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/ISHFR/RN_MCO_ORDER_CREATE - IS-H FR: Manual Dispatch Order Creation for Various MCO Procedures

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Title

IS-H FR: Manual Message Generation for Various MCO Communication Procedures

Purpose

This report allows you to trigger communication events manually even if you have changed no data in the system.

This means that you can send messages even when the events are not automatically registered by SAP for message processing.

Prerequisites

The following criteria must be met if the report is to be able to write the order to the database:

  • The communication procedure must be active for the institution specified.
  • You must define a communication partner (data collection point).
  • Customizing must be set up correctly.

Features

RSS: Standardized Discharge Message (PMSI MCO)

Message creation is independent of the insurance provider.

The system selects all inpatient and day care cases that fit the selection criteria (selection by discharge date).

The system handles clinical trials like normal inpatient stays.

The system only creates messages for the following situations:

  • Inpatient and day care stays on an Organizational Unit (OU) for which the value M, C, O, or N is entered in the specialty category (=7).
  • Inpatient and daycare dialysis cases (the Dialysis indicator is set in the case category.)
  • Inpatient and daycare radiotherapy cases (the Radiotherapy indicator is set in the case category.)

The system generates a new RUM message for each different movement on an MCO unit (departmental OU of admission/transfer).

The system uses specialty category B to fill the RSS field ORGUNIT (unité medicale). This category should also be specified for the PDG-MCO grouper in the file UM.txt.

Absences with the movement type Transfer to ext. hospital are considered in the previous stay's RUM. If the patient returns to the same MCO unit after an absence, only one RUM message is generated.

If the patient changes specialty after an absence, the period of the absence is treated as a part of the previous stay, and the system generates a new RUM for the time following the absence.

Dialysis and radiotherapy cases are also selected. During a normal MCO stay, these treatments should be documented as outpatient visits in an inpatient/daycare stay.

RSP: Standardized Message for Radiotherapy Preparation (PMSI MCO)

Message creation is independent of the insurance provider.

The system selects all outpatient cases (for which the Radiotherapy indicator is set in the case category) that are assigned to an inpatient or daycare case for which the RSS procedure is relevant.

The outpatient case must have a case-to-case assignment with the internal category R to these cases.

The system handles clinical trials like normal inpatient stays.

Dialysis cases are treated as daycare cases.

Preparation for radiotherapy (outpatient case) must be assigned to the last of the daycare cases or to the inpatient case.

UCD: FICHCOMP File Data Exchange for Drugs (PMSI MCO)

Message creation is independent of the insurance provider.

The system selects all inpatient and daycare cases that fit the criteria (selection by discharge date) and have at least one movement (admission/transfer) on an MCO department.

The following conditions apply to message generation:

  • The stay is treated as an inpatient or daycare stay on an OU that has the value M, C, O, or N entered for the specialty category (=7). (The system analyzes the departmental OU of the movement.)
  • At least one RSS message (EDI procedure FRRSS) with a status >=02 (OK, ready for dispatch) must exist for the case. If this is not the case, the message is stopped (NC301S-SESTA = 02 and NC301S-HOLDD = '99991231') and the system displays a warning. The system always checks for a FRUCD message that has been stopped during the EDI procedure FRRSS whenever a new message with status =02 is generated. In this case, the system releases the stopped message for dispatch.
  • The system takes into account all billable UCD services (charge type = F8) for which the indicator T2A is set in the service master. It does not matter whether the service has already been billed or not. The system also ignores the insurance provider.
  • If the service price cannot be determined, or has a value of zero, the message is assigned the status "incomplete" (NC301S-SESTA =02).

LPP: FICHCOMP File Data Exchange for Medical Products (PMSI MCO)

Message creation is independent of the insurance provider.

The system selects all inpatient and daycare cases that fit the criteria (selection by discharge date) and have at least one movement (admission/transfer) on an MCO department.

The following conditions apply to message generation:

  • The stay is treated as an inpatient or daycare stay on an OU that has the value M, C, O, or N entered for the specialty category (=7). (The system analyzes the departmental OU of the movement.)
  • At least one RSS message (EDI procedure FRRSS) with a status >=02 (OK, ready for dispatch) must exist for the case. If this is not the case, the message is stopped (NC301S-SESTA = 02 and NC301S-HOLDD = '99991231') and the system displays a warning. The system always checks for a FRLPP message that has been stopped during the EDI procedure FRRSS whenever a new message with status =02 is generated. In this case, the system releases the stopped message for dispatch.
  • The system analyzes all billable LPP services (charge type = F4). It does not matter whether the service has already been billed or not. The system also ignores the insurance provider.
  • If the service price cannot be determined, or has a value of zero, the message is assigned the status "incomplete" (NC301S-SESTA =02).

FPO: Data Transfer of FICHCOMP File for Organ Removals (PMSI MCO)

Message creation is independent of the insurance provider.

The system selects all inpatient and daycare cases that fit the criteria (selection by discharge date) and have at least one movement (admission/transfer) on an MCO department.

The following conditions apply to message generation:

  • The stay is treated as an inpatient or daycare stay on an OU that has the value M, C, O, or N entered for the specialty category (=7). (The system analyzes the departmental OU of the movement.)
  • At least one RSS message (EDI procedure FRRSS) with a status >=02 (OK, ready for dispatch) must exist for the case. If this is not the case, the message is stopped (NC301S-SESTA = 02 and NC301S-HOLDD = '99991231') and the system displays a warning. The system always checks for a FRFPO message that has been stopped during the EDI procedure FRRSS whenever a new message with status =02 is generated. In this case, the system releases the stopped message for dispatch.
  • The system analyzes all billable PO services (organ removals - charge type = FO). It does not matter whether the service has already been billed or not. The system also ignores the insurance provider.

FXI: Data Transfer of FICHCOMP File for Cross-Institution Treatment (PMSI MCO)

Message creation is independent of the insurance provider.

The system selects all inpatient and daycare cases that fit the criteria (selection by discharge date) and have at least one movement (admission/transfer) on an MCO department.

The following conditions apply to message generation:

  • The stay is treated as an inpatient or daycare stay on an OU that has the value M, C, O, or N entered for the specialty category (=7). (The system analyzes the departmental OU of the movement.)
  • The case must have at least one absence for which the "Transfer to Ext. Hospital" indicator (TN14B-TREXH) is selected.
  • At least one RSS message (EDI procedure FRRSS) with a status >=02 (OK, ready for dispatch) must exist for the case. If this is not the case, the message is stopped (NC301S-SESTA = 02 and NC301S-HOLDD = '99991231') and the system displays a warning. The system always checks for a FRFXI message that has been stopped during the EDI procedure FRRSS whenever a new message with status =02 is generated. In this case, the system releases the stopped message for dispatch.
  • The system analyzes all billable services for cross-institution treatment (charge type = FZ) that are assigned to an absence in an external hospital. It does not matter whether the service has already been billed or not. The system also ignores the insurance provider.

VIDHOSP: File for inpatient and home treatment

Message generation does not depend on the insurance provider.

The report selects all inpatient and day care cases that fit the selection criteria (selection by discharge date).

The system only creates messages for the following situations:

  • Inpatient and day care stays on an Organizational Unit (OU) for which the value M, C, O, N, or HAD is entered in the specialty category (=7). (The system checks the departmental OU to which the patient was admitted.)

The system selects all invoices for all insurance providers and self-payers that have not been canceled for the selected cases. Cases that do not have an invoice are only selected if coverage or the percentage covered by the social insurance fund has not been clarified (see the coverage status in the insurance relationships), or if the patient is marked as a healthy newborn (appropriate admission type and case classification).

Caution: The service rules must also be processed for unbilled cases to ensure that the VIDHOSP message is filled correctly, in particular with regard to exemptions and coverage portions. For this reason, the report executes all the service rules defined in Customizing for event NLRG20 (service check before EDI communication).

Please note that in this callup point - as is the case for all callup points that can involve mass processing - the service rules only perform an action if you have selected "Actions Without Confirmation and in Batch Input" in the service rule.

Selection

EDI procedure

First, choose the relevant EDI procedure.

General

  • Institution
Choose the appropriate institution from the value help (F4).
  • Discharge date from/to
Enter a period for the discharge movement, so that the system selects the case. If the period comprises only a single day, it is sufficient to enter only Discharge date from.

You must make an entry for both criteria.

Additional criteria

  • Case Number From/To
You can further restrict the selected cases by specifying case numbers.
  • Selection parameters (for case selection)
If you have already executed the case selection program, you can use the same selection criteria here. The system only processes cases that have been assigned these selection criteria by the case selection.
  • Med. Doc. Status Key
  • Med. Doc. Status Profile

Further options

  • Log
When you select this option, the system generates a log of the processed cases.
  • Layout (Display Variant)
You can use this option to control the log layout. To use this option, you must also select the Log option.
  • Test
When you select this option, the system only displays the processed cases - it does not actually generate real dispatch orders.
  • Create messages directly
If you select this option, the system automatically triggers the message formatting relevant to the data exchange at the end of the run.

Output

Output The report writes a data record to dispatch order table NC301. This is used as a trigger to generate a new message during the next message formatting (program RNC30100).

If you have selected log, the system displays all available information about dispatch orders in the standard layout:

  • Case
  • Patient
  • Patient 's Name

You can create your own layout as well.

If you have not selected log, the system displays the number of processed cases and created dispatch orders in a message.

If you have selected create messages directly, the system always displays a log of the executed message generation.






CPI1466 during Backup   Addresses (Business Address Services)  
This documentation is copyright by SAP AG.

Length: 15831 Date: 20191021 Time: 140927     sap01-206 ( 76 ms )

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