Hi Gurus,
I have a question regarding contract schemes behavior:
there us a note that when contract schemes contain more than one item, the system processes the items in accordance with the ranking order specified independently of one another.
Let's assume that the following items belong to contract scheme A in this example:
Whe have: -A service group LAB containing 2 services Lab A and Lab B
-service DTC
-Service DRC
Item 1: Laboratory examinations services of service group LAB (service lab A and service lab B are members of this service group LAB) are not covered. All other services are covered in total to 70%.
Item 2: Service DTC is not covered. All other services are covered in total to 100%.
For the case described in this example, on the basis of item 1 the system only takes into account the services DTC and DRC when calculating the relevant prorated service charges. On the basis of item 2, the system takes into account the services DRC and the laboratory services LAB A and LAB B. As a result, the services DTC, DRC, LAB A and LAB B are invoiced in whole or part to the insurance provider, even though services at item level are excluded from coverage.
so , what is the ideal way to construct the contract schemes item to operate in a dependent manner .. i.e. to get services LAB A , LAB B , DTC excluded from insurance provider share
Thanks,