Table 5 Reasons accounting for deductions in claims due to errors in health insurance claims
Reasons | Total | Reasons for claim deductions | |
|---|---|---|---|
Yes n (%) | No n (%) | ||
Treatment to diagnosis mismatch | 2,713 | 2377 (87.62) | 336 (12.38) |
Multiple ANC visits | 2,713 | 2361 (87.03) | 352 (12.97) |
Duplication of Claims | 2,712 | 2360 (87.02) | 352 (12.98) |
Inappropriate prescription | 2,713 | 2358 (86.91) | 355 (13.09) |
Oversupply of medication | 2,713 | 2351 (86.66) | 362 (13.34) |
Wrong application of Tariffs | 2,713 | 2338 (86.18) | 375 (13.82) |
No diagnosis | 2,713 | 2338 (86.18) | 375 (13.82) |
Inactive member | 2,712 | 2331 (85.95) | 381 (14.05) |
Unclear diagnosis | 2,713 | 2330 (85.88) | 383 (14.12) |
Age treatment mismatch | 2,712 | 2329 (85.88) | 383 (14.12) |
Duplication of Medication | 2,711 | 2304 (84.99) | 407 (15.01) |
No diagnoses request evidence | 2,713 | 2294 (84.56) | 419 (15.44) |
Wrong GDRG | 2,986 | 1195 (40.02) | 1791 (59.98) |
Wrong medicine code | 2,986 | 1194 (39.99) | 1792 (60.01) |