Page 12 - C.Journal 4th edition

Claims Journal 4th Edition Claims Journal 4th Edition

QC Report Of Q1 - 2017

• Quality average of Q1/2017 is 91.6% which is little bit lower comparing with the average of Q4/2016 which was 92.3%

• The most frequent errors during this period is the “wrong ICD/benefit head selected ‘’, which is 22.62% of total errors.

• On the other hand, errors like ‘’Approving service has no indication / irrelevant to condition’’ is frequently repeated with 16.6% of total errors.

• ‘’ Uncovered service was approved’’ noticeably appeared especially in the month of April with 14.6%.

• As we all know those are fatal mistakes that we must avoid. We have to check the entire episode of care before adjudicating the claim.
Good luck

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