Claim overview

The report provides detailed data about results of processing of claims in openIMIS according to insurance products and health facilities. The report can be used as a tool for communication between a health insurance scheme and its contractual health facilities. The report can be run by users with the rsystem role Accountant or with a role including an access to Tools/Reports/Claim Overview. Claims are assigned to the specified period according to date of provision of health care (in case of in-patient care according to the date of discharge). (Image 236)

  1. Parameters for selection for the report:
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Img. 216 Image 217 - Claim Overview Report Criteria

  1. Input parameters of the report:
  • Date From - first claim date to be considered in the report Mandatory
  • Date To - last claim date to be considered in the report Mandatory
  • Region
  • District
  • Health Facility (the code and the name)- if it was entered
  • Insurance product (the code and the name)-if it was entered
  • Scope (claim only, Claims and rejection details, Claimn and all details)
  • Claim Status (Entered, Checked, Processed, Valuated, Rejected)
  • Insuree Number Mandatory
  1. The title of the report
See Input paramaters
  1. Content of the report

this reports shows the number of claims per hospitals

  • claim only
    • claim code
    • claim date
    • claim admin
    • Visit From
    • Visit To
    • Insurance number
    • Insuree name
    • claim status
    • amount claimed
    • Amount approved
    • Amount adjusted
    • Amount Paid
  • Claims and rejection details: same as “claim only” plus Rejected Item & service
    • Item & service code and name
    • Quantity
    • Price
    • Approved Price
    • Justificaiton
    • Valuated
    • Rejection reason
  • Claims and all details: same as “claim only” plus all Item & service
    • Item & service code and name
    • Quantity
    • Price
    • Approved Price
    • Justificaiton
    • Valuated
    • Rejection reason
  1. Example
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Img. 217 Image 236 Preview – Claim Overview