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Content

Summary

Currently, the justification field while reviewing a service or item in each claim is allowed to be free text. This creates an issue that even the same reason might be written in different ways by different claim reviewers, and could potentially create issues for providing coherent feedback to the health facilities for the reason of changes (reject, change of quantity) of services/items. Additionally, the difference in language could also create issues for the upcoming AI module for claims adjudication.

Potential features solution: Justifications changed to a drop-down menu, with the items in drop down menu defined by claim reviews team of each implementation. Additionally, an 'other' option for free text could also be provided for ad-hoc feedback.

Overview

Process Group

JLN Group - Claims Management

Function

Claim dispute and appeals

Source

https://openimis.atlassian.net/jira/servicedesk/projects/OSD/queues/issue/OSD-111

Related

Mobile Strategy

Prioritisation

Score

Current Relevance

8

Future Relevance

10

Global Good

10

Local Funding

Could be potential in Cameroon HIV Elimination programme pilot

Source

This was the idea mentioned during interviews with various stakeholders in February 2021.

Github: https://github.com/openimis/client-fe_js

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