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SONGHAI HEALTH TRUST LTD - SOFTWARE REQUIREMENT
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SNUSER'S STORY
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INTERPHASE
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ADMIN PORTAL
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PROVIDER PORTAL
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ENROLLEE PORTAL
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Underwriting Module
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1Coverage Plan: to define condition for enrolment - dependant type,count, and age_limits control enrolment according to the set parameter
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2User can specify principal's age
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3Dependant type can be spouse,children, extra dependant, additional dependant etc.
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4Number of dependants should be dynamically set by user
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5Age of dependants should be dynamically set by users
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6Healthcare plan should have a band that determines plan's level
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7 Plan Band should define level of access to Healthcare
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8On a plan choose a service category, set count or amount limit to control concerned services
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9On a plan enter or upload corresponding benefit package
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10Benefit package is function of a healthcare plan and should be visible to the enrollee,provider and hmo's interphase.
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11 Plan Band should define level of access to providers because providers are in levels.
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12Create organization (client) profile: Client's full name, location, address, contact person, start date, system compute end date, policy circle(Yearly,monthly,quarterly)
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ENROLMENT
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1Basic Enrolment of PHIS Client
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2Enrolment of dependants above set age, should be restricted by the system(PHIS)
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3Providers are selected based on band. Only providers within enrolee's coverage should be available for selection(PHIS)
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4PHIS Enrollee should be able to do self enrolment via enrolee's portal or mobile app.
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5Bulk enrolment of enrolees.
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6Upload of Current NHIA list to replace the previous list
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7Upload of Current NYSC list to replace the previous list
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8Upload of Current FHIS list to replace the previous list
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9Upload of ANY OTHER list for a new scheme
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10Update NHIA list
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11Update NYSC list
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12Update FHIS list
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13Mandatory Fields:
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14First Name
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15Last Name
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16Organization
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17Plan
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18Phone Number
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19Account Type
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20Hospital
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21Gender
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22DOB
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23Email
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24Location
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25Marital Status
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26On edit dependant ---user should ensure a pricipal is selected before clicking 'update'. if that is not done the dependant will no longer be linked to principal. system should not update if principal is not selected
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Client Deactivation
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1Manual deactivation of organisation. All principals and dependants of this organisation should be deactivated
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2Reason for deactivation should be recorded and visible users
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3Manual deactivation of principal. All dependants of deactivated principal should be deactivated
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4Automatic deactivation of clients based on set policy period
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5Automatic deactivation of dependants who is over age
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6Warn before deactivation-configurable period for warning
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7Ability to replace existing NHIA list with current list
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8Ability to replace existing NYSC list with current list
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9Ability to replace existing FHIS list with current list
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10AUDIT TRAIL - Details of who deactivated or delete enrollee or organization
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11Record of deleted and deactivated clients
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Client Reactivation
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1All Deactivated clients can be easily reactivated
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2Able to set expiring period for reactivated clients,principal
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Business Set up
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Service Type: services to be controlled should be under a category, restriction based on amount, count should be applied to different categories.
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Report
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List of enrollees by organization - Display total number of Principal, Dependant, additional Dependant & Extra Depedants
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List of enrollees by Hospitals - Display total
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Utilization by client for a specified period
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Utilization by enrollee for a specified period
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Utilization by family for a specified period
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Utilization chronic conditions per period,per enrollee,per provider
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QUALITY ASSURANCE
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Tariff
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User can sign up providers using their basic details: full name,email,phone no, NHIA code,address,location,region,password,acct details, band
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A hospital tarff should contain name of service,amount,category,primary/secondary service columns
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Upload of agreed tariff - tarff can be enterred individually or bulk upload
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NHIA tariff is universal - the same for all nhia enrollees at all hospital.
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PHIS tariff differs from hospital to hospital
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Ability to Band hospital based on their tariff
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Create a common category for Services that are controlled by conditions set by benefit package
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Deactivate tariff-one by one and by all
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Deactivated tariff should not affect created transactions
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Fresh upload of updated tariff should not affect created transactions.
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NYSC tariff should be separeted from NHIS for us to rightly format NHIS drug tariff which is not applicable to NYSC
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Ability to deactivate one service in tariff.
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Should have songhai's tariffs which can be assigned to any provider
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No service category field on front end
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CALL CENTRE
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Code Request
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1Enrolee's eligibility. Search and display basic details of enrolee (full name/id, organization, scheme/plan,picture,phone no.)
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2Select diagnosis, select services,select drugs, write note
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3System should count and display cumulative days of admission
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4Submit request as either: Secondary Request or Referral Request or Admission request
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5Prescription drop down to define accurate quantity of drugs
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6System should mandate clinical findings
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7Categorization of latest ICD diagnosis
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8System restricts service duplication on same request