnosis 1
Type of diagnosis 2 Type of disease No
Diagnosis 2 Type of diseases in which person obtain. Note: users are not allowed to choose the same diagnosis/per time. Its value base on Type of diagnosis 2
NO
Invoice No Is the number of receipt which is noted to each invoice?
No
Ward Kind of ward in health center to choose service in it. Its value base on Health Facility and Category Visit
Yes
Service name Kind of service in each ward of hospital. Its value base on Ward
Yes
Service fee Applicable when Variable price is true Yes
Additional service Additional service No
Locked Record’s status whether it’s locked or not
Discharge date Date of discharge from the HF
Entry date Date of entry to the HF
HF Health Facility
Category Category of the visit (OPD, IPD, etc.)
Sub category Sub-category visit
Lumpsum name Lumpsum name
Diagnosis Display Diagnosis 1 and Diagnosis 2
Service fee Total service fee
Drug cost Total Drug cost
Transport cost Total Transport cost
Total cost Sum of Total service fee, Total Drug cost and Total Transport cost
On Utilization list view, select the utilization and click on Detail tab. It will display the
information of contact and services as below screen.
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Figure 20. Cash-less Claim
4.1.1.1 Drug benefit
On the Drugs tab, there are two views: list view and form view.
Figure 21. Drug List
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Figure 22. Drug Form
Field Name Description Required
Pharmacy Name of the pharmacy Yes
Ward Which ward? Yes
Prescriber/Pharmacist Doctor who prescribes or the pharmacist No
Invoice No Invoice number No
Invoice date Date of issuing invoice Yes
Amount Claimed amount Yes
4.1.1.2 Transportation
On Utilization List view, select Utilization and click on Transportation tab:
Figure 23. Transportation List
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Figure 24. Transportation Form
Field Name Description Required
Type Coverage Type of coverage that patience used Yes
Distance Distance between HF and client’s home Yes
Invoice no Invoice number No
Invoice date Date of the invoice Yes
Amount Claimed amount for reimbursement Yes
4.2 Cash-based Claims Health Claim module allow user manage claim information of beneficiary include Contact,
Service usage, Drug usage and Transport usage.
From the Beneficiary List view, Select a beneficiary then click on Cash-based Claim tab.
Figure 25. Cash-based Claim List
Field Description
HF Non Contracted HF
Claim case Claim case
Policy type Policy type
Claim status Display Open / Close
Claim amount Amount of claim
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Approved amount Amount that approved by Operator
Service cost Total service fee
Drug cost Total of Drug cost
Transport cost Total of Transport cost
Field Name Description Required
Claim Status Claim status (Open or Close) Yes
Opening claim date Opening claim date Yes
Claim case Claim case Yes
Product name List all contracted product with beneficiary. Yes
Policy type Policy type. Its value base on selected Claim case and Product
No
Claim amount Claim Amount of beneficiary No
Policy amount Its value get from selected Policy type No
Approve amount Approved amount No
Member accepted Is member accepted? No
Closing claim date Closing claim date. It is enable, if Claim status is Close
No
Patient dossier Patient dossier Yes
OD List all OD Yes
HF Non Contracted Health Facility Yes
Category Category visit (IPD, OPD) Yes
Sub Category Sub Category visit, Its value base on Category visit Yes
Entry date Start date of the contact
Yes
Discharge date End date of the contact in case of hospitalization. It will automatic fill same as entry date when user select entry date with Category as OPD
Yes
Hospitalization day Amount of days patience stay at hospital. If Entry date equals Discharge date, it will be 1 day.
Type visit Type visit Yes
Type of diagnosis 1 Type of disease Yes
Diagnosis 1 Type of diseases in which person obtain. Note: users are not allowed to choose the same diagnosis/per time. Its value base on Type of diagnosis 1
Yes
Type of diagnosis 2 Type of disease No
Diagnosis 2 Type of diseases in which person obtain. Note: users are not allowed to choose the same diagnosis/per time. Its value base on Type of diagnosis 2
No
Invoice No Is the number of receipt which is noted to each invoice?
No
Ward Kind of ward in health center to choose service in it. Its value base on Non Contracted HF Service
Yes
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Service name Kind of service in each ward of hospital. Its value base on Ward
Yes
Service fee Fee of service Yes
From the Cash-based Claims list view, double-click on the record or select a record and
then click on Detail tab.
Figure 26. Cash-based Claim Detail
5 Providers Under Providers menu, there are two groups/sections of menu items: (1) Institutions
(Health Facilities (HFs), HF Services, Pharmacies) and (2) Contracts (Contracts with HFs,
Contracts with Pharmacies).
5.1 Health Facilities To manage information on contracted pharmacies, go to Providers > Institutions > Health
Facilities (HFs). On the list view of HFs, user can filter the HFs by OD or search for a HF by
its code and/or name.
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Figure 27. List of Health Facilities
Field Name Description Required
OD Operational District Yes
Code Code of Health Facility Yes
Name Name in Latin Yes
Name (KH) Name in Khmer Yes
HF Level National Hospital (NH), Provincial Referral Hospital (PRH), Referral Hospital (RH), Health Center (HC), Laboratory (Labs), etc.
Yes
Package Level MPA, CPA1-3, etc.
Households Number of Households in HF’s catchment area Yes
Population Total population (individuals) in HF’s catchment area Yes
Poor population Number of poor population in HF’s catchment area Yes
5.2 HF Services To manage HF services, go to Providers > Institutions > HF Services.
On the list view of HF Services, you can filter the HF Services by OD, HF, Ward and/or
Category or you can search directly for a HF service by its name.
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Figure 28. List of HF Services
Figure 29. HF Service Form
Health Facility Services is a tool which is used to add or make change of service information that contain in specific Health facility.
In search panel, user can filter HF Services by OD, HF, Ward, Service name, Category.
Providers > Institutions > HF Services
Field Description
OD OD of selected HF
HF Health facility is selected into OD for service added.
Ward Type of service is scrolled by ward
Service name Services to be added into health facility
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Category Type of categories respond to health facility
Price Fee of service
Status Active /Inactive
Covered product type Give the type of product to the service you choose.
5.3 Health Facility Transportation
Health Facility Transportation is a tool which is used to add price of Covered
distance and Coverage type of health facility in Operator. It will apply in Transportation
usage of Utilization.
5.3.1 Health Facility Transportations List
In search panel, user can filter Health Facility Transportations by OD, HF.
Providers > Providers > Transportations
Field Description
Operator Operator
OD OD of selected HF
HF Selected Health facility
Type of coverage Selected Type of coverage
Coverage distance Selected Coverage distance
Price Given price
5.3.2 New Health Facility Transportations
On Health Facility Transportations list, click on New button. The creation will
appear.
Field Name Description Required
Operator Operator of login user Yes
OD Select OD to filter HF Yes
HF Select health facility to define how long patience have been travelling?
Yes
Type of coverage Type of health facility coverage on the distance and price.
Yes
Coverage distance Select how far the distance from home is? Yes
Price Amount riel supply to the distance from home to HF. Yes
Variable price If It is true, it allows user to modify the price when user entry data.
No
5.4 Pharmacies To manage information on contracted pharmacies, go to Providers > Institutions >
Pharmacies. On the list view of Pharmacies, user can filter the pharmacies by OD or search
for a pharmacy by its code and/or name.
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Figure 30. List of Pharmacies
Figure 31. Pharmacy Form
Field Name Description Required
OD OD where the pharmacy is located Yes
Code Unique code of the pharmacy Yes
Name Name in Latin Yes
Name (KH) Name in Khmer Yes
Address Address of the pharmacy
Phone Contact’s phone numbers separated by “/”. For example, 012 34 45 67 / 098 98 98 98
Email Email address
Website Website
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5.5 Health Facility Contracts
Health Facility Contracts is a tool which is used to add price of payment type of health facility. From this screen, user can also use it to view all payment type that consists in specific OD. There are three Type of payment are Fee for service, Lumpsum and Capitation. This configuration is used in Utilization, Agent group profile and some reports to filter the contracted Health Facility by Operator and Operational district. In search panel, user can filter Health Facility Contracts by OD, HF, Type of payment, HF
Level.
Operators > Contracts > Contracts with HFs
Field Description
Code Auto generated code by (Operator code + HF code + Month Year of starting date)
Operator Which operator that contract is created for?
OD OD of contract
HF HF of contract
HF level Hospital level type correspond to that health facility
Type of payment Type of payment that HF are using
Price Price of payment type in Health facility
Start date Date of starting contract
End date Date of ending contract
Status Active / Inactive
On Health Facility Contract list, click on New button. The creation will appear.
Field Name Description Required
Code Auto generated code by (Operator code + HF code + Month Year of starting date)
Yes
Operator Which Operator that HF Contract was created for? Yes
OD OD of contract Yes
HF List of Health Facility in selected OD and “Provincial Hospital” of the province
Yes
Type of payment Type of payment that HF are using Yes
Price Price of payment type in Health facility No
Reporting period As day, when the selected HF do monthly report. Yes
Reporting base Does report base on Entry Date or Discharge Date Yes
Start date Date of starting Yes
End date Date of ending No
Active Active / Inactive. When status is inactive, End date is allowed to input.
Yes
5.6 Contracts with Pharmacies
Pharmacy Contract is a tool which is used to create contract between Pharmacy in OD and
Operator.
In search panel, user can filter pharmacy contract by OD and Pharmacy name.
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Operators > Contracts > Contracts with Pharmacies
Field Description
OD OD of contracted Pharmacy
Pharmacy name Contracted pharmacy
Start date Date of starting contract
End date Date of ending contract
Status Active / Inactive
On Pharmacy Contract list, click on New button. The creation will appear.
Field Name Description Required
Code Auto generated code by Yes
Operator Operator of login user Yes
OD Select OD to filter Pharmacy Yes
Pharmacy name Lit of pharmacy that is filtered by OD Yes
Reporting period Day of closing report Yes
Start date Date of starting contract Yes
End date Date of ending contract
Active Active/ Inactive. When status is inactive, End date is allowed to input.
6 Operators
There are 13 modules to manage different function such as: Type Products, Products,
Employers, Health Facility Contracts, Non Contracted Health Facility Services, Health
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Facility Transportations, Other Benefits, Lumpsum, Claims, Pharmacy Contracts, Exchange
Rates, and Coupons
6.1 Operators By convention, only Super Admin can create a new Operator. Super Admin can create
many Operators that is classified by Operator Category (CBHI or NSSF).
To add an operator to the list, go to Operators > Operators > Operators.
6.2 System Users To manage the all users of difference Operator that are system user or member facilitator.
For system user, it requires filling User name and Password.
In search panel, user can filter agent by OD, Position, and Full-name.
Operators > Operators > System Users
Field Description
Operator Operator that agent are working at
OD OD that agent are working in
Full name Full name in Latin
Full name (KH) Full name in Khmer
Login User login name
Telephone Telephone number of agent
Email Email of agent
On System Users list, click on New button. The creation will appear.
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Field Name Description Required
Name that will use to login to the system Yes
Change Password Last name of agent in Latin Yes
Password First name of agent in Latin Yes
Confirm Password Last name of agent in Khmer Yes
Language First name of agent in Khmer Yes
Code Agent code Yes
Last name Last name of agent in Latin Yes
First name First name of agent in Latin Yes
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Last name (KH) Last name of agent in Khmer Yes
First name (KH) First name of agent in Khmer Yes
Gender What gender? Yes
Date of birth When agent was born?
Telephone Telephone number of agent
Email Email of agent
Address Address info
Address (KH) Address info in Khmer
Position What position?
Operator Operator that agent are working for Yes
Agent Profile Profile of agent which access right to system user Yes
OD OD that agent are working in Yes
HF Contracted HF that agent are working with. Some agents are working with all HF by selecting All value in the list
No
Employer Contracted Employer that agent are working at No
Active Active/ Inactive. If Status is Inactive, The agent cannot login to system
Yes
6.3 User Profiles User Profiles is a tool which is used to classify the access right of agent. There are seven
defaults profile such as: IT Admin, Head Office, Field Office, Hostess, Monitoring, Finance,
and Employer.
User Profile List displays the default user profiles and the user profiles that belong to a
specific Operator.
Operators > Operators > User Profiles
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Field Description
Code Code of agent profile
Description Name in Latin
Name (KH) Name in Khmer
On Agent Profiles list, click on New button. The creation will appear. Assigned Privilege List
contains the privileges that allow user to access (Full or Read).
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Field Name Description Required
Operator Operator Yes
Code Code of agent profile Yes
Name Name in Latin Yes
Name (KH) Name in Khmer Yes
Privileges List all functions that exists in the application
Assigned Privileges List all assigned functions. No
Tips:
Privilege Control:
To add one function:
Select a function in Available Privileges. Then click on
Drag-drop a function from Available Privileges to Assigned Privileges
To remove one function:
Select a function in Assigned Privileges. Then click on
Drag-drop a function from Assigned Privileges to Available Privileges
To add functions:
Select some functions in Available Privileges. Then click on
Drag-drop some functions from Available Privileges to Assigned Privileges
To remove one function:
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Select some functions in Assigned Privileges. Then click on
Drag-drop some functions from Assigned Privileges to Available Privileges
6.4 Product Types To manage the types (groups) of products under an operator, go to Operators > Operators
> Product Types.
Field Description
Operator Operator of Type product
Code Code of Type Product
Description Name in Latin
Name (KH) Name in Khmer
On Type Product list, click on New button. The creation will appear.
Field Name Description Required
Operator List of Operator Yes
Code Unique code of Product Type Yes
Name Name in Latin Yes
Name (KH) Name in Khmer Yes
6.5 Products Manage the product information such as: General Info, Premium Info, Contract Info and
Benefit Info
In search panel, user can filter product by Type of product, Sector population, Poverty level,
Size of Household, Discount, and Bonus.
Administration Menu > Operator > Products
Field Description
Operator Operator of Type product
OD Operational District that the product will be used
Code Auto generated code by (Operator code + Type product code + Increment number)
Description Name in Latin
Name (KH) Name in Khmer
Type of product Type of product
Sector population Sector population
Poverty level Poverty level
Premium price Price of product for a month (USD / KHR)
Status Active/ Inactive
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On Product list, click on New button. The creation will appear.
Field Name Description Required
Code Auto generated code by (Operator code + Type product code + Increment number)
Yes
Operator List of Operator Yes
OD Operational District that the product will be used Yes
Type of product List all type of product that belong to selected Operator
Yes
Name Name in Latin Yes
Name (KH) Name in Khmer Yes
Premium Price of product for a month (USD / KHR) Yes
Sector population List of Sector population No
Poverty level List of Poverty level No
Size of Household List of Household size No
Active Active / Inactive Yes
Comment Any comments No
6.5.1 Update Premium Info
On Product list, select a product then click on Premium Info tab. The Premium Info screen
will appear.
Field Name Description Required
Number of reserve
Is number of months. It is used in Premium Payment of Household. Household must fill the reserve amount.
No
Minimum first term payment
Is number of months. It is used in Premium Payment of Household for first payment. It requires Household must pay at leases this minimum amount
No
Minimum term payment
Is number of months. It is used in Premium Payment of Household for next payment. It requires Household must pay at leases this minimum amount
No
Discount List of discounts. It bases on the Advanced Payment. Example, If Advanced Payment is greater or equal 9 months. It will got discount 10%
No
Bonus List of coupon. It bases on the Advanced Payment. Example, If Advanced Payment is greater or equal 12 months. It will got bonus 1 month
No
Regular pay bonus Maximum number of Regular pay bonus. Example, if Household pays regularly 12 times or passes the rule of giving bonus. They will got one month bonus (as regular pay bonus)
No
6.5.2 Update Contract Info
On Product list, select a product then click on Contract Info tab. The Contract Info screen
will appear.
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Field Name Description Required
Term of contract Is number of months. It is used when premium was created for a month. This number is used to limit the month of cycle.
No
Waiting period for delivery
Is number of months. It is used in Household Waiting Period Report to check when Delivery will be usable.
No
Waiting period for plan surgery
Is number of months. It is used in Household Waiting Period Report to check when Plan surgery will be usable.
No
Kinship List of Relational Household. It will apply in Creating or Updating Beneficiary of Household that have contract with product. Beneficiary Form - Kinship with HoH Combo will display only the checked relational Household.
No
6.5.3 Other benefic Info
On Product list, select a product then click on Other Benefits tab.
Field Name Description Required
Benefits Tree of benefits. Some benefits (Copayment, Coinsurance, Deductible) are used in Claim configuration
No
6.6 Other Benefits Other Benefits is a tool which is used to add price of other benefit type of product that
follows the range of min and max seniority in Operator.
In search panel, user can filter Other Benefits by OD, Type of other benefit, Min seniority,
and Max seniority.
Field Name Description Required
Operator Operator of login user Yes
OD Select OD to filter Product Yes
Product name List of Product that was filtered by OD Yes
Type of other benefit Select other benefit type to be existed in specific OD. Yes
Min seniority Select the start oldness membership to define other benefit they could get.
Yes
Max seniority Select the end oldness membership to define other benefit they could get during this period.
Yes
Price Supply the price to benefit type No
6.7 Lumpsum (Case-based) Lumpsum is a tool which is used to add or make change of Lumpsum information that contain in specific Health facility.
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In search panel, user can filter Health Facility Transportations by Operator, OD, HF,
Category, Lumpsum name.
Field Name Description Required
Operator Operator of login user Yes
OD Select OD to filter HF Yes
HF Health facility is selected into OD for Lumpsum added Yes
Category Type of categories respond to health facility Yes
Lumpsum name Lumpsum to be added into health facility Yes
Price Given fee of Lumpsum that user have just selected or type
No
6.8 Claims Claims is a tool which is used to add price or percentage of policy type that was configured
in Benefit info of Product.
In search panel, user can filter Claims by Claim case.
Field Name Description Required
Operator Operator of login user Yes
OD Select OD to filter Product Yes
Claim case List of Claim case (Delivery, Transport) Yes
Product name List of product that was filtered by selected OD Yes
Policy type List of policy type that was chosen in Benefit Info of Product.
Price Price of policy type as “Copayment” or “Deductible”
Coinsurance amount Percentage amount of policy type as “Coinsurance”
6.9 Coupons Coupons is tool which is used to create coupon for OD.
Field Name Description Required
Operator Operator of login user Yes
OD Which OD are using coupon? Yes
Name Description of coupon in Latin Yes
Name (KH) Description of coupon in Khmer Yes
Number of months Given amount of month Yes
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7 Tools
7.1 General Tools
7.1.1 Non Beneficiaries
Non Beneficiaries is a tool which is used to enter the monthly total visit by category visit in
health facility of an Operator.
In search panel, user can filter non beneficiary by Health Facility and Category Visit.
Tools > General > Non Beneficiaries
On Non Beneficiary list, click on New button. The creation will appear.
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Field Name Description Required
Operator Operator Yes
HF Health Facility that non beneficiary visited Yes
Category Category visit (OPD or IPD) Yes
Date Month that non beneficiary visited HF Yes
Total monthly visits Number of non-beneficiary who visit per month Yes
7.1.2 Utilization Validations
Utilization Validations is a tool which is used to lock or unlock the Utilization. If the
Utilization was locked, user is not allowed to modify the Utilization. But user can access
the Drug and Transportation tabs.
In search panel, user can filter Utilization by Operator, OD, HF, Base on (Entry or Discharge
date) and range of date.
Tools > General > Utilization Validations
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7.1.2.1 How to lock Utilization
After result shown in the list, user can lock the Utilization by select the unlocked
Utilization and click on button.
Figure 32. Select the unlocked Utilization
Then the question message will appear as below. Press “Yes” to process.
7.1.2.2 How to unlock Utilization
After result shown in the list, user can unlock the Utilization by deselect the locked
Utilization and click on button.
Figure 33. Select the locked Utilization
Then the question message will appear as below. Press “Yes” to process.
7.1.3 Close Entry
Close Entry is a tool which is used to close the current coverage period and open the new
coverage period of an Operational District that is used by an Operator.
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The below is an example of Closing Entry Aug-2012 for Phnom Penh OD that is used by
SHPO Operator.
Example: Current Coverage Period is Aug-2012
- Create the coverage period for Sep-2012
- Close the coverage period for Aug-2012
- Lock the payment of the coverage period Aug-2012
- Update the contract of Household automatically. If the size of Household was changed.
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7.1.4 Non Payments
Non Payments is a tool that is used to pay automatically for the Household that remain
Reserved or Advanced balance and drop out Household that has no enough Reserved or
Advanced balance.
7.1.5 Households Rollback
Household Rollback is a tool that is used to roll-back the drop-out Household.
7.1.6 Household Balance
Household Balance is a tool that is used to refund and keep the balance amount of
Household.
7.1.7 Balance Transfer
Household Balance is used to transfer remaining balance of one or more dropped-out
households to one or more active households.
7.2 Complaints
7.3 Surveys It depends on the answers or reviews of some questions by different users. A survey may
have multiple sections. Each section may contain multiple questions and each question
may have multiple answers. Different users may give different answers to the question and
according to that survey is done.
A feedback form is a survey, a tool for assessment through a questionnaire. The system
provides a module to manage the surveys. There are currently several feedback collections
captured by schemes such as Client Satisfaction Survey Tool (CSST)1, Health Facility Exit
feedback, Dropout feedback, home spot-check, community scorecard, etc.
These are conducted at different points in the processes which are involved in the
insurance scheme and are undertaken by different actors and administered to different
types of clients.
H-SPIS v4 provides a flexible tool that system users can develop questionnaires and link
them with relevant surveys.
A survey contains the following information:
Field Description
Survey code The code of the survey used as reference
Survey name The name or title of the survey
1 Client Satisfaction Survey Tool (CSST) is the MoH standard client satisfaction survey. AFH uses this in
Kampong Thom every quarter (with GIZ's support) to monitor client satisfaction. Other SHPA members also use this in some form and MoH may encourage more to do so in the future.
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Description The description of the survey
Category The category of the survey which can be Referral Hospital, Health Centre, etc.
Date of Creation Date of Creation
Created by User who creates this survey
Date of Modification Date of latest modification
Modified by User who made the latest modification
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Every survey is linked with a questionnaire. A question shall include the following
information:
Field Description
Questionnaire code The code of the questionnaire used as reference
Questionnaire title The title of the questionnaire
Description The description (purpose, etc.)
Category Used as category, classification, etc.
Author Name of the main author
Date of Creation Date of Creation
List of questions List of questions
A questionnaire is a list of questions and each question shall contain the following
information:
Field Description
Question code The code or order of the question used as reference
Question The question
Comment Extra comment or explanation on the question
Section Which section does this question belong to in the questionnaire?
Type of question Multiple choices etc.
A response to a question in a given questionnaire from a respondent shall contain the
following information:
The raw data can be downloaded in CSV or Excel format from the system looks like in this
following example:
No OD HF Scheme Respondent Q1 Q2 … Qm
1
2
3
…
n
Legend: HF – Health Facility OD – Operational District n – Number of respondents
Q – Question m – Number of questions
7.4 Integrated Documents Management
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To access to the integrated documents management tool, go to Tools > Documents.
Field Name Description
Operator Which scheme?
OD Which OD? Value: ID of the OD and False if not applicable.
HF Which HF? Value: ID of the HF and False if not applicable.
Attachment ID The reference of this attachment
Attachment name The name of the attachment, by default, the filename without extension
Description Description of the attachment
File name The filename of the attachment with extension
File type The attachment type: Utilization
File location Where the file is stored.
Owner Owner of the file. This shall be automatically captured for the user who uploads the file.
Date Date/time when the document is uploaded to the server. It is also automatically captured.
7.5 SMS A mobile phone can be used anywhere and anytime across Cambodia. Text messaging
(SMS) is faster, more direct, and can reach out to even the most remote area.
H-SPIS v4 is equipped with an SMS module that can offer a reliable solution for member
identification/verification and recording service utilization data with below situations:
Health facilities without computer or Internet connection
Blackout or temporary loss of Internet connection, etc.
User with any kind of mobile phone can send an SMS to a fixed number with a pre-defined
format and will get back the relevant result or confirmation.
All SMS inbound and outbound messages are recorded in H-SPIS v4.0. To manage those
messages, go to Tools > SMS.
8 Reporting All implemented reports are classified into 3 main categories: Operator Reports, MoH
Reports and Custom Reports.
User can export report as Excel format by clicking on the “Export” button at the top of
screen. The below opening dialog appear after generation of report finish.
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8.1 Operator Reports Several reports have been implemented for Operators such as Active Household, Premium
Collection, SMM, Premium Consolidated Receipt, New Enrollment Summary, Household
Waiting Period, Outreach, Over Utilization, Utilization Info, MMM, Dashboard (Tdb) and
Monitoring.
8.1.1 Active Household
This report shows about the active Household who visit the Health facility in specific OD by
month. In the report, it will show information of active Household such as: Village name,
Household code, Household name, Household size, HF, Employer.
Required Field:
OD: List of ODs which have contracted HF. Select OD to load data of HF
HF: List of all contracted HF with Operator. User can view all contracted HF by select “All”
value.
As of: Date of report
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Figure 34. Active Household Report
8.1.2 Premium Collection Report
This report shows about information of Premium such as: simple info of Household, month
in cycle, monthly premium, reserve remain, advanced remain, required payment, total
paid, receipt no
Required Field:
OD: List of ODs which have contracted HF. Select OD to load data of HF, Employer, and
Coverage date.
HF: List of all contracted HF with Operator. User can view all contracted HF by select “All”
value.
Employer: List of all contracted Employer with Operator of user login. User can view all
contracted Employer by select “All” value.
Currency: View amount as KHR or USD
Coverage date: Date of report
To get the value of Coverage date, it requires select OD first.
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Figure 35. Premium Collection Report
8.1.3 Meeting Report
This report shows about membership and premium collections.
Required Field:
- OD: List of ODs which have contracted HF. Select OD to load data of HF and Coverage date.
- Member Facilitator: is member who collects information of membership and collects
money for premium payment.
- HF: List of all contracted HF with Operator. User can view all contracted HF by select “All”
value.
- Coverage date: Date of report
Figure 36. SMM Report
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8.1.4 Premium Consolidated Receipt
This report shows about Total Amount Paid By New Registered Households, Total Amount
Paid By Existing Households, Entry amount and Transfer amount.
Required Field:
- OD: List of ODs which have contracted HF. Select OD to load data of HF and Coverage date.
- HF: List of all contracted HF with Operator. User can view all contracted HF by select “All”
value.
- Currency: View amount as KHR or USD
- Coverage date: Date of report
Figure 37. Premium Consolidated Receipt
8.1.5 New Enrollment Summary Report
This report shows about the number month paid of renewal Households and new enrolled
Households in a specific HF those groups by product type.
Required Field:
- OD: List of ODs which have contracted HF. Select OD to load data of HF and Coverage date.
- HF: List of all contracted HF with Operator
- Coverage date: Date of report
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Figure 38. New Enrollment Summary Report
8.1.6 Household Waiting Report
This report shows about the simple information of active Household, waiting period
(delivery and surgery) based on the contracted product.
Required Field:
- OD: List of ODs which have contracted HF. Select OD to load data of HF, Employer, and
Coverage date.
- HF: List of all contracted HF with Operator
- Coverage date: Date of report
Figure 39. Household Waiting Report
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8.1.7 Outreach Report
Outreach report is a kind of report that shows about the simple information of HF such as:
Total Population, Total Non-Poor Population, Total Poor Population, Total Household as
Voluntary Member, Total Member of Household as Voluntary Member, Total Household as
Health Equity Fund, Total Member of Household as Health Equity Fund, Rate of Member of
Household as Health Equity Fund, Rate of Member of Household as Voluntary Member.
Required Field:
- OD: List of ODs which have contracted HF
- As of: Date of report
- Include HEF: By default, it is checked. It will display the information of HEF. Otherwise, it
hides the information of HEF
Figure 40. Outreach Report
8.1.8 Over Utilization Report
Over Utilization report shows about the information of beneficiary’s Utilization such as:
beneficiary code, employer name, total service fee and total Lumpsum price.
Required Field:
OD: : List of ODs which have contracted HF. Select OD to load data of HF, Employer
Reporting base: Entry or Discharge date
HF: List of all contracted HF with the operator. User can view all contracted HF by select
“All” value.
Employer: List of all contracted Employer with the operator of user login. User can view all
contracted Employer by select “All” value.
Category visit: All, OPD or IPD
Contact number: Number of contacts
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From…to… : Period of report
Figure 41. Over Utilization Report
8.1.9 Utilization Report
Utilization report shows about the information of contact such as: OD, Contact ID, Health
Facility, Discharge date, Entry date, Member code, Gender, Age, New case-Second case-
Chronic, Diagnosis, Category visit, Day hospitalization, Ward, Service, Lumpsum, Actual
Amount, Employer name, Staff entered, Date time entered.
Required Field:
OD: : List of ODs which have contracted HF. Select OD to load data of HF, Employer
Reporting base: Entry or Discharge date
HF: List of all contracted HF with Operator. User can view all contracted HF by select “All”
value.
From…to… : Period of report
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Figure 42. Utilization Report
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8.2 MoH Reports There are 7 different MoH reports generated from H-SPIS v4:
1. General Information Reports
2. Coverage Reports
3. Utilization Reports
4. Financial Reports - Incomes
5. Financial Reports - Direct costs
6. Financial Reports - Indirect costs
7. Financial Reports - Total costs
Figure 43. MoH Reports
8.3 Query Tools Query tools allow user to create, update, delete, execute report and export to Excel
format. On queries combo, user can select old query report to update or execute report.
Execute to Excel format is available when query was saved and it has result in list.
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Figure 44 : Free Query Report
Field Name Description Required
Code Query code Yes
Description Query description Yes
SQL statement SQL script to generate a report Yes
Action Description
New query Allow user to create new query
Save query Allow user to save or update query
Delete query Allow user to delete selected query
Execute report Execute SQL statement and show result on List
Export Export the result on list to Excel format. If there are no data. User cannot export to Excel format.
9 Settings There are 5 sub main menus in Administration. Such as: Reference data, Operator, Agent
and Tools
9.1 Exchange Rate Exchange Rate is tool which is used to create Exchange from Dollars to Riels. The latest
active exchange rate will be used for every conversion between Dollars and Riels.
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Figure 45. List of Exchange Rates
In search panel, user can filter exchange rate by Year.
Settings > Operator >Exchange Rate
Field Name Description Required
Operator Operator of login user Yes
Month Month of exchange rate Yes
One dollar is Changed amount from 1 dollar to riel Yes
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9.2 Reference data
9.2.1 General data
General data module allow user to manage the reference table. There are 40 table systems
in the below list. When user double clicks on the record, the new tab of selected table
system will appear. In Search panel, user can search by Code and Description.
Administration Menu > Reference Data > General Data
Figure 46 : General data
Action Description
View Data Allow user to view data of selected table system
Refresh Refresh List
9.2.1.1 Category Employer List
After double click or clicking the view data button, the following screen will appear. Then
user can create, update, delete and view.
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Figure 47 : Category Employer List
9.2.1.2 New Category Employer
On Category Employer list, click on New button. The creation will appear.
Figure 48 : New Category Employer
Field Name Description Required
Code Code of Category employer Yes
Description Name in Latin Yes
Name (KH) Name in Khmer Yes
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9.2.1.3 Category Employer Detail
On Category Employer List, Select a record then select Detail tab. Then it will display the
information of Category employer as below.
Figure 49 : Category Employer Detail
Note: For other table system, Health facilities and Pharmacies, it has same behavior as
Category Employer.