Health Funds (Adding and Editing)

Before you begin

Creating Accounts: Entering a New Health Fund- Running Time: 01:19

For convenience, ensure you have done the following first:
  • Created a Fee List for your Health Fund.
  • Setup Bluechip to associate Health Funds with an Address Type of 'Health Fund', as shown in the following image. This is done in the same way you configure Company Groups.

Procedure

To add a new health fund:
  1. From the Bluechip main window, either:
    • Click Folder IconFolder icon
    • Press Ctrl + O
    • Select File > Open
  2. In the Open window, from the List drop-down list, select Health Funds. From here you can search for and select an existing Health Fund record, and then view/edit the record by clicking Open. To create a new record, continue to Step 5.
  3. Click New. The New Company window appears. As a Health Fund is considered a subset of 'Companies', the same window for creating new Companies is used.
    Items of note on this window
    Health Fund Properties Fee List:

    The Service Item list that you use for billing to this health fund. See Creating and Deleting Service Item Lists.
    Eclipse IMC/IHC Setup Fund ID:

    Select the Health Fund you will use for Eclipse Inpatient Medical Claiming or In-Hospital Claiming.
    In-Patient Medical Claiming (IMC) Setup:
    Select the claim type (Agreement or Scheme) that you want associated with this health fund. Then, click the Setup Practitioners Claim Type button to specify which practitioners participate in a fund scheme, and which a fund agreement.
    In Hospital Claiming (IHC) Setup:

    Indicate the IHC Fee List you want to use for In Hospital Claiming.

    Tick the Equitable Payment Model (EMP) check box to indicate that you have one or more practitioners who use an Equitable Payment Model with this health fund. Then, click the Setup Practitioners EPM button to flag the specific practitioners.

    The Prosthesis Code is a read-only field. Select a code by clicking the Change Prosthesis Code button. This calls the Eclipse IHC Setup window, where you can edit the Prosthesis Code. Click within the Prosthesis Code field, and enter the required code.
  4. Enter details as appropriate, including selecting 'Health Funds' as the Company Group (selected by default), and the associated Fee List you created at Step 1, for the Health Fund.
  5. Click OK to confirm. The new record is added to the list of Health Funds and you are presented with the Company Details window. From here you can also manage the Health Fund's Representatives.
  6. If you intend to the use the Health Fund for Inpatient Medical Claiming then:
    • Select the Fund ID (Insurer Code).
    • Select the default Claim Type for the Health Fund (either 'Scheme' or 'Agreement').
    • Click Setup practitioners claim type. The Health Fund Practitioner Claiming Types window appears.

    • Indicate whether each practitioner is associated with a fund scheme or fund agreement, by selecting them, and clicking the <> buttons to move them between fund sections.
  7. Click Save to confirm your selections. You will be returned to the Company Details window.
  8. If you intend to use the Health Fund for In-Hospital Claiming then:
    • Tick the Equitable Payment Model (EPM) check box.
    • Click Setup practitioners EPM. The Health Fund Practitioner Claiming Types window appears.

    • For each practitioner, indicate whether or not they use an Equitable Payment Model with the health fund, by selecting them, and clicking the < > buttons to move them between Fund sections.
  9. Click Save to confirm your selections. You will be returned to the Company Details window.
  10. Ensure you save the changes made to this window, by clicking Save icon located at the top-left of the window.

Results