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/ISHFR/NFR169 - Service &1: Coverage amount smaller than reduction (ins. prov. &2) - /ISHFR/NFR 169

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Diagnosis

The amount covered by insurance provider for service is smaller than the amount that should be deducted from the social insurance fund, and for which the patient should be billed, due to the fact that the coordinated care path was not adhered to. This would result in a negative coverage amount for the social insurance fund.

System Response

The system cannot perform payment distribution correctly. It is not possible to bill the case.

Procedure

Please check:

  • The definition of the contract scheme assigned to the social insurance fund
  • If there are individual adjustments to the contract scheme
  • If there are manual adjustments in the individual payment distribution
  • The values for the deduction in the Customizing table Payment Distribution - Coverage According to Care Path

Procedure for System Administration






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This documentation is copyright by SAP AG.

Length: 1131 Date: 20191017 Time: 143431     sap01-206 ( 7 ms )

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