Stratified Weighted Random Sampling Concept

This is concept for Stratified weighted Random Sampling for claim reviewing process where there is human resource (claim reviewer) constraint. With increasing no. of claims and very few reviewer available, this sampling concept could be helpful.

1. Only the claims with the supporting documents will be taken into the sampling frame

2. A Sampling frame is the total number of claims falling between the lower and upper limit of a range claimed in a specific time period by a service provider.

3. The upper and lower limit of the range for the sampling frame will be determined by the Health Insurance Board (HIB) Nepal.

4. openIMIS will select 10% weighted random sample based on the claimed amount from the specified sampling frame and provide it to the claim reviewer as shown in the table below.

5. Average % of the deducted amount will be generalized to the remaining claims of their respective sampling frame. This deducting process will be done at the end of the month during the valuation of claims.