To do Claims Monitoring, whichmeans Monitoring Claims Activity such as Claims Pre-Admission or Referral Patient, Eligibility, Discharge for Inpatient Claims, OutPatient Claims, or Reimbursement Claims. User can do those Activity with Minimum Risk of Human Error to do Management of those Claims, because all Input is fetch from Database that have relation of Participants once the Card Number Input already in.
Monitoring for Claims Eligibility, Discharge, and Pre-Admission by Claims Referral.
Search Claims Monitoring group By Inpatient or Outpatient will show all Claims separated By Verification Status, so User can easily Process the Claims that need to Update the Informations.
Claims Calculation is Amount Adjustment in Details of Treatment and/or Medication, both Information of must Have Date, Physician, Remarks, and Incurred Amount Data, System will do Auto Calculate for Approved Amount, if there any Limit Condition in Policy for Treatment and/or Medication, Approval Amount will Re-Calculate Automatically by System based on Limit Condition in Policy.
Verification are Required if there any action for the patient, such as Physician Visit, Treatment, etc.
BPJS Kesehatan have INACBG'S Policy, which have Complex Rules and Limit about Treatment and Medication, they just didn't Noticed yet that XIVA are Exist.