OverSpill

1. Process

1.1. Referral Process

1.1.1. Enternal Refarrel

1.1.2. External Refarrel

1.2. Claims Process

1.3. Treatment Plan

1.4. Transportation Plan

1.5. Return To MOH Hospitals

1.6. Reconsilation Process

1.7. Payment Process

1.7.1. Calims Payment

1.7.1.1. Enternal claims

1.7.1.2. External Claims

1.7.2. Tickets

1.7.3. Miscellanies

2. Data

2.1. Overspill Data

2.1.1. Referrals

2.1.2. Approvals

2.1.3. Claims

2.2. Beneficiaries Data

2.2.1. Medical Data

2.2.2. Non-Medical Data

2.3. Provider Data

2.3.1. Enternal Providers

2.3.2. Externals providers

2.4. Archived Documents

2.5. Data Processign

2.5.1. Data modilling & Analysis

2.5.2. Data Management & Governance

2.5.3. BI & Reporting

2.5.4. Data Storage

2.5.5. Data Integration

3. Budget

3.1. Plan Budget

3.2. Approved Budget

3.3. Budget Flow

3.4. Budget Management

4. Providers

4.1. Enternal Providers

4.1.1. Private Sector

4.1.2. OGS

4.2. External Providers

4.3. Communication With Providers

5. Beneficiaries

5.1. Commuincation With Beneficiaries

5.1.1. Complains

5.1.2. Appeals

5.1.3. Inquaries

5.2. Notification for refarrel status

6. Technologies & System

6.1. Enternal - CNHI systems

6.1.1. CNHI - ERP

6.2. Externals systems

6.2.1. ETEMAD

6.2.2. MOH - MAWARD

6.2.3. Claims Systems

6.3. Future Systems

6.3.1. XRM

6.3.2. Communication Channels

7. Business Cases

7.1. Emergency

7.2. Urgent

7.3. Life-saving and critical cases

7.4. Rehabilitation

7.5. Ptosthesis

7.6. Long term

7.7. International treatment

7.8. Exhausted the limit of the insurance policy