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Historia cl\'ednica de los afiliados afectados actualizada.} -\par \pard\plain \intbl\ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024{\loch\f6\fs20\lang1024\i0\b0\f6 \'c1rea de Pagos notificada acerca de las aprobaciones/rechazos de la info enviada por el prestador acerca de prestaciones realizadas.} -\par \pard\plain \intbl\ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024{\loch\f6\fs20\lang1024\i0\b0\f6 \'c1rea de Pagos dispone de los reportes de consumo de los afiliados.} -\par \pard\plain \intbl\ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\aspalpha\rtlch\af5\afs20\lang1033\ltrch\dbch\af5\afs20\langfe1024\loch\f5\fs20\lang1024 -\cell\row\pard \trowd\trql\trleft-113\trpaddft3\trpaddt0\trpaddfl3\trpaddl7\trpaddfb3\trpaddb0\trpaddfr3\trpaddr7\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx8838 -\pard\intbl\pard\plain \intbl\ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af5\afs20\lang1033\ltrch\dbch\af5\afs20\langfe1024\loch\f5\fs20\lang1024 -\par \pard\plain \intbl\ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af5\afs20\lang1033\ab\ltrch\dbch\af5\afs20\langfe1024\ab\loch\f5\fs20\lang1024\b {\loch\f5\fs20\lang1024\i0\b Flujo Principal:} -\par \pard\plain \intbl{\listtext\pard\plain \li720\ri0\lin720\rin0\fi-431\fs20\lang2058\fs20\langfe2058\fs20 1}\ilvl0 \ltrpar\s1\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\ls1\li720\ri0\lin720\rin0\fi-431\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe2058\loch\f1\fs20\lang2058{\loch\f6\fs20\lang2058\i0\b0\f6 El Prestador env\'eda {\b informaci\'f3n de prestaciones e intervenciones} de los afiliados.} -\par \pard\plain \intbl{\listtext\pard\plain \li720\ri0\lin720\rin0\fi-431\fs20\lang2058\fs20\langfe2058\fs20 2}\ilvl0 \ltrpar\s1\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\ls1\li720\ri0\lin720\rin0\fi-431\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe2058\loch\f1\fs20\lang2058{\loch\f6\fs20\lang2058\i0\b0\f6 El Sistema valida cada l\'ednea de la informaci\'f3n recibida; si la l\'ednea pasa la validaci\'f3n, se registra en el sistema la prestaci\'f3n realizada por el afiliado.} -\par \pard\plain \intbl{\listtext\pard\plain \li720\ri0\lin720\rin0\fi-431\fs20\lang2058\fs20\langfe2058\fs20 3}\ilvl0 \ltrpar\s1\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\ls1\li720\ri0\lin720\rin0\fi-431\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe2058\loch\f1\fs20\lang2058{\loch\f6\fs20\lang2058\i0\b0\f6 El Sistema, en base a estos datos y el resultado de la validaci\'f3n, construye un {\b informe de aprobaciones/rechazos de prestaciones} {\b realizadas} y lo env\'eda a Pagos} -\par \pard\plain \intbl{\listtext\pard\plain \li720\ri0\lin720\rin0\fi-431\f6\fs20\lang2058\f6\fs20\langfe2058\f6\fs20 4}\ilvl0 \ltrpar\s1\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\ls1\li720\ri0\lin720\rin0\fi-431\rtlch\af6\afs20\lang1033\ltrch\dbch\af6\afs20\langfe2058\loch\f6\fs20\lang2058 {\loch\f6\fs20\lang2058\i0\b0 Se llama al Caso de Uso \ldblquote Generar Reporte de Consumo\rdblquote } -\par \pard\plain \intbl{\listtext\pard\plain \li720\ri0\lin720\rin0\fi-431\f6\fs20\lang2058\f6\fs20\langfe2058\f6\fs20 5}\ilvl0 \ltrpar\s1\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\ls1\li720\ri0\lin720\rin0\fi-431\rtlch\af6\afs20\lang1033\ltrch\dbch\af6\afs20\langfe2058\loch\f6\fs20\lang2058 {\loch\f6\fs20\lang2058\i0\b0 Finaliza caso de uso.} -\par \pard\plain \intbl\ltrpar\s1\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\aspalpha\li289\ri0\lin289\rin0\fi0\rtlch\af5\afs20\lang1033\ltrch\dbch\af5\afs20\langfe2058\loch\f5\fs20\lang2058 -\cell\row\pard \trowd\trql\trleft-113\trpaddft3\trpaddt0\trpaddfl3\trpaddl7\trpaddfb3\trpaddb0\trpaddfr3\trpaddr7\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx8838 -\pard\intbl\pard\plain \intbl\ltrpar\s1\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\li289\ri0\lin289\rin0\fi0\rtlch\af5\afs20\lang1033\ltrch\dbch\af5\afs20\langfe2058\loch\f5\fs20\lang2058 -\par \pard\plain \intbl\ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\aspalpha\rtlch\af5\afs20\lang1033\ltrch\dbch\af5\afs20\langfe1024\loch\f5\fs20\lang1024{\loch\f5\fs20\lang1024\i0\b{\b Flujos Alternativos: }}{\loch\f5\fs20\lang1024No hay.} -\cell\row\pard \trowd\trql\trleft-113\trpaddft3\trpaddt0\trpaddfl3\trpaddl7\trpaddfb3\trpaddb0\trpaddfr3\trpaddr7\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx8838 -\pard\intbl\pard\plain \intbl\ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af5\afs20\lang1033\ltrch\dbch\af5\afs20\langfe1024\loch\f5\fs20\lang1024 -\par \pard\plain \intbl\ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af5\afs20\lang1033\ltrch\dbch\af5\afs20\langfe1024\loch\f5\fs20\lang1024{\loch\f5\fs20\lang1024\i0\b{\b Flujos de Excepci\'f3n: }}{\loch\f5\fs20\lang1024No hay.} -\par \pard\plain \intbl\ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\aspalpha\li646\ri0\lin646\rin0\fi-360\rtlch\af5\afs20\lang1033\ltrch\dbch\af5\afs20\langfe1024\loch\f5\fs20\lang1024 -\cell\row\pard \trowd\trql\trleft-113\trpaddft3\trpaddt0\trpaddfl3\trpaddl7\trpaddfb3\trpaddb0\trpaddfr3\trpaddr7\clbrdrl\brdrs\brdrw1\brdrcf1\clbrdrb\brdrs\brdrw1\brdrcf1\clbrdrr\brdrs\brdrw1\brdrcf1\cellx8838 -\pard\intbl\pard\plain \intbl\ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af6\afs20\lang1033\ltrch\dbch\af6\afs20\langfe1024\loch\f6\fs20\lang1024 -\par \pard\plain \intbl\ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\aspalpha\rtlch\af6\afs24\lang1033\ltrch\dbch\af6\afs24\langfe1024\loch\f6\fs24\lang1024{\loch\f6\fs20\lang1024\i0\b{\b\fs20 Notas: }}{\loch\f6\fs24\lang1024{\*\cs58\cf0\rtlch\ltrch\dbch\loch\f2\fs20\lang1033\fs20 \~\~\~ - La comunicaci\'f3n Prestador-Sistema podr\'eda ser \ldblquote sincr\'f3nica\rdblquote (el prestador accede al Sistema y carga la informaci\'f3n) \'f3 bien \ldblquote asincr\'f3nica\rdblquote (el Prestador env\'eda un mail, deja un archivo en un FTP, etc y luego el sistema lo procesa con alg\'fan m\'e9todo s -cheduleado.)}} -\cell\row\pard \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 -\par {\loch\f1\fs20\lang1024\i0\b0 Especificaci\'f3n de Datos:} -\par -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024{\loch\f6\fs20\lang1024\i0\b0\f6 1) {\b Informaci\'f3n de prestaciones e intervenciones}} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\li708\ri0\lin708\rin0\fi0\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 a) Identificaci\'f3n de Prestador (n\'famero de CUIT) {\af\f4 \'e0} es posible no incluirlo} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\li708\ri0\lin708\rin0\fi0\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 b) C\'f3digo de autorizaci\'f3n relacionada a la prestaci\'f3n/intervenci\'f3n. } -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\li708\ri0\lin708\rin0\fi0\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 c) C\'f3digo de prestaci\'f3n/intervenci\'f3n (\ldblquote Pr\'e1ctica\rdblquote , en el nomenclador)} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 \tab c) Fecha de Realizaci\'f3n de la prestaci\'f3n/intervenci\'f3n } -\par {\loch\f1\fs20\lang1024\i0\b0 \tab d) Porcentaje de cobertura a cubrir por la Obra Social.} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 \tab e) N\'famero de afiliado. {\af\f4 \'e0} es posible no incluirlo} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 2) {\b\f6 Informe de aprobaciones/rechazos de prestaciones}} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 \tab a) Identificaci\'f3n del Prestador} -\par {\loch\f1\fs20\lang1024\i0\b0 \tab b) Nombre del Prestador} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\li708\ri0\lin708\rin0\fi0\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 c) C\'f3digo de autorizaci\'f3n relacionada a la prestaci\'f3n/intervenci\'f3n, enviada por el Prestador.} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 \tab d) C\'f3digo de prestaci\'f3n/intervenci\'f3n (\ldblquote Pr\'e1ctica\rdblquote , en el nomenclador)} -\par {\loch\f1\fs20\lang1024\i0\b0 \tab e) Identificador de l\'ednea Aprobada/Rechazada} -\par {\loch\f1\fs20\lang1024\i0\b0 \tab f) C\'f3digo de afiliado} -\par {\loch\f1\fs20\lang1024\i0\b0 \tab g) % cobertura reclamado por el prestador} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\li708\ri0\lin708\rin0\fi0\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 h) % cobertura correspondiente al momento de aprobar la autorizaci\'f3n (si la autorizaci\'f3n existe en el sistema)} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 \tab i) Fecha de aprobaci\'f3n de la autorizaci\'f3n (si la autorizaci\'f3n existe en el Sistema)} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\li0\ri0\lin0\rin0\fi708\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 j) Fecha de vencimiento de la autorizaci\'f3n (si la autorizaci\'f3n existe en el Sistema)} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\li708\ri0\lin708\rin0\fi0\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 k) Motivo del rechazo de la l\'ednea (ej: \ldblquote Autorizaci\'f3n recibida inexistente\rdblquote , \ldblquote Autorizaci\'f3n Vencida\rdblquote , \ldblquote % cobertura recibido inv\'e1lido\rdblquote , etc)} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 \tab } -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ab\ltrch\dbch\af1\afs20\langfe1024\ab\loch\f1\fs20\lang1024\b {\loch\f1\fs20\lang1024\i0\b 3){\f7 Reporte de consumo de los afiliados}} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ab\ltrch\dbch\af1\afs20\langfe1024\ab\loch\f1\fs20\lang1024\b {\loch\f1\fs20\lang1024\i0\b \tab Cada l\'ednea:} -\par \pard\plain {\listtext\pard\plain \li1065\ri0\lin1065\rin0\fi-360\fs20\lang1024\fs20\langfe1024\fs20 a)}\ilvl0 \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\ls0\li1065\ri0\lin1065\rin0\fi-360\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 N\'famero de afiliado} -\par \pard\plain {\listtext\pard\plain \li1065\ri0\lin1065\rin0\fi-360\fs20\lang1024\fs20\langfe1024\fs20 b)}\ilvl0 \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\ls0\li1065\ri0\lin1065\rin0\fi-360\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 Nombre, apellido del afiliado} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\li1065\ri0\lin1065\rin0\fi0\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 Por cada afiliado:} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\li0\ri0\lin0\rin0\fi708\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 c) C\'f3digo de prestaci\'f3n/intervenci\'f3n REALIZADA} -\par \pard\plain \ltrpar\s6\cf0{\*\hyphen2\hyphlead2\hyphtrail2\hyphmax0}\rtlch\af1\afs20\lang1033\ltrch\dbch\af1\afs20\langfe1024\loch\f1\fs20\lang1024 {\loch\f1\fs20\lang1024\i0\b0 \tab d) Nombre de la prestaci\'f3n realizada} -\par {\loch\f1\fs20\lang1024\i0\b0 \tab e) C\'f3digo del plan del afiliado} -\par {\loch\f1\fs20\lang1024\i0\b0 \tab f) % Cobertura} -\par } \ No newline at end of file +{\rtf1\ansi\ansicpg1252\uc1\deff0\stshfdbch0\stshfloch0\stshfhich0\stshfbi0\deflang1033\deflangfe1033{\fonttbl{\f0\froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\f1\fswiss\fcharset0\fprq2{\*\panose 020b0604020202020204}Arial;} +{\f2\fmodern\fcharset0\fprq1{\*\panose 02070309020205020404}Courier New;}{\f3\froman\fcharset2\fprq2{\*\panose 05050102010706020507}Symbol;}{\f10\fnil\fcharset2\fprq2{\*\panose 05000000000000000000}Wingdings;} +{\f124\froman\fcharset238\fprq2 Times New Roman CE;}{\f125\froman\fcharset204\fprq2 Times New Roman Cyr;}{\f127\froman\fcharset161\fprq2 Times New Roman Greek;}{\f128\froman\fcharset162\fprq2 Times New Roman Tur;} +{\f129\froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\f130\froman\fcharset178\fprq2 Times New Roman (Arabic);}{\f131\froman\fcharset186\fprq2 Times New Roman 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2\tab}}\pard \s15\ql \fi-431\li720\ri0\nowidctlpar\intbl{\*\pn \pnlvlbody\ilvl0\ls2\pnrnot0 +\pndec\pnstart1\pnindent360\pnsp120\pnhang }\faauto\ls2\rin0\lin720\pararsid7757395 {\f1\fs20\insrsid7562310\charrsid13056714 El Sistema valida cada l}{\f1\fs20\insrsid7757395\charrsid13056714 \'ednea de la informaci\'f3n recibida. Validaciones + sobre la info recibida: +\par {\listtext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid13056714 \hich\af1\dbch\af0\loch\f1 -\tab}}\pard \s15\ql \fi-360\li829\ri0\nowidctlpar\intbl\jclisttab\tx829\faauto\ls3\rin0\lin829\pararsid7757395 { +\f1\fs20\insrsid13056714 La}{\f1\fs20\insrsid7757395\charrsid13056714 autorizaci\'f3n existe en el Sistema. +\par {\listtext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid13056714 \hich\af1\dbch\af0\loch\f1 -\tab}}{\f1\fs20\insrsid13056714 La}{\f1\fs20\insrsid7757395\charrsid13056714 autorizaci\'f3n }{\f1\fs20\insrsid13056714 est +\'e1}{\f1\fs20\insrsid7757395\charrsid13056714 relacionada con la prestaci\'f3n descripta por el Prestador. +\par {\listtext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid7757395\charrsid13056714 \hich\af1\dbch\af0\loch\f1 -\tab}La autorizaci\'f3n deber ser una que est\'e9 aprobada. +\par {\listtext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid7757395\charrsid13056714 \hich\af1\dbch\af0\loch\f1 -\tab}Porcentaje de cobertura }{\f1\fs20\insrsid13056714 debe ser igual al}{ +\f1\fs20\insrsid7757395\charrsid13056714 que se aplicaba al momento de la aprobaci\'f3n de la autorizaci\'f3n +\par {\listtext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid13056714 \hich\af1\dbch\af0\loch\f1 -\tab}}\pard \s15\ql \fi-360\li829\ri0\nowidctlpar\intbl\jclisttab\tx829\faauto\ls3\rin0\lin829\pararsid11668463 { +\f1\fs20\insrsid13056714 Prestador debe ser el mismo que}{\f1\fs20\insrsid7757395\charrsid13056714 }{\f1\fs20\insrsid13056714 e}{\f1\fs20\insrsid7757395\charrsid13056714 l relacionado con la autorizaci\'f3n en el Sistema}{\f1\fs20\insrsid7562310 +\par {\listtext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid13056714 \hich\af1\dbch\af0\loch\f1 -\tab}}{\f1\fs20\insrsid13056714 El afiliado debe estar relacionado con la autorizaci\'f3n recibida.}{ +\f1\fs20\insrsid13056714\charrsid13056714 +\par {\pntext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid11668463\charrsid13056714 \hich\af1\dbch\af0\loch\f1 3\tab}}\pard \s15\ql \fi-431\li720\ri0\nowidctlpar\intbl{\*\pn \pnlvlbody\ilvl0\ls2\pnrnot0 +\pndec\pnstart1\pnindent360\pnsp120\pnhang }\faauto\ls2\rin0\lin720 {\f1\fs20\insrsid11668463\charrsid13056714 Si la l\'ednea pasa la validaci\'f3n, se registra en el sistema la prestaci\'f3 +n realizada por el afiliado. Sino, se la marca como linea rechazada. +\par {\pntext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid7562310\charrsid13056714 \hich\af1\dbch\af0\loch\f1 4\tab}}\pard \s15\ql \fi-431\li720\ri0\nowidctlpar\intbl{\*\pn \pnlvlbody\ilvl0\ls2\pnrnot0 +\pndec\pnstart1\pnindent360\pnsp120\pnhang }\faauto\ls2\rin0\lin720\pararsid2299470 {\f1\fs20\insrsid7562310\charrsid13056714 El Sistema, en base a estos datos y el resultado de la validaci\'f3n, construye un }{\b\f1\fs20\insrsid7562310\charrsid13056714 +informe de aprobaciones/rechazos de prestaciones}{\f1\fs20\insrsid7562310\charrsid13056714 }{\b\f1\fs20\insrsid7562310\charrsid13056714 realizadas}{\f1\fs20\insrsid7562310\charrsid13056714 y lo env\'eda a Pagos}{\f1\fs20\insrsid2299470 +\par {\pntext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid2299470 \hich\af1\dbch\af0\loch\f1 5\tab}}\pard \s15\ql \fi-431\li720\ri0\nowidctlpar\intbl{\*\pn \pnlvlbody\ilvl0\ls2\pnrnot0 +\pndec\pnstart1\pnindent360\pnsp120\pnhang }\faauto\ls2\rin0\lin720\pararsid2299470 {\f1\fs20\insrsid2299470 El Sistema }{\f1\fs20\insrsid2299470\charrsid14763021 genera un }{\b\f1\fs20\insrsid2299470\charrsid14763021 reporte de consumo de los afiliados}{ +\f1\fs20\insrsid2299470 , bas\'e1ndose en la informaci\'f3n recibida del prestador e informaci\'f3n disponible en el propio Sistema y lo env\'eda a Pagos}{\f1\fs20\insrsid2299470\charrsid13056714 +\par {\pntext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid7562310\charrsid13056714 \hich\af1\dbch\af0\loch\f1 6\tab}}\pard \s15\ql \fi-431\li720\ri0\nowidctlpar\intbl{\*\pn \pnlvlbody\ilvl0\ls2\pnrnot0 +\pndec\pnstart1\pnindent360\pnsp120\pnhang }\faauto\ls2\rin0\lin720 {\f1\fs20\insrsid7562310\charrsid13056714 Finaliza caso de uso. +\par }\pard \s15\ql \li289\ri0\nowidctlpar\intbl\aspalpha\faauto\rin0\lin289 {\f1\fs20\insrsid7562310\charrsid13056714 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 +\fs24\lang1024\langfe1024\cgrid\noproof\langnp1033\langfenp1033 {\f1\fs20\insrsid7562310\charrsid13056714 \trowd \irow4\irowband4\ts11\trleft-113\trftsWidth1\trpaddl7\trpaddr7\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrnone \clbrdrl +\brdrs\brdrw5\brdrcf1 \clbrdrb\brdrs\brdrw5\brdrcf1 \clbrdrr\brdrs\brdrw5\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth8951\clshdrawnil \cellx8838\row }\pard \ql \li0\ri0\nowidctlpar\intbl\aspalpha\faauto\rin0\lin0 {\b\f1\fs20\insrsid7562310\charrsid13056714 +Flujos Alternativos: }{\f1\fs20\insrsid7562310\charrsid13056714 No hay.}{\f1\fs20\insrsid7562310 +\par }{\f1\fs20\insrsid2299470\charrsid13056714 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\fs20\insrsid7562310\charrsid13056714 \trowd \irow5\irowband5 +\ts11\trleft-113\trftsWidth1\trpaddl7\trpaddr7\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw5\brdrcf1 \clbrdrb\brdrs\brdrw5\brdrcf1 \clbrdrr\brdrs\brdrw5\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth8951\clshdrawnil +\cellx8838\row }\pard \ql \li0\ri0\nowidctlpar\intbl\faauto\rin0\lin0\pararsid2299470 {\b\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 Flujos de Excepci\'f3n: }{ +\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 No hay.}{\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310 +\par }{\f1\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid13056714 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 +\trowd \irow6\irowband6\ts11\trleft-113\trftsWidth1\trpaddl7\trpaddr7\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw5\brdrcf1 \clbrdrb\brdrs\brdrw5\brdrcf1 \clbrdrr\brdrs\brdrw5\brdrcf1 +\cltxlrtb\clftsWidth3\clwWidth8951\clshdrawnil \cellx8838\row }\pard \ql \li0\ri0\nowidctlpar\intbl\aspalpha\faauto\rin0\lin0 {\b\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 Notas: }{ +\cs68\f1\fs20\lang11274\noproof0\langnp11274\insrsid7562310\charrsid13056714 \~\~\~ - La comunicaci\'f3n Prestador-Sistema podr\'eda ser \'93sincr\'f3nica\'94 (el prestador accede al Sistema y carga la informaci\'f3n) \'f3 bien \'93asincr\'f3nica\'94 + (el Prestador env\'eda un mail, deja un archivo en un FTP, etc y luego el sistema lo procesa con alg\'fan m\'e9todo scheduleado.)}{\f1\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 \cell }\pard +\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 \trowd \irow7\irowband7\lastrow +\ts11\trleft-113\trftsWidth1\trpaddl7\trpaddr7\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw5\brdrcf1 \clbrdrb\brdrs\brdrw5\brdrcf1 \clbrdrr\brdrs\brdrw5\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth8951\clshdrawnil +\cellx8838\row }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 +\par }{\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 Especificaci\'f3n de Datos: +\par }{\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 +\par }{\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 1) }{\b\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 Informaci\'f3n de prestaciones e intervenciones}{ +\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 +\par }\pard \ql \li708\ri0\nowidctlpar\faauto\rin0\lin708\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 a) Identificaci\'f3}{\fs20\lang1024\langfe1024\langnp11274\insrsid13056714 n de Prestador (n\'famero de CUIT)}{ +\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 +\par b) C\'f3digo de autorizaci\'f3n relacionada a la prestaci\'f3n/intervenci\'f3n. +\par c) C\'f3digo de prestaci\'f3n/intervenci\'f3n (\'93Pr\'e1ctica\'94, en el nomenclador) +\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 \tab c) Fecha de Realizaci\'f3n de la prestaci\'f3n/intervenci\'f3n +\par \tab d) Porcentaje de cobertura a cubrir por la Obra Social. +\par \tab e) N\'famero de afiliado. +\par +\par 2) }{\b\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 Informe de aprobaciones/rechazos de prestaciones}{\b\f1\fs20\lang1024\langfe1024\langnp11274\insrsid13056714 realizadas}{ +\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 +\par \tab a) Identificaci\'f3n del Prestador +\par \tab b) Nombre del Prestador +\par }\pard \ql \li708\ri0\nowidctlpar\faauto\rin0\lin708\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 c) C\'f3digo de autorizaci\'f3n relacionada a la prestaci\'f3n/intervenci\'f3n, enviada por el Prestador. +\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 \tab d) C\'f3digo de prestaci\'f3n/intervenci\'f3n (\'93Pr\'e1ctica\'94, en el nomenclador) +\par \tab e) Identificador de l\'ednea Aprobada/Rechazada +\par \tab f) C\'f3digo de afiliado +\par \tab g) % cobertura reclamado por el prestador +\par }\pard \ql \li708\ri0\nowidctlpar\faauto\rin0\lin708\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 h) % cobertura correspondiente al momento de aprobar la autorizaci\'f3n (si la autorizaci\'f3n existe en el sistema) +\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 \tab i) Fecha de aprobaci\'f3n de la autorizaci\'f3n (si la autorizaci\'f3n existe en el Sistema) +\par }\pard \ql \fi708\li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 j) Fecha de vencimiento de la autorizaci\'f3n (si la autorizaci\'f3n existe en el Sistema) +\par }\pard \ql \li708\ri0\nowidctlpar\faauto\rin0\lin708\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 k) Motivo del rechazo de la l\'ednea (ej: \'93Autorizaci\'f3n recibida inexistente\'94, \'93Autorizaci\'f3n Vencida\'94, \'93 +% cobertura recibido inv\'e1lido\'94, etc) +\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 \tab }{\fs20\lang1024\langfe1024\langnp11274\insrsid2299470 +\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0\pararsid2299470 {\b\f1\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid7562310 Reporte de consumo de los afiliados}{\b\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid7562310 + +\par \tab }{\b\fs20\insrsid2299470 Cada l\'ednea: +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\insrsid2299470 \hich\af0\dbch\af0\loch\f0 a)\tab}}\pard \ql \fi-360\li1065\ri0\nowidctlpar\faauto\ls1\rin0\lin1065\itap0\pararsid2299470 {\fs20\insrsid2299470 N\'famero de afiliado +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\insrsid2299470 \hich\af0\dbch\af0\loch\f0 b)\tab}Nombre, apellido del afiliado +\par }\pard \ql \li1065\ri0\nowidctlpar\faauto\rin0\lin1065\itap0\pararsid2299470 {\fs20\insrsid2299470 Por cada afiliado: +\par }\pard \ql \fi708\li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0\pararsid2299470 {\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid7562310 c) C\'f3digo de prestaci\'f3n/intervenci\'f3n REALIZADA +\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0\pararsid2299470 {\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid7562310 \tab d) Nombre de la prestaci\'f3n realizada +\par \tab e) C\'f3digo del plan del afiliado +\par \tab }{\fs20\insrsid2299470 f) % Cobertura +\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid7562310 +\par }} \ No newline at end of file