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Approval Cycle

The document outlines the approval cycle process within a healthcare system, detailing the use of various systems such as OASIS and HIS for managing insurance and patient data. It describes the approval screens, medical records, patient recharges, and admission reports, highlighting the functionalities and navigation pathways for users. Additionally, it includes information on tracking request statuses and managing medical documentation effectively.

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mahetab.muhammad
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6 views53 pages

Approval Cycle

The document outlines the approval cycle process within a healthcare system, detailing the use of various systems such as OASIS and HIS for managing insurance and patient data. It describes the approval screens, medical records, patient recharges, and admission reports, highlighting the functionalities and navigation pathways for users. Additionally, it includes information on tracking request statuses and managing medical documentation effectively.

Uploaded by

mahetab.muhammad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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APPROVAL CYCLE

From request to action

DR. Amir Sultan 02/2021


Approval cycle
A) oasis system
1-Notes on insurance
and RCM. 2-System tools.

B) HIS system

C) Insurance
sites ,contacts and
NPHIES.
3-Approval process and
Tasks distribution.
Tools • OASIS • Insurance
SYSTEM interface
• HIS SYSTEM
Group ,major and minor screens
,each represents a special
function ,press the Cross sign
beside the group screen name
to open the other screens.

Major screens lead to further


minor screens by a certain
PART (1) pathway.

Oasis
system Regarding approval department,
not all screens are needed.

Only required screens will be


highlighted in yellow.
• APPROVAL SCREEN.

-All requests (In-pt /Out-pt


/Dental) ,
1-Setup medical data and action.

group
screens
• IOS PRICE MAINTAINANCE.

-For package search and confirmation.


• All credit cases requests that are
Approval created by the treating physician
and needs approval will appear in
screen this screen.
(1) • Most of medical data and
documents will be available in this
major screen by certain steps.
• The action will be taken though this
screen
APPROVAL
SCREEN
(1)
• SCAN

• TO FIND A SCANED
DOCUMENTS
• SCAN FILES (STILL NOT
ACTIVATED)
• EXIT
• FILE NO(MRN)

Approval • REQUEST STATUES AND DONE ACTION TO


CHOOSE FROM :-

screen -POSTED SCREEN: FOR OUT-PATIENT.


-OPEND SCREEN :FOR IN-PATINET.
(3) -SENT SCREEN : TO BE ABLE TO TAKE
ACTION U SHOULD CHANGE THE 2
PREVIOUS SCREENS TO SENT SCREEN.
-HOLD SCREEN:UNDER PROCESSING
CASES.
-APPROVED ,REJECTED SCREEN.
-ALL SCREEN: FOR ALL PREVIOUSLY
MENTIONED CASES.
• COMMENT :write a comment on each service.

APPROVAL
• MEDICAL RECORD :Contain all pt medical data ,history
and investigations

screen • U-CAF : the official prescription attached.

(4) • SCAN: to scan any document

• Opened book :To find the previously scanned document


scanned

• APPLY ACTION.
COLOUR : reflecting the case statues
Blue : posted(out-pt)
Approval Grey : opened(in-pt)
screen Yellow : ready for action

(5) Orange : hold (under processing)


Green : approved
Red : rejected

SIGN : to be able to take an action on a


case or a service
Medical
record screen
1- Problems:
medical data for each
episode.
MEDICAL
RECORD
screen
2- Visits:
show details of each
visit and clinical notes.
Medical
record
screen
3- All medical data
related to each visit
otherwise in/pt or out/pt.
MEDICAL
RECORD
SCREEN
4 –LAB AND RADIO.
MEDICAL
RECORD
SCREEN
5 -MEDICATION
MEDICAL
RECORD
SCREEN
6 –O.R. REPORTS
• Search and confirmation of packages and procedures codes.

2-IOS PRICE • By default ,the search will be in the cash price list.
MAINTENAN
CE -You can choose a certain company from the companies list.
TO FIND A PACKAGE
• PRICE TYPE:
• Standard for cash price.
• Group purchaser to chose for different insurance company.

• Price filter:
• To show the codes and package with and without prices

• STEPS:
Choose Service 2 press GO press F7 write the description u need its package
between two signs of percentage (% the
description %) press F8
2-Patient Re-
charges
(1)
• POLICY NOTES.
• SEARCH A PATIENT.
• PATIENT PERSONAL.
DATA AND I.D.
• DONE SERVES.
• THE CREDIT AND
CASH INVOICES.
PATINET
RECHARGES
(2)
• WE CAN SEARCH
THE REQUESTED
SCREEN WITH
DIRECT SEARCH
• ENTER PATIENT RE-
CHARGE SCREEN
• PUT FILE NO
• PRESS START
PATIENT
RECHARGE
(3)
• L.R :
To search pt
personal data and
find I.D number.
Patient
Recharges
(4)
• L.S:
To search a patient.
Patient
Recharges
(5)
• Information tape
1- BILLING: policy notes

INFORMATIO 2-DELIVERY: the already done


N TAPE services.

3-REPTS: patient invoice.


Information
tape
• Billing
Information
tape
• Delivery
Information
tape
• Repts.
Transcription
document
requisition.
(1)
• IN/PT reports
Transcription
document requisition
(2)

1-CHOOSE ALL in
ENCOUNTER type.
2-Put the file no(MR).
3-Press the show icon.
Transcription
document
requisition
(3)

• OR ,still admission and


discharge reports
• Press print
Admission
reports
(1)
1- Purchaser admission
census report
2- Admission patient daily
report
3- Admission reports
Admission
reports
(2)
Purchaser
admission census
report to search
admitted by
purchaser
Admission
reports
(3)
• Admission patient
report
Admission
reports
(4)
• Admission patient
report
admitted
credit
Admission
reports
(5)
-Death list during a
period

-Room transfer
-Discharge list
-Inpatient occupancy
Admission
reports.
(6)
• In-patient report
by staff
• Expected adm by
date
• Booked not
admitted
ADMISSION DATA BY

Admission WARD

reports DOCTOR
(7) SERVICE DEPARTMENT
• We can get admission
NEW FILES
data by many indices.
LENGTH OF STAY

NATIONALITY

PATINET NAME

ADMISSION DATE

USERNAME
Daily
discharge

(by company
or department
Daily
discharge
• There are many ways to get
patient laboratory result

Lab result 1-Medical record screen (approval screen)


2-Result engine screen.
3-General chart.
LAB RESULT
(2)

RESULT ENGINE
LAB RESULT
(2)

RESULT ENGINE
LAB
RESULT(3)

GENERAL CHART
RadioLOGY
result
Endoscopy
result
HIS Riyadh.

NEXT PART
HIS Beverly clinics.

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