Claim - Primary Operational Indicators
Comments about the report
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.
There are various subtotal levels:
Overall totals
Subtotals for each month
Subtotals for each
Health Facilityin each monthSubtotals for each
Productavailable in eachHealth Facilityin each month
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
ClaimItemand eachClaimServicethat:have the status
PASSEDare linked to a claim with the status
PAID
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