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:

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

Image 236 Preview – Claim Overview