Shafafiya

ClaimGross Simple Type Simple Type

Description

Is the total AED amount of the charges included on the Claim. ClaimGross includes any patient financial responsibility for the Claim, such as co-pays and deductibles, as well as charges made to other insurers for the Encounter(s) covered by the Claim. The prices on which ClaimGross are based should reflect the general agreement between the payer and provider for the Claim items for insuree. Example 1 | A patient visits a clinic for a hip operation. The published list price is AED 8000. However, the insurer has negotiated with the provider a general discount of 10% on the published list price. ClaimGross is AED 7200. Example 2 | A patient visits a clinic for a routine physical exam which costs AED 2000.The patient pays a co-pay of AED 250. ClaimGross is AED 2000. Example 3 | A patient visits a clinic for a physical exam (AED 500) and an expensive diagnostic test (AED 1500) in one Encounter. The patient pays a co-pay of AED 250 and claims the diagnostic test from a supplementary insurance, because the primary insurance does not cover this diagnostic test. ClaimGross is AED 2000. Note | If the claimed amount is not in AED, then value should be converted to AED on the date of ClaimDateSubmission Restrictions: Non-negative and greater than or equal to ClaimPatientShare + ClaimNet.

Type

restriction of float