Settlements with the NHF - step by step

The jHIS™ system supports settlements with the NFZ for non-commercial visits. The process of settlements with the NFZ starts with import the files of contracts with the NFZ (UMX files) as described in the "Agreement (UMX)" section. Before importing you should take care of proper setting parameters related to the settlement in the application configuration as described in the "Configuration" section and for VII and VIII part of ministerial code of clinic entered into the system were consistent with those that are contained in the contract (UMX file). During import a contract there is automatically created dictionary of NFZ services. At creating a dictionary of services, the system based on the knowledge base automatically assigns ministerial codes of benefits to the services and default ICD-9 codes of procedures. After importing the agreement, in order to facilitate subsequent encoding visits, you should verify the dictionary for automatically filled values and possibly fill the values which the system was not able to fill automatically. You should also remember to keep updated dictionaries of ICD-9 procedures and ICD-10 diagnoses, which new versions are announced by the NFZ. In order to ensure proper settlement with the NFZ you should be aware of:

  • keep importing into the system all annexes to contracts with the NFZ (also UMX files) in the same way as import contracts
  • keep introducing into a system the declaration of patients as described in the "Patients (active card)" section
  • keep coding in the system services and diagnostic tests as described in "Coding visits" and "Coding diagnostic tests" sections

Accounting with the NFZ is based on generating in jHIS system messages in formats accepted by the NFZ, uploading them to the SZOI NFZ system, downloading from SZOI NFZ system feedback messages, import them into the jHIS™ system, correcting the declaration of patients / services / diagnostic tests according to the information contained in feedback messages and resume the cycle by again passing messages as described in the "Messages" section.