Object documentationContract Scheme

 

Classification of insurance relationships (IRs) to further qualify a patient's IR.

 

You can specify the services covered in the IR more precisely by means of the contract scheme. Its use is dependent on the respective insurance verification procedure:

  • If you use insurance verification (for example, in the country versions Germany and Austria), you can define preapproved insurance and default values per insurance provider in the contract scheme.

    For more information, see Customizing for SAP Healthcare – Industry-Specific Components for Hospitals under Start of the navigation path Patient Accounting Next navigation step Business Partners/Insurance Relationships Next navigation step Maintain Contract Schemes End of the navigation path.

  • If you use payment distribution (for example, in the country versions Singapore, Canada and Switzerland), you can make payment distribution settings in the contract scheme. The system assigns particular services to an IR dependent on these specifications.

    For more information, see Customizing for SAP Healthcare – Industry-Specific Components for Hospitals under Start of the navigation path Patient Accounting Next navigation step Business Partners/Insurance Relationships Next navigation step SG, CH, CA: Maintain Contract Schemes End of the navigation path.

    You can modify the contract schemes for a specific case. For more information, see Maintaining Individual Contract Schemes (CH,SG,CA).

You specify the contract scheme in the ContSc field in the Maintain Insurance Relationships function (transaction code NV33).

The IS-H: Contract Scheme Where-Used List program (RNUVTRTY) enables you to determine for each contract scheme all of the cases that contain this contract scheme, and to have the case data and IR data output in list form.

Note Note

If you have activated the business function SAP Patient Management: Legal Process Adoption (ISH_MISC1), additional selection criteria such as service category, charge type, tariff type, and grouping key are available in addition to the service code and service group.

End of the note.

For a list of the selection criteria, see Customizing for SAP Healthcare under Start of the navigation path Patient Accounting Next navigation step Business Partners / Insurance Relationships Next navigation step Selection Criteria for Contract Scheme Items End of the navigation path.

You can add customer-specific selection criteria using the Business Add-In (BAdI) ISH_CONTRACT_SCHEME.

You activate the BAdI in Customizing for SAP Healthcare under Start of the navigation path Patient Accounting Next navigation step Business Partners / Insurance Relationships Next navigation step Business Add-Ins for Contract Schemes Next navigation step IS-H: BAdI for Contract Schemes End of the navigation path.

Note Note

When activating an insurance relationship from the insurance relationship proposal pool for a specific case, the system uses the contract scheme from table NPIR that was used last. However, this contract scheme does not always match the case type of the current case. For this reason, the system now only proposes the contract scheme if the case type defined in Customizing for the contract scheme at header level matches that of the current case.

If the case type in the contract scheme does not match that of the case, the system displays the information message NZ 053 (Contract scheme cannot be copied from proposal list).

End of the note.

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