Idea: Claim resubmission

Content

Summary

This was edited from the idea “editing a claim”. It was deemed that editing a claim should not be allowed for fraud control purposes, rather it is more interesting to focus on the claims resubmission process. Indeed, it should be more clear exactly what the “standard” process should be if a submitted claim is incorrect and needs to be altered. This is particularly interesting for new implementations and programs that in the process of setting up a health insurance scheme, such as in Niger and Mauritania, where the claims management procedures are not necessarily in place yet. If the openIMIS Community could provide a standardized process on claim resubmission, scheme administrators would then already be guided on best practice when using openIMIS.

Overview

Process Group

 

Function

Claim resubmission

 

Source

 

 

Related

 

Prioritisation

Score

9.3

Current Relevance

8

Future Relevance

10

Global Good

10

Local Funding

Need to see perhaps Nepal or Cameroon HIV scheme can potentially take this up in their implementation

 

Source

This was edited from the original idea “editing a claim”. It was deemed that editing a claim should not be allowed for fraud control purposes, rather it is more interesting to focus on the claims resubmission process.

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