TB PATIENT MANAGEMENT PROJECT BUSINESS USE CASE SPECIFICATION 104: BILLING

Transcription

1 TB PATIENT MANAGEMENT PROJECT BUSINESS USE CASE SPECIFICATION 104: BILLING Version /23/2004 This document has been developed by Science Applications International Corporation (SAIC) under a contract with the U.S. Centers for Disease Control and Prevention Department of Health and Human Services.

2 VERSION HISTORY Date Version Description Author 08/07/ Initial Draft T. Oemig 09/02/ Revised R. Tracy 09/12/ Revised on include (UCTR311) R. Tracy 01/16/ Revise style template G. Casdorph 02/10/ Revise from reconciliation of Post-JAD session Use G. Casdorph Cases to Final Use Cases 02/23/ Document baselined per PM CCB. G. Casdorph Revision Date: 02/23/2004 Page 2 of 6

3 TABLE OF CONTENTS 1 BUSINESS USE CASE 104: BILLING Brief Description Actors Activity diagram Flow of Events Pre-Conditions Triggering Event(s) Basic Flow Alternative Flows Post Conditions Relationships Requirements Functional Capabilities Business Rules Supplemental Requirements Sources Issues... 6 Revision Date: 02/23/2004 Page 3 of 6

4 1 BUSINESS USE CASE 104: BILLING 1.1 BRIEF DESCRIPTION This business use case will allow a user to gather billing information so that appropriate TB-related services can be billed and reimbursed. Depending on the regulations for a jurisdiction, all or part of TB services may not be entirely unbillable to any agency, insurance company or other third-party. 1.2 ACTORS Health Care Worker (HCW) Contract Service Worker Clerical staff Billing staff 1.3 ACTIVITY DIAGRAM 1.4 FLOW OF EVENTS Pre-Conditions The user must have proper security rights to enter and view billing information The patient must exist in the system The user must be viewing the patient information in the system Health department identifies/verifies patient's payment source (Private health insurance, including third-party sources, such as Medicaid.). This determination may be made through the patient or searching other databases Triggering Event(s) A TB-related service is provided or arranged Basic Flow User selects Billing option System displays Billing screen User enters payment information into system. (Patient doesn t know eligibility status for Third Party payment, see alternate flow) User documents provision of TB-related service in system User selects the option to generate a bill. Revision Date: 02/23/2004 Page 4 of 6

5 System generates bill User documents payment User document care and progress notes (UC.311.Document Care Note) System generates receipt Use case ends Alternative Flows Patient has no third-party payment source, but may be eligible for Medicaid Health department staff enters Medicaid eligibility data and generates Medicaid application form (using Medicaid required data as well as patient demographic data). Form is submitted to Human Services Department Health department staff receives acknowledgement that patient is enrolled in Medicaid Use case continues Patient has no third-party payment source and is not eligible for enrollment in a program Use case ends Post Conditions A payment source is billed for the TB-related service provided A receipt is generated for patient payment(s) Relationships UC.102.Demographics (to enter and/or complete gathering demographic information) UC.105.Schedule Appointment (to schedule appointments for testing, assessment, follow-up visits, therapy, chest x-ray, etc) UC.402.Manage Care Plan (to determine the appropriate services, materials, tests, medications, etc that can be submitted for billing). 1.5 REQUIREMENTS Functional Capabilities Business Rules Supplemental Requirements Revision Date: 02/23/2004 Page 5 of 6

6 1.6 SOURCES 1.7 ISSUES # Issue Opened Owner Status mm/dd/yy Revision Date: 02/23/2004 Page 6 of 6