1. preLink to GoodX Mappings
1.1. Insurance Requests
Insurance companies are setup as a ‘Client’ in preLink. Insurance companies are setup as a ‘Medical Aid’ in GoodX.
The preLink Client Primary Code must match the GoodX Medical Aid Scheme Code. The preLink Client Location Code must match the GoodX Medical Aid Option Code. E.g.:
preLink
Client Name: 1Life Direct
Client Primary Code: 1L001
Client Location Name: 1Life Fourways
Client Location Code: 1LF01
GoodX
Medical Aid Scheme Name: 1Life Direct
Medical Aid Scheme Code: 1L001
Medical Aid Option Name: 1Life Fourways
Medical Aid Option Code: 1LF01
Note: Test and Profile pricing will need to be setup for this Medical Aid Option in GoodX.
1.2. Cash/Credit Card Requests
To provide proper financial reporting and reconciliation in GoodX, a ‘Private’ Medical Aid record will have to be created in GoodX using the following details:
Medical Aid Scheme Name: Private Patients
Medical Aid Scheme Code: PRIVAT
Medical Aid Option Name: Private Patients
Medical Aid Option Code: PRIVAT
Note: Test and Profile pricing will need to be setup for this Medical Aid Option in GoodX.
preLink will set the scheme code and option code to ‘PRIVAT’ in the invoice data that is sent to GoodX.
1.3. Pro Deo Requests
Pro Deo requests are when the debtor (Guarantor, Insurance Company or Medical Aid) must not be debited or billed. These are usually requests done for lab staff at a cost to the lab and not the staff member.
To provide proper financial reporting and reconciliation in GoodX, a ‘Private’ Medical Aid record will have to be created in GoodX using the following details:
Medical Aid Scheme Name: Pro Deo Requests
Medical Aid Scheme Code: PRODEO
Medical Aid Option Name: Pro Deo Requests
Medical Aid Option Code: PRODEO
Note: Test and Profile pricing will need to be setup for this Medical Aid Option in GoodX. This would probably be the cost price of the test and not the price charged to a private client for example.
preLink will set the scheme code and option code to ‘PRODEO’ in the invoice data that is sent to GoodX.
1.4. Medical Aid Requests
Medical Aid requests are straightforward. The Medical Aid number, code and dependent number are captured in preLink.
preLink will use the scheme code and option code from the captured Medical Aid to create the invoice data that is sent to GoodX.
Note: Test and Profile pricing will need to be setup for each Medical Aid Scheme/Option in GoodX.
1.5. Project Requests
Note: Due to the complexity of billing for Projects and the fact that Motion Pathology will probably not be partaking in and Projects/Studies at this time, this has been excluded from the GoodX integration.
1.6. Account Requests
Account payments are when a company will be billed for patients’ tests instead of the Guarantor or Medical Aid being billed. The companies must be setup as a ‘Client’ in preLink. The companies must be setup as a ‘Medical Aid’ in GoodX.
The preLink Client Primary Code must match the GoodX Medical Aid Scheme Code. The preLink Client Location Code must match the GoodX Medical Aid Option Code. E.g.:
preLink
Client Name: Sappi Employee Benefit Fund
Client Primary Code: SAP001
Client Location Name: Sappi Lomati
Client Location Code: SAPL01
GoodX
Medical Aid Scheme Name: Sappi Employee Benefit Fund
Medical Aid Scheme Code: SAP001
Medical Aid Option Name: Sappi Lomati
Medical Aid Option Code: SAPL01
Note: Test and Profile pricing will need to be setup for this Medical Aid Option in GoodX.
2. Employee Codes
When capturing Cash and Credit Card payment methods for requests, a valid user must be selected in the “Accepted By:” field of the payment details. For this to happen, the selected user MUST have a unique Employee Code setup for them in the “Details” tab of Employee Management.
Figure 1: Employee Details
3. Test and Profile Cost Codes
Every billable Test and Profile in preLink must have the correct Cost Code(s) associated with it as the ‘Tariff’ code (which should be a proper NHRPL code) is sent to GoodX to identify the ‘procedure’ and determine its price. If the Test/Profile doesn’t have any Cost Code(s) associated to it, it will not be billed.
Figure 2: Test Management – Glucose fasting has no Cost Code setup
4. Medical Aid Update
preLink currently has over 500 Medical Aids setup in the Medical Aid Management. To ensure that the correct Medical Aid Scheme and Option codes are sent to GoodX, preLink will need the have the correct MedPrax EDI code for all the Medical Aids.
This will require deleting all Medical Aids in preLink and then allowing the preLink GoodX Export service to import the MedPrax Medical Aid Scheme and Option files.
Note: Medical Aids already associated to a Request in preLink can’t be deleted so those Medical Aids will be updated manually.
4.1. Medical Aid Management
All Medical Aids must have a valid MedPrax EDI code otherwise they will not be switched. GoodX will not even create an invoice if an incorrect or empty EDI code is sent through.
There are currently several Medical Aids within preLink that do not have a valid EDI code as they did not exist in the Medprax Scheme file.
Figure 3: Medical Aid Management
5. preLink Service Setup
The GoodX service must be enabled in the preLink system configuration on service management:
- Navigate Administration
- Click General
- Click System Configuration
- Click Service Management
- Click Edit on GoodX
- Add the API Key, Username and Password
6. Billing Process
6.1. Invoice Creation
6.1.1. Cash and Credit Card
During the data capture process, preLink will display the total “Amount Due:” if the “Cash” or “Credit Card” payment method is selected by the user.
Figure 6: Amount Due after selecting "Cash"
The total amount due is calculated using the prices setup for the Cost Codes that are associated to the Tests and/or Profiles that have been ordered for the Request.
If the user enters a value higher than 0 in the “Amount” text box, preLink assumes the Guarantor is paying upfront and will immediately send the invoice data to GoodX after completing the data capture.
If the user enters 0, preLink assumes the user is paying later on (maybe EFT) and will automatically send the invoice data to GoodX once all the tests are resulted and all the departments are signed off in preLink. GoodX will then send a bill to the Guarantor.
6.1.2. Medical Aid, Account, Insurance and Pro Deo
The invoice data is automatically sent to GoodX once all the tests are resulted and all the departments are signed off in preLink.
6.2. Billing status
There are several billing statuses in preLink:
- Not Required: Invoice will not be created – currently Project requests
- To be Invoiced: Invoice will be created – waiting for completion
- Ready: Completed and signed off – waiting to send to GoodX
- Invoiced: GoodX has created the invoice and returned the invoice number
- Error: An error has occurred when sending to GoodX
The billing status of a request can be seen in the “Request” details when viewing a Request, as seen below:
Figure 7: Viewing the billing status of a Request.
6.3. Billing Report
There is a billing ‘report’ that is located in the menu under Administration -> Reports -> Billing -> Billing Status.
The page will display all the Requests (with their basic information and billing status) for the current day. The user is able to click on the Request to open the View Request page in a new browser tab or window.
The user is also able to search for all Requests with a specific “Status” and/or within a selectable data range.
Figure 8: Billing Status report page.
Note: If the billing status for the Request is “Error”, there will be a “Resend” link that the user can click and it will mark the Request as “Read” so that the invoice can be resent to GoodX.
7. Outstanding Issues
7.1. Credits or Refunds
We need to determine what must happen, and how it must happen, when a Test or Profile is deleted from a Request that has already been invoiced or paid for (upfront cash/credit card).
GoodX will need to create functionality that will allow preLink to transmit the request data that indicates what must be credited or refunded.
7.2. Cash Payment Method
During the request capture, if the user selects “Cash” as the payment type, the total price is calculated and displayed to the user. They need to enter the amount received, receipt number and user that received the money.
What should happen if the user enters an amount that differs from the total price that we calculated and displayed to the user?
Should it email someone?
Should it prevent them from capturing the request?
Maybe the patient will pay a portion upfront and the outstanding amount later?
7.3. Project Requests
We need to discuss how clients of Projects/Studies are billed. Once this has been determined, we can discuss a way forward with GoodX.
7.4. Insurance EDI
We need to determine if GoodX support EDI for Insurance Requests.
preLink currently has an Insurance EDI export service that is used in conjunction with a third party to provider the data conversion and switching. E.g. Global Labs uses Vodacom to retrieve, process and switch the exported file from preLink.
It would be cheaper (no need for another service provider like Vodacom) if GoodX could perform the insurance EDI.
Due to our previous experience with insurance EDI, there are several fields that would need to be added to the invoice data that is transmitted to GoodX. These fields include:
- IBB - Broker Branch (e.g. H01, G99)
- IBN - Broker Name and Code
- VTP - Collection Type
- VCD - Collection Location
- DPT - Department
- SGN – Sign off User / Doctor Authorisation Name
E.g. The above mentioned fields are required for Sanlam insurance requests.
7. Service Center Code
In order for transactions to be processed through GoodX, it is important to make sure that a Service Centre code is assigned to each site (laboratory/company) in the preLink Site Management module.
To access Site Management, navigate to "Administration > General > Site Admin > Site Management" on the preLink menu bar.
This will bring you to the following screen:
Each site listed in Site Management must have a unique Service Center code assigned to it, which can be obtained from GoodX.
To add a Service Center code, click on "Edit" on the listed site, and, in the following screen, enter the Service Center code in the field indicated below.
Next, click on "Update".
For other sites on the list, click on "Return to List" to return to the Site Management screen, and then repeat the process for each site.