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Comments about the report

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Note

This report handles claims and products. Every report that handles claims with a specific product will not produce 100% reliable data. Due to architectural choices, claims are only linked to a specific product if they have already been submitted and if they have not been automatically rejected.

For a given product, it is currently impossible to know:

  • the number of entered claims (as in “not yet submitted”)

  • the number of automatically rejected claims (as opposed to manually rejected by a claim administrator)

Any “rejected” or “total” numbers of claims - if a specific product is given - will never include these two cases.

While this is usually not an issue with large numbers, it can make some totals seem wrong.

How it works

For each requested month, a query fetches all claims with the requested criteria (product, region, district…). Then, the content of each claim is analyzed and results are added to subtotals.

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The following values are calculated, based on the previously described fetched claims:

  • Total number of claims. ⚠️ not 100% reliable - see above warning.

  • Total number of rejected claims: each claim that has the status REJECTED. ⚠️ not 100% reliable - see above warning.

  • Total amount remunerated: the sum of ClaimItem and each ClaimService that:

    • have the status PASSED

    • are linked to a claim with the status PAID