H-SPIS v4 User Manual

H-SPIS v4.0

Page 1

H-SPIS v4.0 MIS Platform for SHP (Informal Sector)

User Manual

Draft Version

June 2014

H-SPIS v4.0

Page 2

Table of Contents

1 Overview ......................................................................................................................................... 5

1.1 Acronyms and Abbreviations .................................................................................................. 5

1.2 Key definitions ........................................................................................................................ 7

2 Accessing the system ...................................................................................................................... 8

2.1 Login ........................................................................................................................................ 8

2.2 User Right for IT Admin ........................................................................................................... 9

2.3 Screen Layout .......................................................................................................................... 9

3 Members ....................................................................................................................................... 10

3.1 Households ........................................................................................................................... 10

3.1.2 Household’s members (Beneficiaries) .......................................................................... 15

3.1.3 Household Contracts/Policies ....................................................................................... 17

3.1.4 Premium Collection ....................................................................................................... 18

3.1.5 Membership Coverage Period ...................................................................................... 21

3.1.6 Medical History ............................................................................................................. 22

3.1.7 Other Benefit ................................................................................................................ 23

3.2 Contracts/Policies ................................................................................................................. 25

3.3 Beneficiaries .......................................................................................................................... 26

3.4 Group Enrollment ................................................................................................................. 27

3.4.1 New Employer ............................................................................................................... 27

3.4.2 Group/Employer Contracts ........................................................................................... 28

4 Utilization/Claims .......................................................................................................................... 28

4.1 Cash-less Claims .................................................................................................................... 29

4.2 Cash-based Claims ................................................................................................................ 33

5 Providers ....................................................................................................................................... 35

5.1 Health Facilities ..................................................................................................................... 35

5.2 HF Services ............................................................................................................................ 36

5.3 Health Facility Transportation .............................................................................................. 38

5.3.1 Health Facility Transportations List ............................................................................... 38

5.3.2 New Health Facility Transportations ............................................................................. 38

5.4 Pharmacies ............................................................................................................................ 38

5.5 Health Facility Contracts ....................................................................................................... 40

5.6 Contracts with Pharmacies ................................................................................................... 40

6 Operators ...................................................................................................................................... 41

H-SPIS v4.0

Page 3

6.1 Operators .............................................................................................................................. 42

6.2 System Users ......................................................................................................................... 42

6.3 User Profiles .......................................................................................................................... 44

6.4 Product Types ....................................................................................................................... 47

6.5 Products ................................................................................................................................ 47

6.5.1 Update Premium Info.................................................................................................... 48

6.5.2 Update Contract Info .................................................................................................... 48

6.5.3 Other benefic Info ......................................................................................................... 49

6.6 Other Benefits ....................................................................................................................... 49

6.7 Lumpsum (Case-based) ......................................................................................................... 49

6.8 Claims .................................................................................................................................... 50

6.9 Coupons ................................................................................................................................ 50

7 Tools .............................................................................................................................................. 51

7.1 General Tools ........................................................................................................................ 51

7.1.1 Non Beneficiaries .......................................................................................................... 51

7.1.2 Utilization Validations ................................................................................................... 52

7.1.3 Close Entry .................................................................................................................... 53

7.1.4 Non Payments ............................................................................................................... 55

7.1.5 Households Rollback ..................................................................................................... 55

7.1.6 Household Balance........................................................................................................ 55

7.1.7 Balance Transfer ........................................................................................................... 55

7.2 Complaints ............................................................................................................................ 55

7.3 Surveys .................................................................................................................................. 55

7.4 Integrated Documents Management ................................................................................... 57

7.5 SMS ....................................................................................................................................... 58

8 Reporting....................................................................................................................................... 58

8.1 Operator Reports .................................................................................................................. 59

8.1.1 Active Household .......................................................................................................... 59

8.1.2 Premium Collection Report ........................................................................................... 60

8.1.3 Meeting Report ............................................................................................................. 61

8.1.4 Premium Consolidated Receipt..................................................................................... 62

8.1.5 New Enrollment Summary Report ................................................................................ 62

8.1.6 Household Waiting Report ............................................................................................ 63

8.1.7 Outreach Report ........................................................................................................... 64

H-SPIS v4.0

Page 4

8.1.8 Over Utilization Report ................................................................................................. 64

8.1.9 Utilization Report .......................................................................................................... 65

8.2 MoH Reports ......................................................................................................................... 67

8.3 Query Tools ........................................................................................................................... 67

9 Settings .......................................................................................................................................... 68

9.1 Exchange Rate ....................................................................................................................... 68

9.2 Reference data ...................................................................................................................... 70

9.2.1 General data .................................................................................................................. 70

H-SPIS v4.0

Page 5

1 Overview

This user manual focus on how to use H-SPIS v4.0 to manage information on operator

configurations (products, premiums, benefit packages etc.), memberships (enrolment,

renewal, dropout and join-back), premium collections and promotions, system users and

user profiles, tools (daily administration tools, complains surveys, integrated documents

management and SMS), utilizations (medical and non-medical, cash-less and cash-based

claims) at Health facilities, reporting (operators, MoH and custom reports) etc.

1.1 Acronyms and Abbreviations

AF Access Facilitator

AFD Agence Française de Développement

AFH Action for Health

AHC Angkor Hospital for Children

ALOS Average Length of Stay

BfH Buddhism for Health

CAAFW Cambodia Organization for Assistance to Families and Widows

CBHI Community-Based Health Insurance

CHC Cambodian Health Committee

CHO Cambodian Health Organization

CPA Complementary Package of Activities

DBO Database Officer

DEO Data Entry Officer

DPHI Department of Planning and Health Information System

DoB Date of Birth

DRG Diagnosis-Related Group

DVL Delivery

FHD Family Health Development

GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit

GRET Groupe de Recherches et d'Echanges Technologiques

HC Health Centre

HCMC Health Centre Management Committee

HEF Health Equity Fund

HF Health Facility

HIP Health Insurance Project

H-SPIS v4.0

Page 6

HNI Health Net International

H-SPIS Health Social Protection Insurance System

HSSP2 Second Health Sector Support Project

KSFH Khmer-Soviet Friendship Hospital

MIS Management Information System

MoH Ministry of Health

MPA Minimum Package of Activities

SKY Sokaphheap Krousar Yeung

IA Insurance Agent

IPD Inpatient Department

MIA Micro Insurance Academy

MIS Management Information System

NGO Non-Governmental Organization

NSSF National Social Security Fund

OD Operational District

OPD Outpatient Department

PC Personal Computer

PCHSFA Pursat Community Health Support Fund Association

PH Provincial Hospital

PM Project Manager

PMRS Patient Management and Registration System

RACHA Reproductive and Child Health Alliance

RH Referral Hospital

SHP Social Health Protection

SHPA Social Health Protection Association

SOP Standard Operating Procedure

SRS Software Requirement Specification

STSA Angkor Chum OD cooperative Health Insurance

UI User Interface

URC University Research of Cambodia

USAID United States Agency for International Development

VIP Village Insurance Promoter

VIV Village Insurance Volunteer

H-SPIS v4.0

Page 7

VM Voluntary Membership

1.2 Key definitions

Table 1: A listing of terms and acronyms used throughout this document.

Term Definition

Benefit Package Services that a VM scheme offers to members.

Capitation A payment mechanism where a fixed rate (per month), whether per

person, family, household or group, is negotiated with a health care

provider who shall be responsible for delivering or arranging for the

delivery of health services required by the covered person under the

conditions of a health care provider contract.

Case Base Payment Lump sum payment made by Operator to a contracted health facility for a

patient treated by the provider.

Cycle A cycle is a minimum period (months) of coverage.

Complementary

Package of Activities

(CPA)

Refers to the activities undertaken at the referral hospital level. Three

levels of CPA packages exist: CPA1, CPA2 and CPA3.

Death certificate Provided by the village chief to the member in order to receive the death

benefit.

Discharge Letter Official document produced by medical staff at hospital to allow the patient

to go back home. Some schemes use it as an evidence for IPD case.

Enrolment The process determined by the VM scheme to enlist households as

members covered by the VM scheme.

Enrolment Period The period during which a scheme accept member enrolments (new,

renewal and join-back). Normally during November and December.

Fee for Service A health care payment system in which health care providers receive a

payment for each unit of service.

Grace Period When a household is not able to pay the premium but still want to continue

the membership, there is a grace period during which the household can

catch up with payments, and is allowed to receive healthcare.

Group Enrolment

HF Receipts Given by health facilities when a member is paid directly. It is used as

evidence for exceptional benefits reimbursement.

H-SPIS v4.0

Page 8

Household A group of persons usually living together under the same roof and

composed of the head and other persons related to the head by blood,

marriage and adoption and depend financially on the head.

Member Any person on whose behalf premium contributions have been regularly

paid to the VM scheme.

Minimum Package of

Activities (MPA)

Refers to activities undertaken at the health centre level.

Operational District

(OD)

Refers to the peripheral sub-unit within the health system closest to the

population. It is composed of health centres and a referral hospital.

Prescription Document issued by a medical staff. Some schemes use it as evidence for

payment of drugs or exceptional benefit.

Referral Slip Document provided by a lower health facility to refer the member to an

upper one.

Waiting period A period during which premiums are paid but without entitlement to

benefits normally referred to (1) pregnancy-related benefits (e.g.

Deliveries) and (2) elective surgeries.

2 Accessing the system

2.1 Login This application is password protected so that any unauthorized persons cannot access the

application and change your data.

So every time you want to use the platform, you have to enter your correct username and

password.

Figure 1. Login Screen

H-SPIS v4.0

Page 9

The first screen of the H-SPIS v4.0 is login screen. This screen requires user to input User

Name and Password fields then press Log In button to verify. If the user exists in the

system, it will go to main screen. Otherwise it will alert Access Denied message.

2.2 User Right for IT Admin

IT Admin can access according to the assigned privilege of “IT Admin” in User Profiles.

Screen Members Claims Providers Operators Tools Reporting Setting

Assigned Privilege

Full Full Full Full Full Full Full

2.3 Screen Layout

After User login successfully Main screen appear as bellow.

Main Screen Left Menu

Top Menu

H-SPIS v4.0

Page 10

3 Members Under Members menu, there are four menu items: Households, Contracts, Beneficiaries

and Groups.

3.1 Households Household List views all Households (active and inactive) at first time or by filtering in

search panel. And Beneficiary List will view the beneficiaries of selected Household (active

and inactive). Search panel allows user to search Household and beneficiary by its Code,

name, Household Coverage starting date, Beneficiary’s code, Beneficiary’s name,

coverage start date, Health Facility then click on Search button to filter data.

Figure 2. List of Households

Household List

Field Description

Household Code Auto generate code by (Operational District code + Health Facility code + Increment number)

Name Full name in Latin

Name (KH) Full name in Khmer

Size of Household Number of active beneficiary

Registered date Date of Household Enrollment

H-SPIS v4.0

Page 11

3.1.1.1 New Household

On Household and Beneficiary List view, when user clicks on New Household button, the

creation screen will appear. User must input the required field (yellow box).

Figure 3 : New Household

Field Name Description Required

Household Code Auto generate code by (Household code + Increment of letter (starting from A to Z))

Yes

Operator Defined Operator Yes

OD Defined Operational District Yes

HF List the defined HF or All HF that is defined in Agent Configuration

Yes

Last name Last name in Latin Yes

First name First name in Latin Yes

Last name (KH) Last name in Khmer Yes

First name (KH) First name in Khmer Yes

Marital status Marital status of Policyholder No

Year of birth Year of birth of Policyholder No

Gender Gender of Policyholder No

ID card no ID card number of Policyholder No

Occupation Occupation No

Size of Household Number of active beneficiary. It will increase or decrease when beneficiary was created, activated or

Yes

H-SPIS v4.0

Page 12

deactivated.

Registered date Date of Enrollment Yes

Sector population List of sector population Yes

Poverty level List of poverty level Yes

Member facilitator

List of Agent of current OD No

Employer List of Contracted Employer No

HEF Is Equity Fund No

Staff Household Is Household of staff No

Coverage staring date

Date of start using product. It will be set automatically when Registered Date was changed. And It will be updated automatically when Household was activated by Renew or Rollback tools

Yes

Coverage ending date

Date of stop using product. It will be updated automatically when Household was deactivated by Non-payment and Household balance tools

No

Status Active or Inactive Household Yes

Province Which province the Household is in? Yes

District Which district the Household is in? Yes

Commune Which commune the Household is in? Yes

Village Which village the Household is in? Yes

Group no Which group number that Household is in? No

Address Extra address information No

Telephone Telephone No

3.1.1.2 Household Detail

On Household and Beneficiary List view, select a Household then click on Detail tab. It will

display the information of as below.

H-SPIS v4.0

Page 13

Figure 4 : Household Detail

3.1.1.3 New Beneficiary

On Household List, Select a Household then click on New Beneficiary button. The

creation screen will appear. User must input the required field (bold label).

H-SPIS v4.0

Page 14

Figure 5. New Household


Code Auto generate code by (Household code + Increment of letter (starting from “A” to “Z”))

Yes

Last name Last name in Latin Yes

First name First name in Latin Yes

Last name (KH) Last name in Khmer Yes

First name (KH) First name in Khmer Yes

Marital status Marital status of beneficiary No

Year of birth Year of birth of beneficiary Yes

Gender Gender of beneficiary Yes

Kinship Relational Household. In one Household must have only one “Head of household”

Yes

ID card no ID card number of Policyholder No

Occupation Occupation No

State Beneficiary It can be “Individual IN”, “New baby born”, “Dead” and “Individual Out”.

- It can be blank when new beneficiary is created immediately after Household is created.

- It must be “Individual In” or “New baby born” (based on rule) when new beneficiary is created while Household is using product.

- It must be “Individual In” when beneficiary is

Yes

H-SPIS v4.0

Page 15

activated.

- It must be “Dead” or “Individual Out” (based on rule) when beneficiary is deactivate

Coverage starting date Date of start using product. It will be updated automatically when Renewing Household and Renewing Beneficiary by setting state beneficiary as “Individual IN”

Yes

Coverage ending date Date of stop using product. No

Status Active or Inactive Beneficiary Yes

Remarks Remarks

3.1.2 Household’s members (Beneficiaries)

On Beneficiary List, select a beneficiary then click on Beneficiary detail tab. It will display

the information as follows:

H-SPIS v4.0

Page 16

Figure 6. Household Detail

Beneficiary List

Field Description

Beneficiary Code Auto generate code by (Household code + Increment of letter (starting from “A” to “Z”))

Full Name Last name and first name in Latin

Full Name (KH) Last name and first name in KHMER

Gender Gender

Age Age of beneficiary

Kinship Relational Household

Action Description

Save Allow user to edit beneficiary info

Upload Image Allow user to upload image to server. When user click on Upload Image, the following dialog appear. Then user can select an image to upload. After selection, the below progressing appear

Tips:

- Name of beneficiary : Left top blue text

- Creation and modification info : Right top text

H-SPIS v4.0

Page 17

3.1.3 Household Contracts/Policies

To manage membership contracts/policies with a household, go to Members >

Households > Households, select the household from the list; then click on Contracts tab.

Figure 7. List of Contracts

Field Name Description

Code Household contract code, It generate automatically by (Product Code + Household Code + Month Year of Start Coverage Date)

Product name Contracted product name

Price Monthly Premium

Start date Date of start using product

End date Date of end using product

Active Status of the record, checked if active.

Action

New Allow user to create new Household contract

Delete Allow user to delete the selected Household contract

Refresh Get current data


Code Auto generated code by (Product Code + Household Code + Month + Year)

Yes

Registered Date Date of Household Enrollment Yes

Size of Household Assign automatically the value that match the real size of Household

Poverty level Inherit from Household

Applied sector price List of sector price

H-SPIS v4.0

Page 18

Type of product List of type product of current Operator

Product name These products are filtered by Size of Household, Poverty level, Applied sector price and Type of product

Yes

Price Monthly premium of selected product Yes

Coupon As month, to encourage the beneficiary that using the selected product. Or It is for the promotion period.

No

Start date Date of start using product Yes

End date Date of end using product No

Active It will be Active when creating new contract, renewing Household or Household rollback. It will be Inactive when Household is dropped-out by Non-Payment or Household Balance tools

Yes

On Household Contract screen, select a contract then click on Detail tab. It will display the

information of beneficiary contract as below screen.

Figure 8. Contract Form

3.1.4 Premium Collection

To manage premium collections, go to Members > Households > Households.

You can record all premium collections from members to insure the contracted product by

month. You can input the several payments for a month.

On Household List, select a Household then click on Premium payment tab. Then it will

display all payments of selected product as below screen.

H-SPIS v4.0

Page 19

Figure 9. Premium Collection Form

There are 3 parts: Household contract, Contract Info and Payment List.

Household Contract:

List all active and inactive contracted products. By default, it selects the last contracted

product. When user selects a contracted product, the data in Contract Info and Payment

List will be changed.

Contract Info:

Label Name Label Description

Due date Current coverage period

Due premium Required payment for the Household including coverage for next month missing reserve if needed

Monthly premium Amount of the money to be paid monthly by the Household to be covered for the next month

Reserve balance Amount of money currently available in the reserve

Advanced balance Amount of money currently available in the advanced

Bonus Sum of Advanced Bonus’s amount and Regular Bonus’s amount

Coverage until Period of last coverage date. It bases on Reserve balance, Advanced balance and Bonus

H-SPIS v4.0

Page 20

Payment List:

There are two types of data (lock and unlock). User can’t modify the locked data.

Field Description

Locked Display lock or unlocked payment. The data will be locked after running Close Entry

Due date Date when user paid money during month

Receipt no Receipt number of payment

Total amount Total paid amount that include Discount amount, Coupon amount and Cash paid

Paid date Date of payment

Cash paid Cash amount that beneficiary paid

Discount Discount

Coupon Coupon as month that contract got

Collected by Agent of Operator who collect the money

On Payment List view, select on new button. Then the creation screen will appear.

Figure 10. New Payment


Coverage date Current coverage period Yes

Receipt no Receipt number of payment Yes

Total amount Total paid amount that include Discount amount, Coupon amount and Cash paid

Yes

H-SPIS v4.0

Page 21

Discount Discount as percentage that get from the rule of advanced payment in product configuration. Example, Product configuration defined that if the advanced balance amount greater than 9 months, It will discount 10%

No

Coupon Coupon as month. For the first payment of the selected contract. It inherits from the coupon of contracted product.

No

Cash paid Cash amount that beneficiary paid No

Grand total amount The calculation between Total amount, Coupon amount and Discount amount

No

Paid date Date of payment Yes

Member Facilitator Agent of Operator who collect the money No

3.1.5 Membership Coverage Period

Coverage Info allows user to view the history of coverage premium. It displays by each

Household contract when user select it.

Figure 11. Membership Coverage Period

Field Description

Due date Coverage period of premium

Month of cycle This number will increase one after premium was created. It will set to 1 when cycle is completed. (bases on term of contract)

Monthly premium Contracted product’s price for a month.

Due premium Due premium

Regular pay This number will increase one for regular payment. It will set to one when it equals to Number of Regular Payment that configure in Product

Status Status of premium.

- OK : When premium was paid or used enough advanced balance

H-SPIS v4.0

Page 22

- ReserveCut1: When premium used enough reserve balance at first time.

- ReserveCut2: When premium used enough reserve balance at second time.

- Drop Out: When

Premium does not paid

Reserve balance, Advanced balance or Bonus don’t have enough amount to use

Month of cycle is equal to Term of Contract

- Drop Out In :

Premium does not paid

Reserve balance, Advanced balance or Bonus don’t have enough amount to use

Month of cycle is less than Term of Contract

3.1.6 Medical History

To record the medical history of beneficiary, go to Members > Households > Households,

select the household from the list; then from the list of beneficiaries (individuals), select

the beneficiary.

On Beneficiary List view, Select a beneficiary then click Medical History tab. Then it will

display all medical history of the selected beneficiary as below screen.

Figure 12. Medical History List

Field Description

Code Beneficiary contract code, auto generate code

Product name Contracted product name

H-SPIS v4.0

Page 23

Price Price in KHR / USD

Start date Start coverage date

End date End coverage date

Status Active / Inactive

On Medical History screen, when user clicks on new button, the creation screen will

appear.

Figure 13. Medical History Form


Medical history Medical history Yes

Note Note Yes

Validated It will be checked by Doctor after he validated.

On Medical History screen, select medical history record and click on Detail tab. It will

display the information of selected Medical history as below screen.

3.1.7 Other Benefit

Other Benefit module allow user to manage the payment to the product with type of other

benefit such as: funeral grant, funeral music etc.

On Beneficiary List view, Select a beneficiary then click on Other Benefit tab. Then it will

display all other benefit of the selected beneficiary as below screen.

H-SPIS v4.0

Page 24

Figure 14. Other Benefit List

Field Description

Product name Name of Product

Type of other benefit Type of Other benefit

Receipt no Indicate the number of receipt

Paid amount Paid amount, can be USD or KHR

Paid date Date of payment

Status Active or Inactive

On Other benefit List view, when user clicks on new button, the creation screen will

appear.

Figure 15 : New Other Benefit


Receipt no Indicate the number of receipt No

Product name Contracted product Yes

H-SPIS v4.0

Page 25

Type of benefit Type of other benefit Yes

Paid amount Paid Amount, it can be USD or KHR. Its value base on Product and Type of benefit

Yes

Paid date Date of payment No

Active No

On Other Benefit List view, select other benefit record and click on “Detail” tab. It will

display the information of selected Other Benefit as below screen.

Figure 16. Other Benefit Detail

3.2 Contracts/Policies To access directly the list of all beneficiaries, go to Members > Households > Beneficiaries.

H-SPIS v4.0

Page 26

Figure 17. List of Contracts/Policies

By default, only active records are displayed. To see inactive records, uncheck the Active

field in the search panel above the list.

More detail on the fields, see also 3.1.3 Household Contracts/Policies

3.3 Beneficiaries To access directly the list of all beneficiaries, go to Members > Households > Beneficiaries.

Figure 18. List of Beneficiaries

H-SPIS v4.0

Page 27

By default, only active records are displayed. To see inactive records, uncheck the Active

field in the search panel above the list.

More detail on the fields, see also 3.1.2 Household’s members (Beneficiaries)

3.4 Group Enrollment Manage the employer and configure the contracted between Operator and Employer with

product.

In search panel, user can filter employer by View as (All, Contracted, Non

Contracted, OD, Category Employer, and Description.

Administration Menu > Operator >Employers

Field Description

Code Auto generated code by (“EMP” + OD code + Increment number)

OD Operational District that the employer locates in

Description Name in Latin

Name (KH) Name in Khmer

Number of worker Number of workers are working

Category Employer Category of employer. Example, Employer, Group or Other

Status Active/ Inactive

3.4.1 New Employer

On Employer list, click on New button. The creation will appear.


Code Auto generated code by (“EMP” + OD code + Increment number)

Yes

OD Operational District that the employer locates in Yes

Description Name in Latin Yes

Name (KH) Name in Khmer Yes

Number of workers

Number of workers are working Yes

Category employer

Category of employer. Example: Employer, Group or Other

Yes

Province Which province the employer is in? Yes

District Which district the employer is in? Yes

Commune Which commune the employer is in? Yes

Village Which village the employer is in? Yes

Address Line 1 Address line 1. Example: Building No, Street,

Address Line 2 Address line 2

Telephone Telephone

Email Email

H-SPIS v4.0

Page 28

Comment Any Comments

Active Active/ Inactive

3.4.2 Group/Employer Contracts

It configures the contract between employer and contracts.

On Employer Contracts list, select the group/employer then click on Contracts tab. The

Contract List view will appear.

Field Description

Code Auto generated code by (Product code + Employer code + Month Year of starting date)

Product name List of all products of selected Operator

Premium price Price of contracted product

Sharing cost Percentage that employer will pay for employee. The remaining percentage will be paid by employee.

Start date Date of starting contract

End date Date of ending contract

Active Active / Inactive. When status is inactive, End date is allowed to input.

On Employer Contract list, click on New button. The creation will appear.


Code Auto generated code by (Product code + Employer code + Month Year of starting date)

Yes

Operator Which Operator that employer make contract with product in?

Yes

Product name List of all products of selected Operator Yes

Premium price Price of contracted product No

Sharing cost Percentage that employer will pay for employee. The remaining percentage will be paid by employee.

Yes

Term of contract Is number of months. It is used in Employer Report to define the auto renew member.

No

Start date Date of starting contract Yes

End date Date of ending contract No


Yes

4 Utilization/Claims There are two kinds of claims: (1) Cash-less claims at contracted health facilities and (2)

Cash-based claims that clients access the service at a non-contracted health facility where

s/he need to pay to the facility and then claim for reimbursement from the Operator.

H-SPIS v4.0

Page 29

4.1 Cash-less Claims This module allows user to record the utilization (cash-less) medical and non-medical

benefits such as medical service, drug, transportation (ambulance), etc. at contracted

health facilities.

Cash-less claims - List-view:

On Beneficiary List view, select a beneficiary then click Utilization tab. Then it will display

all utilizations (cash-less claims) of the selected beneficiary. When locked ( icon is

shown in the column Locked), the record is protected from any modification. But user can

modify the information on Drug and Transportation according to his assigned privilege.

Fig 19. Utilization List


Patient dossier Visit number as given by the HF Yes

HF Contracted Health Facility Yes

Category Category of the visit (OPD, IPD, etc.) Yes

Sub Category Sub Category visit, Its value base on Category visit Yes

Entry date Date of entry. It must be before or same as current date

Yes

Discharge date End date of the contact in case of hospitalization. It will automatic fill same as entry date when user select entry date with Category as OPD. It must be not after the current date and after or equal Entry date.

Yes

Hospitalization day Amount of days patience stay at hospital. If Entry date equals Discharge date, it will be 1 day.

Yes

Type visit Type visit Yes

Referral letter A letter which is sent to hospital to confirm patience date.

No

Referred by Who sign the letter for the patience? Yes

Lumpsum name Total of moneys have to pay for each health facility. Its value base on Selected Health Facility and Category Visit. It is enable, if the selected Health Facility has type payment as Lumpsum.

Yes, If it is enable

Type of diagnosis 1 Type of disease Yes

Diagnosis 1 Type of diseases in which person obtain. Note: users are not allowed to choose the same

Yes

H-SPIS v4.0

Page 30

diagnosis/per time. Its value base on Type of diagnosis 1

Type of diagnosis 2 Type of disease No

Diagnosis 2 Type of diseases in which person obtain. Note: users are not allowed to choose the same diagnosis/per time. Its value base on Type of diagnosis 2

NO

Invoice No Is the number of receipt which is noted to each invoice?

No

Ward Kind of ward in health center to choose service in it. Its value base on Health Facility and Category Visit

Yes

Service name Kind of service in each ward of hospital. Its value base on Ward

Yes

Service fee Applicable when Variable price is true Yes

Additional service Additional service No

Locked Record’s status whether it’s locked or not

Discharge date Date of discharge from the HF

Entry date Date of entry to the HF

HF Health Facility

Category Category of the visit (OPD, IPD, etc.)

Sub category Sub-category visit

Lumpsum name Lumpsum name

Diagnosis Display Diagnosis 1 and Diagnosis 2

Service fee Total service fee

Drug cost Total Drug cost

Transport cost Total Transport cost

Total cost Sum of Total service fee, Total Drug cost and Total Transport cost

On Utilization list view, select the utilization and click on Detail tab. It will display the

information of contact and services as below screen.

H-SPIS v4.0

Page 31

Figure 20. Cash-less Claim

4.1.1.1 Drug benefit

On the Drugs tab, there are two views: list view and form view.

Figure 21. Drug List

H-SPIS v4.0

Page 32

Figure 22. Drug Form


Pharmacy Name of the pharmacy Yes

Ward Which ward? Yes

Prescriber/Pharmacist Doctor who prescribes or the pharmacist No

Invoice No Invoice number No

Invoice date Date of issuing invoice Yes

Amount Claimed amount Yes

4.1.1.2 Transportation

On Utilization List view, select Utilization and click on Transportation tab:

Figure 23. Transportation List

H-SPIS v4.0

Page 33

Figure 24. Transportation Form


Type Coverage Type of coverage that patience used Yes

Distance Distance between HF and client’s home Yes

Invoice no Invoice number No

Invoice date Date of the invoice Yes

Amount Claimed amount for reimbursement Yes

4.2 Cash-based Claims Health Claim module allow user manage claim information of beneficiary include Contact,

Service usage, Drug usage and Transport usage.

From the Beneficiary List view, Select a beneficiary then click on Cash-based Claim tab.

Figure 25. Cash-based Claim List

Field Description

HF Non Contracted HF

Claim case Claim case

Policy type Policy type

Claim status Display Open / Close

Claim amount Amount of claim

H-SPIS v4.0

Page 34

Approved amount Amount that approved by Operator

Service cost Total service fee

Drug cost Total of Drug cost

Transport cost Total of Transport cost


Claim Status Claim status (Open or Close) Yes

Opening claim date Opening claim date Yes

Claim case Claim case Yes

Product name List all contracted product with beneficiary. Yes

Policy type Policy type. Its value base on selected Claim case and Product

No

Claim amount Claim Amount of beneficiary No

Policy amount Its value get from selected Policy type No

Approve amount Approved amount No

Member accepted Is member accepted? No

Closing claim date Closing claim date. It is enable, if Claim status is Close

No

Patient dossier Patient dossier Yes

OD List all OD Yes

HF Non Contracted Health Facility Yes

Category Category visit (IPD, OPD) Yes

Sub Category Sub Category visit, Its value base on Category visit Yes

Entry date Start date of the contact

Yes

Discharge date End date of the contact in case of hospitalization. It will automatic fill same as entry date when user select entry date with Category as OPD

Yes

Hospitalization day Amount of days patience stay at hospital. If Entry date equals Discharge date, it will be 1 day.

Type visit Type visit Yes

Type of diagnosis 1 Type of disease Yes


Yes

Type of diagnosis 2 Type of disease No


No

Invoice No Is the number of receipt which is noted to each invoice?

No

Ward Kind of ward in health center to choose service in it. Its value base on Non Contracted HF Service

Yes

H-SPIS v4.0

Page 35

Service name Kind of service in each ward of hospital. Its value base on Ward

Yes

Service fee Fee of service Yes

From the Cash-based Claims list view, double-click on the record or select a record and

then click on Detail tab.

Figure 26. Cash-based Claim Detail

5 Providers Under Providers menu, there are two groups/sections of menu items: (1) Institutions

(Health Facilities (HFs), HF Services, Pharmacies) and (2) Contracts (Contracts with HFs,

Contracts with Pharmacies).

5.1 Health Facilities To manage information on contracted pharmacies, go to Providers > Institutions > Health

Facilities (HFs). On the list view of HFs, user can filter the HFs by OD or search for a HF by

its code and/or name.

H-SPIS v4.0

Page 36

Figure 27. List of Health Facilities


OD Operational District Yes

Code Code of Health Facility Yes

Name Name in Latin Yes


HF Level National Hospital (NH), Provincial Referral Hospital (PRH), Referral Hospital (RH), Health Center (HC), Laboratory (Labs), etc.

Yes

Package Level MPA, CPA1-3, etc.

Households Number of Households in HF’s catchment area Yes

Population Total population (individuals) in HF’s catchment area Yes

Poor population Number of poor population in HF’s catchment area Yes

5.2 HF Services To manage HF services, go to Providers > Institutions > HF Services.

On the list view of HF Services, you can filter the HF Services by OD, HF, Ward and/or

Category or you can search directly for a HF service by its name.

H-SPIS v4.0

Page 37

Figure 28. List of HF Services

Figure 29. HF Service Form

Health Facility Services is a tool which is used to add or make change of service information that contain in specific Health facility.

In search panel, user can filter HF Services by OD, HF, Ward, Service name, Category.

Providers > Institutions > HF Services

Field Description

OD OD of selected HF

HF Health facility is selected into OD for service added.

Ward Type of service is scrolled by ward

Service name Services to be added into health facility

H-SPIS v4.0

Page 38

Category Type of categories respond to health facility

Price Fee of service

Status Active /Inactive

Covered product type Give the type of product to the service you choose.

5.3 Health Facility Transportation

Health Facility Transportation is a tool which is used to add price of Covered

distance and Coverage type of health facility in Operator. It will apply in Transportation

usage of Utilization.

5.3.1 Health Facility Transportations List

In search panel, user can filter Health Facility Transportations by OD, HF.

Providers > Providers > Transportations

Field Description

Operator Operator

OD OD of selected HF

HF Selected Health facility

Type of coverage Selected Type of coverage

Coverage distance Selected Coverage distance

Price Given price

5.3.2 New Health Facility Transportations

On Health Facility Transportations list, click on New button. The creation will

appear.


Operator Operator of login user Yes

OD Select OD to filter HF Yes

HF Select health facility to define how long patience have been travelling?

Yes

Type of coverage Type of health facility coverage on the distance and price.

Yes

Coverage distance Select how far the distance from home is? Yes

Price Amount riel supply to the distance from home to HF. Yes

Variable price If It is true, it allows user to modify the price when user entry data.

No

5.4 Pharmacies To manage information on contracted pharmacies, go to Providers > Institutions >

Pharmacies. On the list view of Pharmacies, user can filter the pharmacies by OD or search

for a pharmacy by its code and/or name.

H-SPIS v4.0

Page 39

Figure 30. List of Pharmacies

Figure 31. Pharmacy Form


OD OD where the pharmacy is located Yes

Code Unique code of the pharmacy Yes



Address Address of the pharmacy

Phone Contact’s phone numbers separated by “/”. For example, 012 34 45 67 / 098 98 98 98

Email Email address

Website Website

H-SPIS v4.0

Page 40

5.5 Health Facility Contracts

Health Facility Contracts is a tool which is used to add price of payment type of health facility. From this screen, user can also use it to view all payment type that consists in specific OD. There are three Type of payment are Fee for service, Lumpsum and Capitation. This configuration is used in Utilization, Agent group profile and some reports to filter the contracted Health Facility by Operator and Operational district. In search panel, user can filter Health Facility Contracts by OD, HF, Type of payment, HF

Level.

Operators > Contracts > Contracts with HFs

Field Description

Code Auto generated code by (Operator code + HF code + Month Year of starting date)

Operator Which operator that contract is created for?

OD OD of contract

HF HF of contract

HF level Hospital level type correspond to that health facility

Type of payment Type of payment that HF are using

Price Price of payment type in Health facility




On Health Facility Contract list, click on New button. The creation will appear.


Code Auto generated code by (Operator code + HF code + Month Year of starting date)

Yes

Operator Which Operator that HF Contract was created for? Yes

OD OD of contract Yes

HF List of Health Facility in selected OD and “Provincial Hospital” of the province

Yes

Type of payment Type of payment that HF are using Yes

Price Price of payment type in Health facility No

Reporting period As day, when the selected HF do monthly report. Yes

Reporting base Does report base on Entry Date or Discharge Date Yes

Start date Date of starting Yes

End date Date of ending No


Yes

5.6 Contracts with Pharmacies

Pharmacy Contract is a tool which is used to create contract between Pharmacy in OD and

Operator.

In search panel, user can filter pharmacy contract by OD and Pharmacy name.

H-SPIS v4.0

Page 41

Operators > Contracts > Contracts with Pharmacies

Field Description

OD OD of contracted Pharmacy

Pharmacy name Contracted pharmacy




On Pharmacy Contract list, click on New button. The creation will appear.


Code Auto generated code by Yes


OD Select OD to filter Pharmacy Yes

Pharmacy name Lit of pharmacy that is filtered by OD Yes

Reporting period Day of closing report Yes

Start date Date of starting contract Yes


Active Active/ Inactive. When status is inactive, End date is allowed to input.

6 Operators

There are 13 modules to manage different function such as: Type Products, Products,

Employers, Health Facility Contracts, Non Contracted Health Facility Services, Health

H-SPIS v4.0

Page 42

Facility Transportations, Other Benefits, Lumpsum, Claims, Pharmacy Contracts, Exchange

Rates, and Coupons

6.1 Operators By convention, only Super Admin can create a new Operator. Super Admin can create

many Operators that is classified by Operator Category (CBHI or NSSF).

To add an operator to the list, go to Operators > Operators > Operators.

6.2 System Users To manage the all users of difference Operator that are system user or member facilitator.

For system user, it requires filling User name and Password.

In search panel, user can filter agent by OD, Position, and Full-name.

Operators > Operators > System Users

Field Description

Operator Operator that agent are working at

OD OD that agent are working in

Full name Full name in Latin

Full name (KH) Full name in Khmer

Login User login name

Telephone Telephone number of agent

Email Email of agent

On System Users list, click on New button. The creation will appear.

H-SPIS v4.0

Page 43


Name that will use to login to the system Yes

Change Password Last name of agent in Latin Yes

Password First name of agent in Latin Yes

Confirm Password Last name of agent in Khmer Yes

Language First name of agent in Khmer Yes

Code Agent code Yes

Last name Last name of agent in Latin Yes

First name First name of agent in Latin Yes

H-SPIS v4.0

Page 44

Last name (KH) Last name of agent in Khmer Yes

First name (KH) First name of agent in Khmer Yes

Gender What gender? Yes

Date of birth When agent was born?

Telephone Telephone number of agent

Email Email of agent

Address Address info

Address (KH) Address info in Khmer

Position What position?

Operator Operator that agent are working for Yes

Agent Profile Profile of agent which access right to system user Yes

OD OD that agent are working in Yes

HF Contracted HF that agent are working with. Some agents are working with all HF by selecting All value in the list

No

Employer Contracted Employer that agent are working at No

Active Active/ Inactive. If Status is Inactive, The agent cannot login to system

Yes

6.3 User Profiles User Profiles is a tool which is used to classify the access right of agent. There are seven

defaults profile such as: IT Admin, Head Office, Field Office, Hostess, Monitoring, Finance,

and Employer.

User Profile List displays the default user profiles and the user profiles that belong to a

specific Operator.

Operators > Operators > User Profiles

H-SPIS v4.0

Page 45

Field Description

Code Code of agent profile



On Agent Profiles list, click on New button. The creation will appear. Assigned Privilege List

contains the privileges that allow user to access (Full or Read).

H-SPIS v4.0

Page 46


Operator Operator Yes

Code Code of agent profile Yes



Privileges List all functions that exists in the application

Assigned Privileges List all assigned functions. No

Tips:

Privilege Control:

To add one function:

Select a function in Available Privileges. Then click on

Drag-drop a function from Available Privileges to Assigned Privileges

To remove one function:

Select a function in Assigned Privileges. Then click on

Drag-drop a function from Assigned Privileges to Available Privileges

To add functions:

Select some functions in Available Privileges. Then click on

Drag-drop some functions from Available Privileges to Assigned Privileges

To remove one function:

H-SPIS v4.0

Page 47

Select some functions in Assigned Privileges. Then click on

Drag-drop some functions from Assigned Privileges to Available Privileges

6.4 Product Types To manage the types (groups) of products under an operator, go to Operators > Operators

> Product Types.

Field Description

Operator Operator of Type product

Code Code of Type Product



On Type Product list, click on New button. The creation will appear.


Operator List of Operator Yes

Code Unique code of Product Type Yes



6.5 Products Manage the product information such as: General Info, Premium Info, Contract Info and

Benefit Info

In search panel, user can filter product by Type of product, Sector population, Poverty level,

Size of Household, Discount, and Bonus.

Administration Menu > Operator > Products

Field Description

Operator Operator of Type product

OD Operational District that the product will be used

Code Auto generated code by (Operator code + Type product code + Increment number)



Type of product Type of product

Sector population Sector population

Poverty level Poverty level

Premium price Price of product for a month (USD / KHR)

Status Active/ Inactive

H-SPIS v4.0

Page 48

On Product list, click on New button. The creation will appear.


Code Auto generated code by (Operator code + Type product code + Increment number)

Yes

Operator List of Operator Yes

OD Operational District that the product will be used Yes

Type of product List all type of product that belong to selected Operator

Yes



Premium Price of product for a month (USD / KHR) Yes

Sector population List of Sector population No

Poverty level List of Poverty level No

Size of Household List of Household size No

Active Active / Inactive Yes

Comment Any comments No

6.5.1 Update Premium Info

On Product list, select a product then click on Premium Info tab. The Premium Info screen

will appear.


Number of reserve

Is number of months. It is used in Premium Payment of Household. Household must fill the reserve amount.

No

Minimum first term payment

Is number of months. It is used in Premium Payment of Household for first payment. It requires Household must pay at leases this minimum amount

No

Minimum term payment

Is number of months. It is used in Premium Payment of Household for next payment. It requires Household must pay at leases this minimum amount

No

Discount List of discounts. It bases on the Advanced Payment. Example, If Advanced Payment is greater or equal 9 months. It will got discount 10%

No

Bonus List of coupon. It bases on the Advanced Payment. Example, If Advanced Payment is greater or equal 12 months. It will got bonus 1 month

No

Regular pay bonus Maximum number of Regular pay bonus. Example, if Household pays regularly 12 times or passes the rule of giving bonus. They will got one month bonus (as regular pay bonus)

No

6.5.2 Update Contract Info

On Product list, select a product then click on Contract Info tab. The Contract Info screen

will appear.

H-SPIS v4.0

Page 49


Term of contract Is number of months. It is used when premium was created for a month. This number is used to limit the month of cycle.

No

Waiting period for delivery

Is number of months. It is used in Household Waiting Period Report to check when Delivery will be usable.

No

Waiting period for plan surgery

Is number of months. It is used in Household Waiting Period Report to check when Plan surgery will be usable.

No

Kinship List of Relational Household. It will apply in Creating or Updating Beneficiary of Household that have contract with product. Beneficiary Form - Kinship with HoH Combo will display only the checked relational Household.

No

6.5.3 Other benefic Info

On Product list, select a product then click on Other Benefits tab.


Benefits Tree of benefits. Some benefits (Copayment, Coinsurance, Deductible) are used in Claim configuration

No

6.6 Other Benefits Other Benefits is a tool which is used to add price of other benefit type of product that

follows the range of min and max seniority in Operator.

In search panel, user can filter Other Benefits by OD, Type of other benefit, Min seniority,

and Max seniority.



OD Select OD to filter Product Yes

Product name List of Product that was filtered by OD Yes

Type of other benefit Select other benefit type to be existed in specific OD. Yes

Min seniority Select the start oldness membership to define other benefit they could get.

Yes

Max seniority Select the end oldness membership to define other benefit they could get during this period.

Yes

Price Supply the price to benefit type No

6.7 Lumpsum (Case-based) Lumpsum is a tool which is used to add or make change of Lumpsum information that contain in specific Health facility.

H-SPIS v4.0

Page 50

In search panel, user can filter Health Facility Transportations by Operator, OD, HF,

Category, Lumpsum name.



OD Select OD to filter HF Yes

HF Health facility is selected into OD for Lumpsum added Yes

Category Type of categories respond to health facility Yes

Lumpsum name Lumpsum to be added into health facility Yes

Price Given fee of Lumpsum that user have just selected or type

No

6.8 Claims Claims is a tool which is used to add price or percentage of policy type that was configured

in Benefit info of Product.

In search panel, user can filter Claims by Claim case.



OD Select OD to filter Product Yes

Claim case List of Claim case (Delivery, Transport) Yes

Product name List of product that was filtered by selected OD Yes

Policy type List of policy type that was chosen in Benefit Info of Product.

Price Price of policy type as “Copayment” or “Deductible”

Coinsurance amount Percentage amount of policy type as “Coinsurance”

6.9 Coupons Coupons is tool which is used to create coupon for OD.



OD Which OD are using coupon? Yes

Name Description of coupon in Latin Yes

Name (KH) Description of coupon in Khmer Yes

Number of months Given amount of month Yes

H-SPIS v4.0

Page 51

7 Tools

7.1 General Tools

7.1.1 Non Beneficiaries

Non Beneficiaries is a tool which is used to enter the monthly total visit by category visit in

health facility of an Operator.

In search panel, user can filter non beneficiary by Health Facility and Category Visit.

Tools > General > Non Beneficiaries

On Non Beneficiary list, click on New button. The creation will appear.

H-SPIS v4.0

Page 52


Operator Operator Yes

HF Health Facility that non beneficiary visited Yes

Category Category visit (OPD or IPD) Yes

Date Month that non beneficiary visited HF Yes

Total monthly visits Number of non-beneficiary who visit per month Yes

7.1.2 Utilization Validations

Utilization Validations is a tool which is used to lock or unlock the Utilization. If the

Utilization was locked, user is not allowed to modify the Utilization. But user can access

the Drug and Transportation tabs.

In search panel, user can filter Utilization by Operator, OD, HF, Base on (Entry or Discharge

date) and range of date.

Tools > General > Utilization Validations

H-SPIS v4.0

Page 53

7.1.2.1 How to lock Utilization

After result shown in the list, user can lock the Utilization by select the unlocked

Utilization and click on button.

Figure 32. Select the unlocked Utilization

Then the question message will appear as below. Press “Yes” to process.

7.1.2.2 How to unlock Utilization

After result shown in the list, user can unlock the Utilization by deselect the locked

Utilization and click on button.

Figure 33. Select the locked Utilization

Then the question message will appear as below. Press “Yes” to process.

7.1.3 Close Entry

Close Entry is a tool which is used to close the current coverage period and open the new

coverage period of an Operational District that is used by an Operator.

H-SPIS v4.0

Page 54

The below is an example of Closing Entry Aug-2012 for Phnom Penh OD that is used by

SHPO Operator.

Example: Current Coverage Period is Aug-2012

- Create the coverage period for Sep-2012

- Close the coverage period for Aug-2012

- Lock the payment of the coverage period Aug-2012

- Update the contract of Household automatically. If the size of Household was changed.

H-SPIS v4.0

Page 55

7.1.4 Non Payments

Non Payments is a tool that is used to pay automatically for the Household that remain

Reserved or Advanced balance and drop out Household that has no enough Reserved or

Advanced balance.

7.1.5 Households Rollback

Household Rollback is a tool that is used to roll-back the drop-out Household.

7.1.6 Household Balance

Household Balance is a tool that is used to refund and keep the balance amount of

Household.

7.1.7 Balance Transfer

Household Balance is used to transfer remaining balance of one or more dropped-out

households to one or more active households.

7.2 Complaints

7.3 Surveys It depends on the answers or reviews of some questions by different users. A survey may

have multiple sections. Each section may contain multiple questions and each question

may have multiple answers. Different users may give different answers to the question and

according to that survey is done.

A feedback form is a survey, a tool for assessment through a questionnaire. The system

provides a module to manage the surveys. There are currently several feedback collections

captured by schemes such as Client Satisfaction Survey Tool (CSST)1, Health Facility Exit

feedback, Dropout feedback, home spot-check, community scorecard, etc.

These are conducted at different points in the processes which are involved in the

insurance scheme and are undertaken by different actors and administered to different

types of clients.

H-SPIS v4 provides a flexible tool that system users can develop questionnaires and link

them with relevant surveys.

A survey contains the following information:

Field Description

Survey code The code of the survey used as reference

Survey name The name or title of the survey

1 Client Satisfaction Survey Tool (CSST) is the MoH standard client satisfaction survey. AFH uses this in

Kampong Thom every quarter (with GIZ's support) to monitor client satisfaction. Other SHPA members also use this in some form and MoH may encourage more to do so in the future.

H-SPIS v4.0

Page 56

Description The description of the survey

Category The category of the survey which can be Referral Hospital, Health Centre, etc.

Date of Creation Date of Creation

Created by User who creates this survey

Date of Modification Date of latest modification

Modified by User who made the latest modification

H-SPIS v4.0

Page 57

Every survey is linked with a questionnaire. A question shall include the following

information:

Field Description

Questionnaire code The code of the questionnaire used as reference

Questionnaire title The title of the questionnaire

Description The description (purpose, etc.)

Category Used as category, classification, etc.

Author Name of the main author

Date of Creation Date of Creation

List of questions List of questions

A questionnaire is a list of questions and each question shall contain the following

information:

Field Description

Question code The code or order of the question used as reference

Question The question

Comment Extra comment or explanation on the question

Section Which section does this question belong to in the questionnaire?

Type of question Multiple choices etc.

A response to a question in a given questionnaire from a respondent shall contain the

following information:

The raw data can be downloaded in CSV or Excel format from the system looks like in this

following example:

No OD HF Scheme Respondent Q1 Q2 … Qm

1

2

3

…

n

Legend: HF – Health Facility OD – Operational District n – Number of respondents

Q – Question m – Number of questions

7.4 Integrated Documents Management

H-SPIS v4.0

Page 58

To access to the integrated documents management tool, go to Tools > Documents.

Field Name Description

Operator Which scheme?

OD Which OD? Value: ID of the OD and False if not applicable.

HF Which HF? Value: ID of the HF and False if not applicable.

Attachment ID The reference of this attachment

Attachment name The name of the attachment, by default, the filename without extension

Description Description of the attachment

File name The filename of the attachment with extension

File type The attachment type: Utilization

File location Where the file is stored.

Owner Owner of the file. This shall be automatically captured for the user who uploads the file.

Date Date/time when the document is uploaded to the server. It is also automatically captured.

7.5 SMS A mobile phone can be used anywhere and anytime across Cambodia. Text messaging

(SMS) is faster, more direct, and can reach out to even the most remote area.

H-SPIS v4 is equipped with an SMS module that can offer a reliable solution for member

identification/verification and recording service utilization data with below situations:

Health facilities without computer or Internet connection

Blackout or temporary loss of Internet connection, etc.

User with any kind of mobile phone can send an SMS to a fixed number with a pre-defined

format and will get back the relevant result or confirmation.

All SMS inbound and outbound messages are recorded in H-SPIS v4.0. To manage those

messages, go to Tools > SMS.

8 Reporting All implemented reports are classified into 3 main categories: Operator Reports, MoH

Reports and Custom Reports.

User can export report as Excel format by clicking on the “Export” button at the top of

screen. The below opening dialog appear after generation of report finish.

H-SPIS v4.0

Page 59

8.1 Operator Reports Several reports have been implemented for Operators such as Active Household, Premium

Collection, SMM, Premium Consolidated Receipt, New Enrollment Summary, Household

Waiting Period, Outreach, Over Utilization, Utilization Info, MMM, Dashboard (Tdb) and

Monitoring.

8.1.1 Active Household

This report shows about the active Household who visit the Health facility in specific OD by

month. In the report, it will show information of active Household such as: Village name,

Household code, Household name, Household size, HF, Employer.

Required Field:

OD: List of ODs which have contracted HF. Select OD to load data of HF

HF: List of all contracted HF with Operator. User can view all contracted HF by select “All”

value.

As of: Date of report

H-SPIS v4.0

Page 60

Figure 34. Active Household Report

8.1.2 Premium Collection Report

This report shows about information of Premium such as: simple info of Household, month

in cycle, monthly premium, reserve remain, advanced remain, required payment, total

paid, receipt no

Required Field:

OD: List of ODs which have contracted HF. Select OD to load data of HF, Employer, and

Coverage date.


value.

Employer: List of all contracted Employer with Operator of user login. User can view all

contracted Employer by select “All” value.

Currency: View amount as KHR or USD

Coverage date: Date of report

To get the value of Coverage date, it requires select OD first.

H-SPIS v4.0

Page 61

Figure 35. Premium Collection Report

8.1.3 Meeting Report

This report shows about membership and premium collections.

Required Field:

- OD: List of ODs which have contracted HF. Select OD to load data of HF and Coverage date.

- Member Facilitator: is member who collects information of membership and collects

money for premium payment.

- HF: List of all contracted HF with Operator. User can view all contracted HF by select “All”

value.

- Coverage date: Date of report

Figure 36. SMM Report

H-SPIS v4.0

Page 62

8.1.4 Premium Consolidated Receipt

This report shows about Total Amount Paid By New Registered Households, Total Amount

Paid By Existing Households, Entry amount and Transfer amount.

Required Field:


- HF: List of all contracted HF with Operator. User can view all contracted HF by select “All”

value.

- Currency: View amount as KHR or USD


Figure 37. Premium Consolidated Receipt

8.1.5 New Enrollment Summary Report

This report shows about the number month paid of renewal Households and new enrolled

Households in a specific HF those groups by product type.

Required Field:


- HF: List of all contracted HF with Operator


H-SPIS v4.0

Page 63

Figure 38. New Enrollment Summary Report

8.1.6 Household Waiting Report

This report shows about the simple information of active Household, waiting period

(delivery and surgery) based on the contracted product.

Required Field:

- OD: List of ODs which have contracted HF. Select OD to load data of HF, Employer, and

Coverage date.

- HF: List of all contracted HF with Operator


Figure 39. Household Waiting Report

H-SPIS v4.0

Page 64

8.1.7 Outreach Report

Outreach report is a kind of report that shows about the simple information of HF such as:

Total Population, Total Non-Poor Population, Total Poor Population, Total Household as

Voluntary Member, Total Member of Household as Voluntary Member, Total Household as

Health Equity Fund, Total Member of Household as Health Equity Fund, Rate of Member of

Household as Health Equity Fund, Rate of Member of Household as Voluntary Member.

Required Field:

- OD: List of ODs which have contracted HF

- As of: Date of report

- Include HEF: By default, it is checked. It will display the information of HEF. Otherwise, it

hides the information of HEF

Figure 40. Outreach Report

8.1.8 Over Utilization Report

Over Utilization report shows about the information of beneficiary’s Utilization such as:

beneficiary code, employer name, total service fee and total Lumpsum price.

Required Field:

OD: : List of ODs which have contracted HF. Select OD to load data of HF, Employer

Reporting base: Entry or Discharge date

HF: List of all contracted HF with the operator. User can view all contracted HF by select

“All” value.

Employer: List of all contracted Employer with the operator of user login. User can view all

contracted Employer by select “All” value.

Category visit: All, OPD or IPD

Contact number: Number of contacts

H-SPIS v4.0

Page 65

From…to… : Period of report

Figure 41. Over Utilization Report

8.1.9 Utilization Report

Utilization report shows about the information of contact such as: OD, Contact ID, Health

Facility, Discharge date, Entry date, Member code, Gender, Age, New case-Second case-

Chronic, Diagnosis, Category visit, Day hospitalization, Ward, Service, Lumpsum, Actual

Amount, Employer name, Staff entered, Date time entered.

Required Field:

OD: : List of ODs which have contracted HF. Select OD to load data of HF, Employer

Reporting base: Entry or Discharge date


value.

From…to… : Period of report

H-SPIS v4.0

Page 66

Figure 42. Utilization Report

H-SPIS v4.0

Page 67

8.2 MoH Reports There are 7 different MoH reports generated from H-SPIS v4:

1. General Information Reports

2. Coverage Reports

3. Utilization Reports

4. Financial Reports - Incomes

5. Financial Reports - Direct costs

6. Financial Reports - Indirect costs

7. Financial Reports - Total costs

Figure 43. MoH Reports

8.3 Query Tools Query tools allow user to create, update, delete, execute report and export to Excel

format. On queries combo, user can select old query report to update or execute report.

Execute to Excel format is available when query was saved and it has result in list.

H-SPIS v4.0

Page 68

Figure 44 : Free Query Report


Code Query code Yes

Description Query description Yes

SQL statement SQL script to generate a report Yes

Action Description

New query Allow user to create new query

Save query Allow user to save or update query

Delete query Allow user to delete selected query

Execute report Execute SQL statement and show result on List

Export Export the result on list to Excel format. If there are no data. User cannot export to Excel format.

9 Settings There are 5 sub main menus in Administration. Such as: Reference data, Operator, Agent

and Tools

9.1 Exchange Rate Exchange Rate is tool which is used to create Exchange from Dollars to Riels. The latest

active exchange rate will be used for every conversion between Dollars and Riels.

H-SPIS v4.0

Page 69

Figure 45. List of Exchange Rates

In search panel, user can filter exchange rate by Year.

Settings > Operator >Exchange Rate



Month Month of exchange rate Yes

One dollar is Changed amount from 1 dollar to riel Yes

H-SPIS v4.0

Page 70

9.2 Reference data

9.2.1 General data

General data module allow user to manage the reference table. There are 40 table systems

in the below list. When user double clicks on the record, the new tab of selected table

system will appear. In Search panel, user can search by Code and Description.

Administration Menu > Reference Data > General Data

Figure 46 : General data

Action Description

View Data Allow user to view data of selected table system

Refresh Refresh List

9.2.1.1 Category Employer List

After double click or clicking the view data button, the following screen will appear. Then

user can create, update, delete and view.

H-SPIS v4.0

Page 71

Figure 47 : Category Employer List

9.2.1.2 New Category Employer

On Category Employer list, click on New button. The creation will appear.

Figure 48 : New Category Employer


Code Code of Category employer Yes

Description Name in Latin Yes


H-SPIS v4.0

Page 72

9.2.1.3 Category Employer Detail

On Category Employer List, Select a record then select Detail tab. Then it will display the

information of Category employer as below.

Figure 49 : Category Employer Detail

Note: For other table system, Health facilities and Pharmacies, it has same behavior as

Category Employer.

Presentations & Public Speaking

H-SPIS v4 User Manual