CMS flow for TPA/Insurance portal
This new automation feature, there will be a button on CMS medical coverage page to do a direct check with the TPA portal and display the benefit information on CMS. Please refer to the step-by-step information on the Actions Description section below to see how the new button and screens look like.
Note: This is only applicable for MHC Medical Network portal for time being.
Link for MHC medical network: https://www.mhcasia.net/mhc/
Do register patient as per normal and proceed to medical coverage page to add in the coverage.
3 different scenarios the coverage information is reflected on CMS.
1st Scenario: Attaching new MHC coverage and plan
Under Medical coverage tab, add the respective MHC coverage and select “Find Plan”. Medical plan will be extracted through automation and appear under the plan column.
Policy no. will be Employee ID, which is stated in the MHC portal. Staff can manually change the plans, if applicable.
Part of the RPA feature, staff can refer to “TPA/Corporate Remarks” for the following information
- Benefits
- Special remarks (inclusive exclusions)
This information are the ones which are reflected on the TPA portal when clinic staff does verification.
Note: Staff may input the plan, policy no. manually if deemed necessary.
2nd Scenario: Reconfirmation of existing medical coverage
When adding patient to registry, there is a popup for confirmation of patient visit details. Under the medical coverage portion, proceed to select “view coverage”. This will then trigger the extraction of the details from the portal and allow the TPA / Corporate Remarks portion to appear.
3rd Scenario: Update of Medical Coverage under Dispensing/Post consult
Screen
When updating coverage from patient registry, click on Actions and select “Update coverage”
AND / OR
When updating coverage from dispense screen, click on medical coverage button on the top.
There will be a popup to reflect the coverage. Clinic staff will be able to select “View coverage”. This will then trigger the extraction of the details from the portal and allow the TPA / Corporate Remarks portion to appear.
