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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;} +{\f38\froman\fcharset238\fprq2 Times New Roman CE;}{\f39\froman\fcharset204\fprq2 Times New Roman Cyr;}{\f41\froman\fcharset161\fprq2 Times New Roman Greek;}{\f42\froman\fcharset162\fprq2 Times New Roman Tur;} +{\f43\froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\f44\froman\fcharset178\fprq2 Times New Roman (Arabic);}{\f45\froman\fcharset186\fprq2 Times New Roman 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S.A.}{\nofcharsws4467}{\vern24703}}\margl1701\margr1701\margt1417\margb1417 \deftab708\widowctrl\ftnbj\aenddoc\hyphhotz425\noxlattoyen\expshrtn\noultrlspc\dntblnsbdb\nospaceforul\hyphcaps0\horzdoc\dghspace120\dgvspace120 +\dghorigin1701\dgvorigin1984\dghshow0\dgvshow3\jcompress\viewkind1\viewscale100\nolnhtadjtbl\rsidroot7562310 \fet0\sectd \sbknone\linex0\sectdefaultcl\sftnbj {\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl2 +\pnucltr\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang {\pntxta )}}{\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl6 +\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl8\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang +{\pntxtb (}{\pntxta )}}\pard\plain \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 \fs24\lang1024\langfe1024\cgrid\noproof\langnp1033\langfenp1033 {\f1\fs20\insrsid7562310\charrsid13056714 +\par }\trowd \irow0\irowband0\ts11\trleft-113\trftsWidth1\trpaddl7\trpaddr7\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw5\brdrcf1 \clbrdrl\brdrs\brdrw5\brdrcf1 \clbrdrb\brdrs\brdrw5\brdrcf1 \clbrdrr\brdrs\brdrw5\brdrcf1 +\cltxlrtb\clftsWidth3\clwWidth8951\clshdrawnil \cellx8838\pard \ql \li0\ri0\nowidctlpar\intbl\aspalpha\faauto\rin0\lin0 {\b\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 Caso de uso: }{ +\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 Recibir y Cotejar Consumos y Prestaciones\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 { +\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 \trowd \irow0\irowband0\ts11\trleft-113\trftsWidth1\trpaddl7\trpaddr7\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw5\brdrcf1 \clbrdrl\brdrs\brdrw5\brdrcf1 +\clbrdrb\brdrs\brdrw5\brdrcf1 \clbrdrr\brdrs\brdrw5\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth8951\clshdrawnil \cellx8838\row }\trowd \irow1\irowband1\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\pard \ql \li0\ri0\nowidctlpar\intbl\faauto\rin0\lin0 { +\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 +\par }\pard \ql \li0\ri0\nowidctlpar\intbl\aspalpha\faauto\rin0\lin0 {\b\f1\fs20\insrsid7562310\charrsid13056714 Actores: }{\f1\fs20\insrsid7562310\charrsid13056714 Prestador, Pagos.\cell }\pard +\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\fs20\insrsid7562310\charrsid13056714 \trowd \irow1\irowband1\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 { +\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 +\par }\pard \ql \li0\ri0\nowidctlpar\intbl\aspalpha\faauto\rin0\lin0 {\b\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 Precondiciones: }{\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 Existe alg\'fa +n tipo de comunicaci\'f3n entre el Prestador y el Sistema, que permita al Prestador enviar informaci\'f3n hacia \'e9ste \'faltimo; as\'ed como entre el Sistema y Pagos.\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 +{\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 \trowd \irow2\irowband2\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 {\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 +\par }{\b\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 Poscondiciones: }{\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 +\par Historia cl\'ednica de los afiliados afectados actualizada. +\par \'c1rea de Pagos notificada acerca de las aprobaciones/rechazos de la info enviada por el prestador acerca de prestaciones realizadas. +\par \'c1rea de Pagos dispone de los reportes de consumo de los afiliados. +\par }\pard \ql \li0\ri0\nowidctlpar\intbl\aspalpha\faauto\rin0\lin0 {\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 { +\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 \trowd \irow3\irowband3\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 {\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid13056714 +\par }{\b\f1\fs20\insrsid7562310\charrsid13056714 Flujo Principal: +\par {\pntext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid7562310\charrsid13056714 \hich\af1\dbch\af0\loch\f1 1\tab}}\pard\plain \s15\ql \fi-431\li720\ri0\nowidctlpar\intbl{\*\pn \pnlvlbody\ilvl0\ls2\pnrnot0 +\pndec\pnstart1\pnindent360\pnsp120\pnhang }\faauto\ls2\rin0\lin720 \fs24\lang2058\langfe2058\cgrid\langnp2058\langfenp2058 {\f1\fs20\insrsid7562310\charrsid13056714 El Prestador env\'eda }{\b\f1\fs20\insrsid7562310\charrsid13056714 informaci\'f3 +n de prestaciones e intervenciones}{\f1\fs20\insrsid7562310\charrsid13056714 de los afiliados.}{\f1\fs20\insrsid7562310 +\par {\pntext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid5270930 \hich\af1\dbch\af0\loch\f1 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 {\f1\fs20\insrsid5270930 El Sistema obtiene dicha informaci\'f3n y verifica su formato. Si el formato NO es v\'e1lido --> }{\b\f1\fs20\insrsid5270930\charrsid5270930 E1}{ +\f1\fs20\insrsid549190\charrsid13056714 +\par {\pntext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid7562310\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\pararsid7757395 {\f1\fs20\insrsid7562310\charrsid13056714 El Sistema valida cada l}{\f1\fs20\insrsid7757395\charrsid13056714 \'ednea de la informaci\'f3 +n recibida. Validaciones sobre la info recibida: +\par {\listtext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid8614436 \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\insrsid8614436 El Prestador 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 existe en el Sistema.}{ +\f1\fs20\insrsid7757395 +\par {\listtext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid8614436 \hich\af1\dbch\af0\loch\f1 -\tab}}{\f1\fs20\insrsid8614436 Prestador debe ser el mismo que}{\f1\fs20\insrsid8614436\charrsid13056714 }{ +\f1\fs20\insrsid8614436 e}{\f1\fs20\insrsid8614436\charrsid13056714 l relacionado con la autorizaci\'f3n 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 }{\f1\fs20\insrsid8614436 deber ser una que est\'e9 aprobada en la fecha de recepci +\'f3n de la }{\b\f1\fs20\insrsid8614436\charrsid13056714 informaci\'f3n de prestaciones e intervenciones}{\b\f1\fs20\insrsid8614436 }{\f1\fs20\insrsid8614436 enviada por el Prestador.}{\f1\fs20\insrsid7757395 +\par {\listtext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid6114349 \hich\af1\dbch\af0\loch\f1 -\tab}}{\f1\fs20\insrsid6114349 La autorizaci\'f3n no debe estar realizada (en los datos del Sistema) +\par {\listtext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid6114349 \hich\af1\dbch\af0\loch\f1 -\tab}}\pard \s15\ql \fi-360\li829\ri0\nowidctlpar\intbl\jclisttab\tx829\faauto\ls3\rin0\lin829\pararsid6114349 { +\f1\fs20\insrsid6114349 La prestaci\'f3n deber existir en el Sistema y NO tiene que estar dada de baja. +\par {\listtext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid7757395\charrsid13056714 \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\insrsid7757395\charrsid13056714 Porcentaje de cobertura }{\f1\fs20\insrsid13056714 debe ser igual al}{\f1\fs20\insrsid7757395\charrsid13056714 que se aplicaba al momento de la aprobaci\'f3 +n 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 El afiliado }{\f1\fs20\insrsid6114349 deb existir en el Sistema y }{\f1\fs20\insrsid13056714 estar relacionado con la autorizaci\'f3n recibida. +\par {\pntext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid11668463\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 {\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 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\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\insrsid13043882 (se incluyen s +\'f3lo las prestaciones realizadas que hayan sido aprobadas)}{\f1\fs20\insrsid2299470 +\par {\pntext\pard\plain\s15 \intbl\f1\fs20\lang2058\langfe2058\langnp2058\langfenp2058\insrsid2299470 \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\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 7\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 }{\f1\fs20\insrsid7490485 el }{\f1\fs20\insrsid7562310\charrsid13056714 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\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7490485 \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 +\par }\pard \ql \li0\ri0\nowidctlpar\intbl\faauto\rin0\lin0\pararsid5270930 {\b\f1\fs20\lang1024\langfe1024\langnp11274\insrsid5270930\charrsid5270930 E1}{\f1\fs20\lang1024\langfe1024\langnp11274\insrsid5270930 : +\par {\listtext\pard\plain\intbl\f1\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7490485 \hich\af1\dbch\af0\loch\f1 1.\tab}}\pard \ql \fi-360\li780\ri0\nowidctlpar\intbl\jclisttab\tx780\faauto\ls9\rin0\lin780\pararsid7490485 { +\f1\fs20\lang1024\langfe1024\langnp11274\insrsid7490485 El sistema deja constancia en un log los siguientes datos: fecha y hora actual, nombre de la informaci\'f3n recibida (nombre del archivo), descripci\'f3n: \'93Documento rechazado\'94 +\par {\listtext\pard\plain\intbl\f1\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7490485 \hich\af1\dbch\af0\loch\f1 2.\tab}Finaliza el caso de uso. +\par }\pard \ql \li0\ri0\nowidctlpar\intbl\faauto\rin0\lin0\pararsid2299470 {\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 {\listtext\pard\plain\i\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid3550631\charrsid3550631 \hich\af0\dbch\af0\loch\f0 1.\tab}}\pard \ql \fi-360\li1428\ri0\nowidctlpar\jclisttab\tx1428\faauto\ls6\rin0\lin1428\itap0\pararsid14755567 { +\i\fs20\lang1024\langfe1024\langnp11274\insrsid3550631\charrsid3550631 Cabecera: +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid4599262 \hich\af0\dbch\af0\loch\f0 a.\tab}}\pard \ql \fi-360\li2148\ri0\nowidctlpar\jclisttab\tx2148\faauto\ls6\ilvl1\rin0\lin2148\itap0\pararsid14755567 { +\fs20\lang1024\langfe1024\langnp11274\insrsid4599262 N\'famero de CUIT del Prestador.}{\fs20\lang1024\langfe1024\langnp11274\insrsid7562310 +\par {\listtext\pard\plain\i\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid3550631\charrsid3550631 \hich\af0\dbch\af0\loch\f0 2.\tab}}\pard \ql \fi-360\li1428\ri0\nowidctlpar\jclisttab\tx1428\faauto\ls6\rin0\lin1428\itap0\pararsid14755567 { +\i\fs20\lang1024\langfe1024\langnp11274\insrsid3550631\charrsid3550631 Detalle: +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 a.\tab}}\pard \ql \fi-360\li2148\ri0\nowidctlpar\jclisttab\tx2148\faauto\ls6\ilvl1\rin0\lin2148\itap0\pararsid14755567 { +\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 C\'f3digo de autorizaci\'f3n relacionada a la prestaci\'f3n}{\fs20\lang1024\langfe1024\langnp11274\insrsid4599262 . +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 b.\tab}}{\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 C\'f3digo de prestaci\'f3n}{ +\fs20\lang1024\langfe1024\langnp11274\insrsid4599262 .}{\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 c.\tab}Fecha de Realizaci\'f3n de la prestaci\'f3n +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 d.\tab}Porcentaje de cobertura a cubrir por la Obra Social. +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid3550631 \hich\af0\dbch\af0\loch\f0 e.\tab}}{\fs20\lang1024\langfe1024\langnp11274\insrsid3550631 C\'f3digo}{\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 + de afiliado. +\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 +\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 {\listtext\pard\plain\i\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid14755567\charrsid14755567 \hich\af0\dbch\af0\loch\f0 1.\tab}}\pard \ql \fi-360\li1428\ri0\nowidctlpar\jclisttab\tx1428\faauto\ls7\rin0\lin1428\itap0\pararsid11564094 { +\i\fs20\lang1024\langfe1024\langnp11274\insrsid14755567\charrsid14755567 Cabecera:}{\i\fs20\lang1024\langfe1024\langnp11274\insrsid14755567 +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid14755567\charrsid11821112 \hich\af0\dbch\af0\loch\f0 a.\tab}}\pard \ql \fi-360\li2148\ri0\nowidctlpar\jclisttab\tx2148\faauto\ls7\ilvl1\rin0\lin2148\itap0\pararsid11564094 { +\fs20\lang1024\langfe1024\langnp11274\insrsid14755567\charrsid11821112 Fecha de generaci\'f3n de }{\fs20\lang1024\langfe1024\langnp11274\insrsid14755567 \'e9ste informe}{\fs20\lang1024\langfe1024\langnp11274\insrsid14755567\charrsid14755567 +\par {\listtext\pard\plain\i\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid14755567\charrsid14755567 \hich\af0\dbch\af0\loch\f0 2.\tab}}\pard \ql \fi-360\li1428\ri0\nowidctlpar\jclisttab\tx1428\faauto\ls7\rin0\lin1428\itap0\pararsid11564094 { +\i\fs20\lang1024\langfe1024\langnp11274\insrsid14755567\charrsid14755567 Detalle: +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid9260979 \hich\af0\dbch\af0\loch\f0 a.\tab}}\pard \ql \fi-360\li2148\ri0\nowidctlpar\jclisttab\tx2148\faauto\ls7\ilvl1\rin0\lin2148\itap0\pararsid11564094 { +\fs20\lang1024\langfe1024\langnp11274\insrsid9260979 N\'famero de CUIT}{\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 del Prestador +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 b.\tab}Nombre del Prestador +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 c.\tab}C\'f3digo de autorizaci\'f3n relacionada a la prestaci\'f3n}{\fs20\lang1024\langfe1024\langnp11274\insrsid11494555 +, enviado}{\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 por el Prestador. +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 d.\tab}C\'f3digo de prestaci\'f3n}{\fs20\lang1024\langfe1024\langnp11274\insrsid11494555 enviado por el Prestador.}{ +\fs20\lang1024\langfe1024\langnp11274\insrsid9260979 +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 e.\tab}}{\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 C\'f3digo de afiliado}{ +\fs20\lang1024\langfe1024\langnp11274\insrsid11494555 enviado por el Prestador}{\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 f.\tab}% cobertura reclamado por el prestador +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 g.\tab}% cobertura correspondiente al momento de aprobar la autorizaci\'f3n (si la autorizaci\'f3n existe en el sistema) +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 h.\tab}Fecha de aprobaci\'f3n de la autorizaci\'f3n (si la autorizaci\'f3n existe en el Sistema) +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 i.\tab}Fecha de vencimiento de la autorizaci\'f3n (si la autorizaci\'f3n existe en el Sistema)}{ +\fs20\lang1024\langfe1024\langnp11274\insrsid7562310 +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid11564094 \hich\af0\dbch\af0\loch\f0 j.\tab}}{\fs20\lang1024\langfe1024\langnp11274\insrsid11564094 Fecha de recepci\'f3n de la }{ +\b\fs20\lang1024\langfe1024\langnp11274\insrsid11564094\charrsid11564094 Informaci\'f3n de prestaciones e intervenciones}{\b\fs20\lang1024\langfe1024\langnp11274\insrsid11564094 }{\fs20\lang1024\langfe1024\langnp11274\insrsid11564094 +enviada por el prestador, }{\fs20\lang1024\langfe1024\langnp11274\insrsid11494555 en la cual ven\'eda la autorizaci\'f3n especificada en c).}{\fs20\lang1024\langfe1024\langnp11274\insrsid11564094\charrsid11494555 +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid11494555\charrsid7562310 \hich\af0\dbch\af0\loch\f0 k.\tab}}{\fs20\lang1024\langfe1024\langnp11274\insrsid11494555\charrsid7562310 Identificador de l\'ednea Aprobada/Rechazada}{ +\fs20\lang1024\langfe1024\langnp11274\insrsid11494555 .}{\fs20\lang1024\langfe1024\langnp11274\insrsid11494555\charrsid7562310 +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid7562310\charrsid7562310 \hich\af0\dbch\af0\loch\f0 l.\tab}}{\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 Motivo del rechazo de la l\'ednea (ej: \'93 +Autorizaci\'f3n recibida inexistente\'94, \'93Autorizaci\'f3n Vencida\'94, \'93% cobertura recibido inv\'e1lido\'94, }{\fs20\lang1024\langfe1024\langnp11274\insrsid8614436 \'93Autorizaci\'f3n recibida no relacionada con el afiliado\'94, \'93Autorizaci\'f3 +n recibida no relacionada con la prestaci\'f3n\'94}{\fs20\lang1024\langfe1024\langnp11274\insrsid7562310\charrsid7562310 ) +\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 {\listtext\pard\plain\i\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid11821112\charrsid11821112 \hich\af0\dbch\af0\loch\f0 1.\tab}}\pard \ql \fi-360\li1425\ri0\nowidctlpar\jclisttab\tx1425\faauto\ls5\rin0\lin1425\itap0\pararsid2299470 { +\i\fs20\lang1024\langfe1024\langnp11274\insrsid11821112\charrsid11821112 Cabecera}{\fs20\lang1024\langfe1024\langnp11274\insrsid11821112\charrsid11821112 :}{\fs20\lang1024\langfe1024\langnp11274\insrsid11821112 +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid11821112\charrsid11821112 \hich\af0\dbch\af0\loch\f0 a.\tab}}\pard \ql \fi-360\li2145\ri0\nowidctlpar\jclisttab\tx2145\faauto\ls5\ilvl1\rin0\lin2145\itap0\pararsid2299470 { +\fs20\lang1024\langfe1024\langnp11274\insrsid11821112\charrsid11821112 Fecha de generaci\'f3n de \'e9ste reporte}{\b\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid7562310 \tab }{ +\i\fs20\lang1024\langfe1024\langnp11274\insrsid11821112\charrsid11821112 +\par {\listtext\pard\plain\i\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid14755567 \hich\af0\dbch\af0\loch\f0 2.\tab}}\pard \ql \fi-360\li1425\ri0\nowidctlpar\jclisttab\tx1425\faauto\ls5\rin0\lin1425\itap0\pararsid11821112 { +\i\fs20\lang1024\langfe1024\langnp11274\insrsid14755567 Detalle (c}{\i\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid9260979 ada l\'ednea}{\i\fs20\lang1024\langfe1024\langnp11274\insrsid14755567 )}{ +\i\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid9260979 : +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid9260979\charrsid9260979 \hich\af0\dbch\af0\loch\f0 a.\tab}}\pard \ql \fi-360\li2145\ri0\nowidctlpar\jclisttab\tx2145\faauto\ls5\ilvl1\rin0\lin2145\itap0\pararsid14755567 { +\fs20\lang1024\langfe1024\langnp11274\insrsid9260979\charrsid9260979 C\'f3digo}{\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid9260979 de afiliado +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid11821112 \hich\af0\dbch\af0\loch\f0 b.\tab}}{\fs20\lang1024\langfe1024\langnp11274\insrsid11821112 Nombre y a}{\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid9260979 +pellido del afiliado +\par {\listtext\pard\plain\i\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid2299470\charrsid9260979 \hich\af0\dbch\af0\loch\f0 c.\tab}}{\i\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid9260979 Por cada afiliado}{ +\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid9260979 : +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid11821112 \hich\af0\dbch\af0\loch\f0 i.\tab}}\pard \ql \fi-180\li2865\ri0\nowidctlpar\jclisttab\tx2865\faauto\ls5\ilvl2\rin0\lin2865\itap0\pararsid14755567 { +\fs20\lang1024\langfe1024\langnp11274\insrsid11821112 N\'famero de CUIT del Prestador donde se realiz\'f3 la prestaci\'f3n +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid11821112 \hich\af0\dbch\af0\loch\f0 ii.\tab}Nombre Prestador donde se realiz\'f3 la prestaci\'f3n +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid2299470\charrsid7562310 \hich\af0\dbch\af0\loch\f0 iii.\tab}}{\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid7562310 C\'f3digo de prestaci\'f3n REALIZADA +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid2299470\charrsid7562310 \hich\af0\dbch\af0\loch\f0 iv.\tab}Nombre de la prestaci\'f3n realizada}{\fs20\lang1024\langfe1024\langnp11274\insrsid2299470 +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid11821112\charrsid7562310 \hich\af0\dbch\af0\loch\f0 v.\tab}}{\fs20\lang1024\langfe1024\langnp11274\insrsid11821112\charrsid7562310 Fecha de Realizaci\'f3n de la prestaci\'f3n +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid2299470\charrsid7562310 \hich\af0\dbch\af0\loch\f0 vi.\tab}}{\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid7562310 C\'f3digo del plan del afiliado +\par {\listtext\pard\plain\fs20\lang1024\langfe1024\noproof\langnp11274\insrsid2299470\charrsid11821112 \hich\af0\dbch\af0\loch\f0 vii.\tab}}{\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid11821112 % Cobertura +\par }\pard \ql \li0\ri0\nowidctlpar\faauto\rin0\lin0\itap0 {\fs20\lang1024\langfe1024\langnp11274\insrsid2299470\charrsid7562310 +\par }} \ No newline at end of file