Switching: Claim Administration

Business Requirement: Patient Validation is used to see if the patient is a valid and active member of the medical aid. 

Patient Validation can be done in a few places in GoodX namely:

MedDebs:

• Admittance screen
  
• Debtor input screen
  
• Patient Input screen
  
• Claim History
  

Diary:

• Information bar (Side Bar)
  

All of them perform the same function.

• The next example will be done from the admittance screen but the same function will be performed from all places:
• From the Admittance screen, select the patient and click on Validation.

 or  to complete this function.

• There are 3 options to choose from:

1. Validation (Yes/No)
   
2. Dependants Data
   
3. Benefits
   

1. Validation (Yes/No)

• The patient validation (Yes/No) will give you a Yes or No response if it is a valid member or not.

2. Dependant data

• Dependant data will show you if it is a valid member as well as if the details of all the members are correct. On the left-hand side is the information of all the members and the medical aid, and on the right-hand side are all the members that are already loaded on the system.

• Click on continue.

There are three different colours that will display the results:

• Red means that a match was found on GoodX and an update is available.
• Blue means that no match was found and an import is needed.
• Green means that a match was found and the information is up to date.

TAKE NOTE: If you see a red block together with this icon it means that the update function will update more than three fields of the patient. In this case please make sure that there is not a mismatch. Make sure that the patient information indeed belongs to the patient that you want to import.

3. Benefits

• The benefit validation checks if there are funds available on the member's savings account.
• It will only validate that specific amount, it will not indicate how much is available on the savings account and only three benefit checks per patient can be done per day.

• It will confirm if there are funds available or not.
• Click on the disabled icon to see more information on the member's plan or click on continue to do a dependant data import.