Medical Aid Member Checking and Claiming

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Hari S.Neoadams I. have already sent a proposal.
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Experience Level: Intermediate
\"medilink\" - Providing a verification service to healthcare professionals for the members of contracted medical aid societies.

I think that we should break it down into 3 distinct parts based on what we want to achieve. And for ease of implementation.

Phase One (MediCheck)

We simply have a web page that can query a database as to a members validity.

This web page should include:-

All the info about what we do and the services we offer with a link to another login page.

The reason for this is so that the next login page can be text based so the speeds on a slow connection are acceptable. We will control the entry of this data initially through myPHPAdmin for the first beta sites as this will enable you to concentrate on the interface that the healthcare provider sees and the functionality.

Once the healthcare provider is authorised, they will be logged in and will have the next screen that will primarily be used for medical aid member verification.

Membership_No Medical_Aid_Scheme SUBMIT REPLY

The screen to have the following input boxes, Membership Number, on a dropdown menu for the medical aid schemes eg FML-Opal, FML-SapphirePlus, FML-Sapphire, FML-Amber, FML-Coral, FML-Topaz - The healthcare provider will be simple sent the reply \"Member Valid\", \"Member NOT Valid\" or \"Please contact the Scheme Directly\"

Phase Two (MediClaim)

We introduce and populate some more tables in the database that will enable us to validate the medical aid members membership status and check whether the claim may be authorised and to what level, ie how much will the healthcare provider get. The screens should be different for each healthcare professional, ie pharmacists should have a drug screen (drug_code) entry and doctors a treatment (tariff_no) entry

The healthcare providers screen will basically have additional information the will enable them to work out what the medical aid member should pay the provider directly

Membership_No Medical_Aid_Scheme SUBMIT REPLY
Tarrif_No, (Drug or Treatment),Qty, Charge, REPLY (TotalAward) REPLY (ShortFall)

The logic that is to be applied to the above is if the first submit queries the database and the Membership_No is valid for the entered medical aid then the next boxes are available for entry. If the tariff_no is null and the drug or treatment may be looked up in a tariff_master_table. The user enters the quantity and the charge. Once the submit button is clicked, the database is queried to return the award that that medical_aid_scheme will pay. This is where the we would have to check two parameters, one is it within the balance left for this Membership_No and if is then go on to the calculation of award from the medical_Aid_Schemes rules, ie tariff_No 1544 is paid at $1.20 per tablet. etc

Phase Three (MediCash)

We introduce the last concept of medical aid claim submission which is the addition of a claim button to the page. this should reply with a reference number for the claim. This claim will be stored in a received_claims_table which when submitted to the medical aid societies is copied to a submitted_claims_table and when paid to an awarded_claim_table. This will enable a differentiation for reporting for the healthcare provider to see their claim status.

I have attached a sql script to create the tables as I have them visualised, please have a look and let me know where improvements can be done. The database was called medi_check, please create the database and run the script inside to get the tables.

Please can you revert with any questions that you may have to the above, I know that it is an oversimplification but basically as it is to work and thus we can go into the back end functionality to get there.

The database is to be MySql and the interface into it a webpage with embedded PHP scripts

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