Inward Admission Claimable Configuration - hmislk/hmis GitHub Wiki

Inward Admission – Claimable Field Configuration

What is the Claimable Field?

The Claimable checkbox on the Inward Admission page indicates that the patient's bill is expected to be claimed against a credit company, insurer, or third-party payer — rather than being settled entirely by the patient in cash.

In practice, when a patient is admitted under a corporate credit agreement or insurance scheme, the hospital will eventually submit a claim to that organisation and recover the amount. Marking the admission as Claimable signals this intention at the point of admission so that:

The billing team knows to send a claim rather than collect cash from the patient.
Reports can separate claimable and non-claimable revenue for accounting and reconciliation.
The discharge summary can be formatted correctly for the credit company.

Important: Not every hospital uses this feature. Some hospitals track credit-company billing through the payment method alone and have no need for a separate Claimable flag. The HMIS supports both modes through the configuration options below.

Claimable in Other Healthcare Systems

The concept is well-established across healthcare billing globally, though the terminology varies:

System / Region	Term Used	Meaning
US (Epic, Cerner, Meditech)	Assignment of Benefits / Third-Party Billing	Patient assigns the right to receive insurance payment directly to the provider
UK NHS Private	Funded Treatment / Pre-Authorised Admission	Treatment funded by an insurer or employer; provider submits a claim
Australia (HICAPS)	Insurance Claiming	Real-time claim lodged with the health fund at point of service
Sri Lanka (HMIS)	Claimable	Admission cost to be claimed from a credit company, insurer, or employer scheme

In all systems the core workflow is the same: the provider records that a third party will pay (or partially pay), then submits a claim for reimbursement. Whether the field is labelled Claimable, Insured, or Assigned, its purpose is to distinguish patient-pay encounters from third-party-pay encounters.

When to Enable the Feature

Hospital Type	Recommended Setup
Hospitals with no corporate/insurance billing	Disable the field entirely (`Show Claimable Field = false`)
Hospitals where credit patients are usually (but not always) claimable	Enable auto-mark, leave user free to override
Hospitals where all credit admissions are always claimed	Enable enforce-for-credit: checkbox locked and auto-checked
Hospitals that track claimable for cash patients too	Set `Claimable Required For = All`

Configuration Options

Navigate to Admin → Application Options and search for "Inward Admission" to find all settings.

Master Switch

Key	Type	Default	Description
`Inward Admission - Show Claimable Field`	Boolean	`true`	Master on/off switch. When `false`, the Claimable checkbox is completely hidden on the admission form, no claimable validation is performed anywhere, and the flag is ignored. This overrides all other claimable settings. Set to `false` for hospitals that do not use the claimable workflow at all.

Enforcement

Key	Type	Default	Description
`Inward Admission - Enforce Claimable for Credit`	Boolean	`false`	When `true`, Credit admissions are always marked as Claimable. The checkbox is automatically checked when the user selects Credit as the payment method, and it is locked (disabled) so it cannot be unchecked. Cash and other payment methods are unaffected — the user controls the Claimable checkbox freely. Use this for hospitals where every credit admission is claimed without exception.

Automation (without locking)

Key	Type	Default	Description
`Inward Admission - Auto Mark Claimable for Credit Admissions`	Boolean	`false`	When `true`, the Claimable checkbox is automatically checked when the user selects Credit — but it remains editable (the user can still uncheck it). Also disables save-time validation so the user is never forced to tick or untick the box.
`Inward Admission - Auto Apply Claimable For Credit`	Boolean	`false`	When `true`, selecting Credit auto-sets Claimable to `true`; selecting any other payment method auto-resets Claimable to `false`. Useful to ensure the checkbox resets cleanly when the user switches away from Credit.

Required-For Rule

Key	Type	Default	Description
`Inward Admission - Claimable Required For`	Short Text	`Credit`	Controls which payment method requires the Claimable checkbox to be ticked before the admission can be saved. See values below. Only evaluated when neither `Enforce Claimable for Credit` nor `Auto Mark Claimable for Credit Admissions` is `true`.

Claimable Required For allowed values:

Value	Behaviour
`None`	Claimable is never required; the checkbox is shown but optional.
`Credit`	(Default) Claimable must be ticked for Credit admissions.
`Cash`	Claimable must be ticked for Cash admissions.
`All`	Claimable must be ticked for every admission regardless of payment method.

The value is case-insensitive (credit, Credit, and CREDIT all work the same way).

Configuration Priority (highest → lowest)

When multiple options are set, they are evaluated in this order:

Show Claimable Field = false — hides everything; nothing else matters.
Enforce Claimable for Credit = true — Credit checkbox is locked and auto-checked; Cash and others fall through to rule 3 or 4.
Auto Mark Claimable for Credit Admissions = true — checkbox auto-checked for Credit (editable); save validation disabled entirely.
Claimable Required For — enforces the required-for rule with a save-time validation error.

Recommended Setups by Hospital Type

Hospital with no claimable workflow

Inward Admission - Show Claimable Field = false

Result: Field is hidden. No validation. Claimable flag always stays false.

Hospital where credit patients are always claimed (locked)

Inward Admission - Show Claimable Field          = true
Inward Admission - Enforce Claimable for Credit  = true
Inward Admission - Auto Apply Claimable For Credit = true

Result: Selecting Credit auto-checks Claimable and locks the checkbox. Switching away from Credit auto-resets to false (user then controls manually for other methods).

Hospital where credit patients are usually claimed (auto-check, not locked)

Inward Admission - Show Claimable Field                       = true
Inward Admission - Auto Mark Claimable for Credit Admissions  = true
Inward Admission - Auto Apply Claimable For Credit            = true

Result: Selecting Credit auto-checks Claimable but the user can still uncheck it. No save-time validation error regardless of what the user selects.

Hospital where claimable is required for all admissions

Inward Admission - Show Claimable Field      = true
Inward Admission - Claimable Required For    = All

Result: The Claimable checkbox is shown and is required to be ticked before any admission can be saved.

Quick Access — Claimable Config Button

Administrators can reach these settings directly from the admission form:

Open the Inward Admission page.
In the page header, look for the Claimable Config button (visible to Admin users only).
Clicking it navigates directly to Application Options, pre-filtered to show only "Inward Admission" settings.

Applies To

This configuration applies to:

Admission entry — inward/inward_admission.xhtml (AdmissionController.findLastUsedCreditCompanies() + saveSelected())
Appointment to Admission Conversion — inward/convert_inward_admission.xhtml
Edit Admission Details — inward/inward_edit_bht.xhtml (BhtEditController.saveCurrent())
Edit Payment Details — inward/inward_edit_admission_payment.xhtml (BhtEditController.listnerForPaymentMethodChange() + saveCurrent())

Auto-Mark Behaviour by Page

Page	Trigger	Method
Admission entry	Dropdown change (AJAX)	`findLastUsedCreditCompanies()`
Admission entry	Save (server-side)	`saveSelected()`
Edit Payment Details	Dropdown change (AJAX)	`listnerForPaymentMethodChange()`
Edit Payment Details	Save (server-side)	`saveCurrent()`

All pages share the same configuration keys, so changing a setting affects every entry point simultaneously.