1. Healthcare Guide
  2. What's New in This Release

8Facilities

About Facilities

Facilities are healthcare organizations that are paid by or file claims with your health plan or health insurance company. Examples of facilities are hospitals, clinics, and pharmacies. Facilities are also referred to as provider organizations.

Using the procedures given in this chapter, you will be able to perform the administrator tasks of adding facilities to Facility Locator. End users use the Facilities screens to associate providers, facilities, and contacts with a facility, add a facility contract, add a facility payment, and add a facility claim.

Scenario for Adding a New Healthcare Facility

This scenario features sample tasks performed by a contracting specialist. Your company might follow a different workflow according to its business requirements.

In this scenario, a contracting specialist for a health plan is responsible for managing information about the healthcare facilities, such as hospitals and healthcare networks, with which your company does business. She just established a contract with a single facility.

She adds the new facility to the Siebel database. Next, she adds information about the facility’s business hours and specialties. Then, she associates the facility with individual providers and with other facilities. Next, she adds information about contracts the facility holds with your company along with the facility’s payment preferences.

In this scenario, the end users are contracting specialists for a health plan. They enter information to:

  • Add new facilities

  • Associate providers, facilities, and contacts with a facility

  • Add facility contracts, facility payments, or facility claims

Administrator Procedures for Facilities

The following administrator procedure is described in this section:

Adding Facilities to the Facility Locator

As an administrator, you can add facilities to the facility locator. The facility locator searches for facilities using latitude and longitude. If you do not know the latitude and longitude, leave those fields blank. If the City, State, Zip Code, and Country fields are correct, the latitude and longitude values will automatically generate when you save the facility.

Note: The latitude and longitude values will not generate if any one value in the City, State, Zip Code, or Country fields is incorrect. For example, if the ZIP Code is incorrect, you will receive an error message. To correct this problem, navigate to the Application Administration, ZIP Code Administration view and make sure the Geo values for that city, state, and ZIP Code combination has been loaded. For more information, see Siebel Self Service Administration Guide.

To add a facility to the facility locator

  1. Navigate to Site Map, Administration - Application, and then Branch Locator.

  2. In the Branch Locations list, add a record.

  3. In the Branch Locations list, complete the necessary fields.

End-User Procedures for Facilities

The following end-user procedures are described in this section:

Adding Facilities

End users can add or change healthcare facility records. After users add facility records in the Facilities screen, they can view them in both the Facilities screen and the Companies screen. In the Companies screen, a check mark appears in the Facility field of the record, indicating that the company is a facility.

Note: If users add healthcare facility records in the Companies screen, the records will not appear in the Facilities screen.

To add a facility

  1. Navigate to the Facilities screen and the Facility List view.

  2. In the Facilities list, add a record and complete the necessary fields.

    Note: Records in the Facilities list contain a few of the most frequently used facility fields. You can add text into additional fields, such as Main Office, in the More Info form.

Associating Providers, Facilities, and Contacts with a Facility

Facilities usually have affiliations with providers, other facilities, or contacts. For example, a hospital might be affiliated with a clinic.

To associate a provider, facility, or contact with a facility

  1. Navigate to the Facilities screen and then the Facility List view.

  2. In the Facilities list, drill down on the facility to associate with a provider, facility, or contact.

  3. Click the appropriate view tab:

    • Summary. To associate a contact with a facility, use the Contacts list on this view tab.

    • Affiliated Providers. To associate a provider with a facility.

    • Facility Affiliations. To associate a facility with another facility.

  4. Add a record and either select an existing contact, provider, or facility or add a new one.

Adding Facility Contracts

A company might have contracts for its healthcare products with a facility or provider organization, in addition to contracts with individual providers. For example, they might have a contract with a pharmacy or clinic. Each contract is based upon one of the company’s healthcare products and might have different terms, payment preferences, and payment methods.

End users can set up payment preferences and payment methods for facilities. Their company might have more than one contract with a facility. They can set up different payment arrangements and methods for each contract.

To add a facility contract

  1. Navigate to the Facilities screen and then the Facility List view.

  2. In the Facilities list, drill down on the desired facility.

  3. Click the Contracts view tab.

  4. In the Contracts list, add a record and complete the necessary fields.

  5. If payments will be made by EFT or check, scroll down to the Payment Preferences - Check form and select one of the following from the drop-down list:

    • Payment Preferences - Check. To add information for check payments.

    • Payment Preferences - EFT. To add information for electronic funds transfer payments.

  6. Complete the necessary fields.

Adding Facility Payments

End users can add information about payments their company makes to facilities. Payment information can include payment amount and payment date.

Facility payments might be imported from a bill payment engine by using Siebel Business Application Integration. For more information, see Business Processes and Rules: Siebel Enterprise Application Integration.

To add a facility payment

  1. Navigate to the Facilities screen and then the Facility List view.

  2. In the Facilities list, drill down on the desired facility.

  3. Click the Payments view tab.

  4. In the Payment list, add a record and complete the necessary fields.

Note: Records in the Payments list contain a few of the most frequently used payment fields. To add text into additional fields, such as Check #, scroll down to the Payment Details form.

Adding Facility Claims

A contract with a facility might specify that the facility must be paid each time it provides a service to a member. If so, the facility or member might contact a company to initiate claims for payment.

Facility claims might be imported from a claims processing engine, by using Siebel Business Application Integration. For more information, see Overview: Siebel Enterprise Application Integration.

To add a facility claim

  1. Navigate to the Facilities screen and then the Facility List view.

  2. In the Facilities list, drill down on the desired facility.

  3. Click the Claims view tab.

  4. In the Claims list, add a record.

  5. In the Add Claims dialog box, perform the appropriate task:

    • To choose an existing record, select a record and click OK.

    • To add a new record, click New and complete the fields.