Entering a Claim (SAP Library - Benefits (PA-BN))

Entering a Claim

Use

This procedure allows you to enter a claim submitted by your employees for any one of the claim plans he or she is eligible for.

Prerequisites

You must have enrolled the employee in the claim plan for which you enter the claim by choosing Human Resources ® Personnel management ® Benefits ® Claims (Asia) ® Enrollment on the SAP Easy Access screen.

Certain features like evidence of insurability, pre- and corequisite plans and investments are valid only for benefit plans and not for claim plans.

In Customizing for Claims, you must have set up the claim plan limit, the dependent coverage and the co-payment options for the plan in the step Define Claim Rule for Plan.

In Customizing for Claims, you must have set up the overclaim options for the plan in the step Define Claim Variant for Plan.

In Customizing for Claims, you may have defined the claim program limit for the claim amount in the step Define Claim Rule for Program.

In Customizing for Claims, you must have assigned a panel of doctors to the plan in the step Assign Claim Plan Attributes.

Procedure

On the SAP Easy Access screen, choose Human Resources ® Personnel management ® Benefits ® Claims (Asia) ® Entry.

The Claims Processing – Main Program screen appears.

In the Period group box, select the appropriate period indicator. If you select the Other period indicator, enter the appropriate date or a range of dates.

In the Selection group box, you may select any one of the criteria or a combination of different criteria listed below:

Enter the personnel number or a range of personnel numbers of your employees for whom the claim has to be entered or leave blank for all personnel numbers.
Enter a personnel area, or a range of personnel areas, or leave blank for all personnel areas.
Enter the personnel subarea, or a range of personnel subareas, or leave blank for all personnel subareas.
Enter the employee group, or a range of employee groups, or leave blank for all employee groups.
Enter the employee subgroup, or a range of employee subgroups, or leave blank for all employee subgroups.
Enter the payroll area, or a range of payroll areas, or leave blank for all payroll areas.

In the Additional data group box, further selection criteria are available. You may restrict your selection of employees based on the criteria below too.

Enter the benefit area, or a range of benefit areas, or leave blank for all benefit areas.
Enter the 1^st program grouping, or a range of 1 ^st program groupings, or leave blank for all 1 ^st program groupings.
Enter the 2^nd program grouping, or a range of 2 ^nd program groupings, or leave blank for all 2 ^nd program groupings.

After entering the criteria of your choice, execute the function.

The Claims Processing: Data Entry screen appears. The list of claims already entered for the employee during the specified period is displayed if available, or else a blank screen is displayed.

To enter a new claim, choose Insert line.

A new record is inserted and the current date is displayed in the Claim Date field.

To enter a new claim, you can also select an existing claim and choose Copy. A new record is inserted with the data from the selected claim. You can make changes to this record.

Enter data in the Bill Date field. The claim is validated based on the date entered in this field.
In the Claims field, select a plan from the list of plans that are valid as of the bill date.

On selecting a plan, the overclaim option defined for the plan during Customizing is automatically displayed in the Over Claim Option field.

Enter data in the Bill No and the Claim Amount fields and choose Enter.

Based on the co-payment option for the plan defined in Customizing and the claim amount entered, the EE Amount, ER Amount and the Overclaim Amount fields are automatically populated.

If required, enter data in the Patient and Dr.ID fields and set the Referal indicator.

Data in these fields are required only for certain plans. Certain plans may not be associated to any panel of doctors, or may not be available for dependents.

If the plan selected is a hospitalization plan, enter the number of days in the Days in Hosp field.
Set the Bill indicator if the claim is of type Bill. Otherwise, it is assumed that the claim is of type Receipt.
If there is any non-reimbursable amount that is part of the claim, enter the amount in the Non-Reimb Amount field. This amount is excluded for claims reimbursement.

You must enter this amount only if the claim is of type Bill. This amount is deducted from the employee’s salary or wages during payroll.

Save your entries.

Result

The status of the claim you have entered is set to To be accounted. If the claim is to be considered for payroll, you need to perform the procedure Accounting a Claim.