GPO e-Claim report (CGD claims)

Why

The 5-digit hospital code is used in every file and zip name. Without it the whole shop is blocked from creating batches, and the claim fields on customer, service and payment pages only appear after enabling

How

1. 1The owner opens Shop settings › Shop information and goes to CGD claim (CSMBS OPD-CS)
2. 2Switch on Enable CGD claim
3. 3Enter the Hospital code (5 digits), required once enabled
4. 4Enter the Cashier station code, up to 4 characters — it is the shop default and a department can override it
5. 5Choose CareAccount and enter the 2-digit Sub-unit code used in the zip name
6. 6Check Send lab/X-ray items as separate rows (LB/XR) — when off, those charges merge into the exam row (EC)
7. 7Check Round charge amounts in claim files (0.25 steps) — it always rounds up, such as 9.12 to 9.25, in the claim file only
8. 8Save the shop settings

Why

Without a code the system sends 00 (no department split) and warns in the report, so a shop with departments should set them

How

1. 1The owner opens Shop settings › Departments and edits a department
2. 2Under CGD claims (GPO), enter CGD clinic code
3. 3Enter CGD station code if it differs from the shop — blank uses the shop default
4. 4Save the department

Why

If the examining or prescribing doctor has no licence number, the bill is blocked and left out of the file

How

1. 1The doctor opens User menu › Profile and goes to the licence section
2. 2Choose License prefix (CGD): doctor, dentist, nurse, pharmacist or other
3. 3Enter the licence number and save

Why

An ID that is not 13 digits or an HN over 9 characters blocks the bill. Without a main hospital code, the shop’s code is used with a warning

How

1. 1Open the customer and edit them
2. 2Make sure the national ID has 13 digits
3. 3Enter Main hospital code (5 digits) if the patient has one
4. 4Save

Why

Drugs without a TMT code block their bills. The catalog report shows which are missing and exports the 21-column CGD file

How

1. 1Open the GPO Drug Catalog report and read Has TMT code and Missing TMT code
2. 2Search by drug name, generic name, code or TMT to find what is missing
3. 3Open the product edit window and go to E-Claim / TMT
4. 4Enter the TMT code, dose-form-strength code, generic name, dosage form, strength, content and manufacturer
5. 5Check the product category and Claim control (Claimcont), then save
6. 6Back in the report, press Export DrugCatalog (.xlsx)

Why

Standard codes are used to claim treatments, and with no claim price for the right, the bill’s claim amount can be 0

How

1. 1Open the checks menu and edit an item
2. 2Enter CGD standard code (STDCode) and CodeSet
3. 3For lab items, enter the TMLT and LOINC codes, then save
4. 4Do the same for courses in the course edit window

Why

Blank fields are chosen automatically at export, so only fill in special cases, such as pre-approval claims or appointments needing a specific service type

How

1. 1In the OPD exam room press More and choose CSMBS claim dataCSMBS claim data
2. 2Choose only what you must specify: TypeIn · TypeServ · TypeOut · ClaimCat — TypeOut Other needs a note
3. 3For pre-approval categories enter Approval code (SvTxCode), or the report warns
4. 4Set the diagnosis order (SL); blank uses the order recorded by the doctor
5. 5Enter a drug supply such as 30D if needed, then save

Why

The report counts bills by payment date. A bill with no receipt is blocked, and undispensed drugs are left out of the drug file

How

1. 1In the payment window read CGD claim (CSMBS): Claimed by clinic and Patient pays
2. 2If others also pay, choose Other payer (OtherPayplan) (several allowed) and enter Amount paid by other payer
3. 3Enter the EDC auth and verify codes if you have them
4. 4Record the payment until a receipt is issued
5. 5The pharmacy records every dispensed drug

Why

The report checks each bill against CGD rules before creating files. Pulling and checking is read-only: no batch is created and nothing is sent

How

1. 1Open Reports › GPO e-Claim Report and choose Payment date range
2. 2Check the tag says CSMBS claims enabled; if not, go back to the shop settings step
3. 3Read Ready: bills that pass every check
4. 4Read Blocked: bills left out of the file until fixed
5. 5Read Warnings: can be sent, but review them

Why

Blocked bills cannot be sent or edited in the report: fix the source data and pull the report again

How

1. 1Bills tab: read each bill’s Issues column
2. 2No 5-digit hospital code: set it in Shop settings › CGD claim
3. 3No licence for the examining or prescribing doctor: the doctor fills it in on their profile with a prefix
4. 4Drug with no TMT code: fill it in the product’s E-Claim / TMT section
5. 5ID not 13 digits or HN over 9 characters: fix it on the customer record
6. 6Right outside CGD claims: do not send it, or choose the claim right on the order if mixed
7. 7No receipt yet: complete the payment
8. 8After fixing, pull the report again and confirm the bill moved to Ready

Why

Test files let you inspect content without saving a batch, so bills stay "Not sent" — ideal before the first real submission

How

1. 1Press the BillDisp tab for prescriptions and dispensed items
2. 2Press the OPServices tab for visits and diagnoses
3. 3Press Test files (batch not saved) and check the download

Why

A batch records which bills were sent, preventing duplicates, and stores files for re-download. This button saves a real record, so check the bills first

How

1. 1Bills tab: tick the bills to send, or press Select all for ready bills not yet sent
2. 2Check the number selected
3. 3Press Create batch (A) — enabled when all selected bills are ready and unsent
4. 4The zip downloads immediately with Batch created and any skipped count
5. 5Send the zip to the CGD through the shop’s assigned channel

Why

The system does not receive CGD results itself, so the shop updates the status to show which batches were sent or need fixing

How

1. 1Open Sent batches, showing the latest 50
2. 2In Batch status, choose the latest status as things progress
3. 3Press Download zip to get the same files again
4. 4If a batch is wrong and unsent, choose Voided — its bills return to not sent

Why

A sent bill cannot be sent as A again. Changed data needs E, and a bill cancelled after sending needs D

How

1. 1To send D, turn on Include cancelled bills (for D) and pull the report again
2. 2Bills tab: tick bills marked Sent
3. 3Press Send edit (E) when the bill data changed
4. 4Or press Send cancel (D) when the bill was cancelled
5. 5Send the downloaded zip to the CGD and update the batch status