Status Of Claims Research Articles

Pension Management System of PRBS in the Philippine National Police: Ba-sis for Policy Enhancement

This study assessed the pension management system of the PRBS in the Philippine National Police, highlighting specific challenges and deficiencies in different areas. These challenges include ensuring the completeness and legality of supporting documents, addressing delays in the issuance of updated documents from the Philippine Statistics Authority (PSA), improving the process of updating and issuing records, and enhancing the feedback mechanism and incorporation of results in the PRBS Program Review and Analysis. There are variations in beneficiaries' perceptions across different aspects of the pension management system, indicating room for improvement. Recommendations include establishing clear guidelines, enhancing communication channels, streamlining processes, and prioritizing solutions favored by beneficiaries. The study also recommends implementing clear guidelines, standardized checklists, training programs, and streamlined processes to address the challenges. These measures, if adopted, could significantly improve the efficiency and effectiveness of the pension management system. Enhancing communication and coordination with the PSA, implementing technological solutions, and establishing a feedback mechanism are also advised. Further, analysis is suggested to understand specific problems and differences in perception. Recommendations also focus on improving access to claim status information, prioritizing beneficiary-favored solutions, and enhancing policy implementation of the Pension Management System. These changes, if implemented, could lead to a more transparent, efficient, and beneficiary-friendly pension management system. Your active participation in this process is crucial and highly valued. In summary, the study highlights the challenges, recommendations, and conclusions related to the pension management system in the Philippine National Police, emphasizing the need for improvements in various aspects to enhance efficiency, effectiveness, and satisfaction among pensioners and stakeholders.

Status of Medical Referral and Transfer Claims in One Region Using the National Health Insurance Claims from 2016 to 2022

Status of Medical Referral and Transfer Claims in One Region Using the National Health Insurance Claims from 2016 to 2022

A qualitative study of military service members undergoing medical separation.

Little research explores military perspectives on medical disability-related transition. A qualitative study sought to understand transition experiences of United States military Service members found unfit for duty following medical and physical evaluation boards (MEBs and PEBs). Confidential telephone interviews were conducted with 25 current and prior Service members. Participants were asked to share their experiences before, during, and after the MEB and PEB processes. Interview questions explored (1) health conditions that prompted the medical disability evaluation, (2) reactions to being recommended for separation, (3) transition-related stress and challenges, and (4) coping strategies. Salient themes were identified across chronological narratives. Participants expressed that debilitating physical (e.g., injury) and/or mental (e.g., post-traumatic stress disorder) illnesses prompted their medical evaluation. In response to the unfit for duty notice, some participants reported emotional distress (e.g., anxiety, anger) connected to uncertainty about the future. Other participants reported relief connected to a sense of progression toward their medical disability claim status. Transition stress included the length of the MEB/PEB process, impact of the COVID-19 pandemic on the process, financial stress, impact on family life, and compounded effect of these stressors on emotional distress, including depression and suicidal thoughts. Participants reported using adaptive (e.g., psychotherapy) and maladaptive (e.g., excessive drinking) strategies to cope with stress. Preliminary reports of emotional distress and transition stress following unfit for duty notices highlight the need for increased support and interventions to facilitate adaptive coping strategies during this vulnerable period.

Status of nutrition claims of food and beverages sold in supermarkets in Ankara Turkey

Status of nutrition claims of food and beverages sold in supermarkets in Ankara Turkey

The Relationship between Insurance Participants' Knowledge of Pending Claims: A Study on Insurance Managed by PT. Multiniaga Intermedia Proteksi

The impact of pending claims can affect insurance service activities, becoming hampered and officers' workloads increasing because they have to revise pending claims that are sent. This study aimed to assess the relationship between insurance participants' knowledge of the occurrence of pending claims: a study on insurance managed by PT. Multiniaga Intermedia Proteksi. This study was an observational study of cross-sectional design. A total of 107 research subjects participated in this study. The results of this study show that the claim submission process at PT. Multiniaga Intermedia Proteksi had 107 claims submitted to insurance, and it was known that the results of paid claims submissions were 87 submissions (81.3%), and pending submissions were 20 submissions (18.7%). The results of participants' level of knowledge regarding submitting claims were obtained from 107 respondents. The average value of participants' knowledge was 89.15, with a median of 86.67. The highest value was 86.67. The lowest score obtained by respondents was 60, and the highest score was 100 as the results of knowledge testing on the results of claim status using the t-test, obtained with a probability value (Sig.) 0.196 > 0.1, indicating that knowledge has no significant effect on submitting claims.

Hubungan Ketepatan Kode Diagnosis Terhadap Status Klaim JKN Rawat Inap di Rumah Sakit Pelabuhan Jakarta

The accuracy of determining the diagnosis code is necessary for the benefit of patient health information in carrying out health services. The accuracy of the diagnosis code is also required for the benefit of claiming National Health Insurance (JKN). The research aims to determine the correlation between the accuracy of the diagnosis code and the status of inpatient National Health Insurance (JKN) claims. The research method was an inferential analysis with a cross-sectional research design using the chi-square statistical test. The samples of the research were 125 medical records. Samples were taken by way of proportional stratified random sampling. Based on the research results, the accuracy of determining the diagnosis code was 114 (91,2%) while the inaccuracy of determining the diagnosis code was 11 (8,8%). JKN claims received were 104 (83,2%) while JKN claims that were postponed were 21 (16,8%). The results of the chi-square statistical test obtained odd ratio value of 20,7, meaning that the correct diagnosis codes has 20,7 times chance of JKN claims approval than the incorrect diagnosis codes. The significance value obtained of 0.000. The p-value shows <0.05, so Ho is rejected and Ha is accepted or there is a correlation between the accuracy of the diagnosis code and the status of inpatient JKN claims at the Pelabuhan Jakarta Hospital. This research concludes that there is a correlation between the accuracy of the diagnosis code and the status of inpatient JKN claims.

Real-world effectiveness of omadacycline and impact of unapproved omadacycline prescription claims among adult outpatients with community-acquired bacterial pneumonia or acute bacterial skin and skin structure infections.

BACKGROUND: Omadacycline is an amino-methylcycline antibiotic that is indicated for the treatment of adults with community-acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections (ABSSSI). Like many new antibiotics, there are scant real-world effectiveness data for omadacycline. There is also a high potential that an omadacycline prescription is rejected or reversed, and it is not known whether patients who have an unapproved omadacycline claim are at higher risk for 30-day emergency department (ED)/inpatient (IP) visits. OBJECTIVE: To describe the real-world effectiveness of omadacycline and assess the impact of unapproved omadacycline claims among adult outpatients with CABP or ABSSSIs. METHODS: The study population included patients who received 1 or more omadacycline outpatient prescriptions from a large US claims database (October 2018 to September 2020) and had a diagnosis for CABP or ABSSSI. The approval status of omadacycline claims was determined. The proportion of all-cause 30-day ED/IP visits among patients with an approved vs unapproved claim was compared. RESULTS: 404 patients met the inclusion criteria (CABP: 97; ABSSSI: 307). Of the 404 patients, 146 (36%) had an unapproved claim (CABP: 28; ABSSSI: 118). Overall, the proportion of 30-day ED/IP visits (yes/no) for those with an unapproved and approved claim was 28% vs 17%, respectively (P < 0.05). The overall adjusted 30-day ED/IP visits incidence difference was 11% (95% CI = 2 - 19), corresponding to an adjusted number needed to treat of 9 (95% CI = 5 - 43). CONCLUSIONS: A high incidence (36%) of unapproved omadacydine claims was observed in this study. Patients with unapproved daims had an 11% higher incidence of 30-day all-cause ED/IP visits than patients with approved claims. DISCLOSURES This study was funded by Paratek Pharmaceuticals, Inc (King of Prussia, PA). Dr Lodise is a consultant to Paratek Pharmaceuticals, Inc, and has received consultancy payments. Drs Gunter, Sandor, and Berman are employees and shareholders of Paratek Pharmaceuticals, Inc. Dr Mu, Ms Gao, Ms Yang, and Ms Yim are employees of Analysis Group. Analysis Group has received payment from Paratek Pharmaceuticals, Inc, to conduct part of this study.

Frege on the introduction of real and complex numbers by abstraction and cross-sortal identity claims

In this article, I try to shed new light on Frege’s envisaged definitional introduction of real and complex numbers in Die Grundlagen der Arithmetik (1884) and the status of cross-sortal identity claims with side glances at Grundgesetze der Arithmetik (vol. I 1893, vol. II 1903). As far as I can see, this topic has not yet been discussed in the context of Grundlagen. I show why Frege’s strategy in the case of the projected definitions of real and complex numbers in Grundlagen is modelled on his definitional introduction of cardinal numbers in two steps, tentatively via a contextual definition and finally and definitively via an explicit definition. I argue that the strategy leaves a few important questions open, in particular one relating to the status of the envisioned abstraction principles for the real and complex numbers and another concerning the proper handling of cross-sortal identity claims.

Undoing the Regional Demos? Gender Equality and Economic Growth in Regional Development

ABSTRACT The aim of this article is to contribute to the discussions about the relationship between feminism and neoliberalism and the status of feminist emancipatory claims in marketized policy fields. My approach has been to analyse gender equality work within the highly marketized field of regional development in Sweden with a specific interest for how the convergence of the policy goals of gender equality and economic growth is represented by gender equality workers and to discuss the status of feminist emancipatory claims in this policy field. The analysis consists of articulating three representations of the relationship between gender equality and economic growth, characterized by various degrees of conflict: reciprocity, co-optation and Trojan horses. However, none of the representations articulate open emancipatory claims as legitimate within the field of regional development. Thus, the study shows gender equality in its relationship to economic growths renders emancipatory claims illegitimate unless beneficial for economic growth or hidden trough marketized language or logics.

52. Stop Denying It: Billing Claims in Reduction Mammaplasty

PURPOSE: Despite evidence documenting the physical and psychological benefit of breast reduction, insurance claims remain a cumbersome process. The objective of this study was to assess denials of insurance claims for reduction mammaplasty in a national cohort. METHODS: We partnered with the Auctus Group to prospectively collect data on all of their plastic surgery clients with denied breast reduction claims (CPT 19318) from January 2022 through August 2022. Data harvested included claim status, reason for denial, network status and other related variables. Descriptive statistics were performed where appropriate. RESULTS: There were 216 denials from insurance companies during this period with an average of 1.37 denials per claim. Of the 158 initial denials, 104 (65.8%) of these were from claims that had already received prior-authorization. Of the remaining 34.1% denied claims, third-party payers stated that no prior-authorization was necessary in 22.2% of cases (n=12/54). The most frequent cited reasons for claim denial were medical record requests (n=80, 37%), non-covered charges (n=61, 28.2%), and medical necessity (n=26, 12%). Over 25% of claims were denied a twice by insurance providers. Nearly 10% of claims required tertiary appeals and one case was approved on the quaternary appeal. Distribution of denials was equally dispersed amongst claims that were in- versus out-of-network. Average claim to payment period was 45.3 days. CONCLUSION: Even for practices following third-party payer established prior-authorization guidelines, denials for breast reduction claims are occurring at high rates creating unnecessary administrative burden. Continual advocacy is needed to reduce these inefficiencies for plastic surgery practices.

The Influence of Outpatients Medical Information Completeness in The Emergency Departments and Policlinics on Returning BPJS Health Claim Status

Background: Returning BPJS Health claim status required some outpatients data, therefor this study conducted to understand the medical information needed for the BPJS Health claim.Objective: The objective of this paper was returning BPJS Health claim status required some outpatients data, therefor this study conducted to understand the medical information needed for the BPJS Health claim.Methods: Retrospective analysis with quantitative approach. Variables were groups of cases in the form of confirmation from BPJS Health related to reviews on pending claim files, differentiated according to the type of case. As far as observations could be grouped into 8 confirmation groups as the theme of the cases taken 396 samples of pending claim files at XXX Hospitals Semarang Central Java Indonesia. Data collection was obtained from observations. Data analysis used quantitative analysis.Results: 16.9% were confirmation related to Z code as diagnosis, 11.1% were confirmation of secondary codes, 17.2% were confirmation of potential outpatient and inpatient care, 7.6% were system confirmation, 11.6% were confirmation related to medical support, 11.1% were confirmation regarding number of visits, 5.3% were confirmation related to medical actions, and 19.2% were other confirmations, which contains about authentication, administrative documents, patient identity.Conclusion: Completeness of medical information on outpatients from emergency departments and polyclinic of BPJS Health patients were confirmation related to Z code as diagnosis, confirmation of secondary codes, confirmation of potential outpatient and inpatient care, system confirmation, confirmation related to medical support, confirmation regarding number of visits, confirmation related to medical actions, and other confirmations.

Can narratives about sovereign debt be generally ideologically suspicious? An exercise in broadening the scope of ideology critique

Can narratives about sovereign debt be generally ideologically suspicious? An exercise in broadening the scope of ideology critique

Status of Gender-Based Insurance Claims: A Comparison

Status of Gender-Based Insurance Claims: A Comparison

Consumen Laptop Service Notification System In Android-Based Family Computer Shops

Currently the Family Computer store already has 3 branches and for sales matters it implements an offline and online system. But at this time the store still uses an offline system in terms of service matters such as: Warranty Claims, Service, and Current Status Checks.For this reason, research was carried out which aims to create a program to provide services online so that users when there are problems can provide easier access.This research was made after passing observations and interviews from local parties. Making this program uses the Android Studio application to create an Android application where almost everyone has an Android cellphone, and uses the Firebase Cloud Messagging feature from Google to provide service access to users so that users can monitor and get the latest information from the program without having to come to the store. or notify the admin at the store

Consumen Laptop Service Notification System In Android-Based Family Computer Shops

Currently the Family Computer store already has 3 branches and for sales matters it implements an offline and online system. But at this time the store still uses an offline system in terms of service matters such as: Warranty Claims, Service, and Current Status Checks.For this reason, research was carried out which aims to create a program to provide services online so that users when there are problems can provide easier access.This research was made after passing observations and interviews from local parties. Making this program uses the Android Studio application to create an Android application where almost everyone has an Android cellphone, and uses the Firebase Cloud Messagging feature from Google to provide service access to users so that users can monitor and get the latest information from the program without having to come to the store. or notify the admin at the store

Litigation in Septorhinoplasty Surgery: A Pan-Specialty Review of National Health Service (the United Kingdom) Data.

Success in septorhinoplasty surgery can be difficult to assess due to a lack of objective and measurable outcomes. If patients' expectations are not met, it places surgeons performing septorhinoplasty at risk of litigation which can be stressful and costly. The National Institute of health (NHS) Resolution is a government-funded organization in the United Kingdom that provides expertise to the NHS on resolving patient concerns. Data were requested from NHS Resolution for claims involving septorhinoplasty surgery over a period of 5 years between April 2015 and April 2020. Rhinoplasty claims performed by all specialties were included. Data included the claim status, incident details, alleged injury, damages claimed, and damages paid. A total of 31 claims were identified by the study, equating to a total cost of £1,347,336.10. Of the 31 claims for rhinoplasty or septorhinoplasty, 9 cases were open (29%, £962,361.00) and 22 cases were closed (71%, £384,975.10). The common causes for claims were "intraoperative problems (32%)," "failure to warn-informed consent (19%)," and "foreign body left in situ (13%)." The most common injuries were "cosmetic disfigurement (39%)," "unnecessary pain (29%)," and "additional/ unnecessary operation (29%)." This study highlights the need for improved awareness of clinical negligence claims among surgeons who perform septorhinoplasty. Results are applicable to all specialties who perform the procedure. The study highlights the importance of assessing patients' motives and expectations prior to surgery and emphasizes the need for a well-documented rigorous consent process.

Men who teach Early Childhood Education: Mediating Masculinity, Authority and Sexuality

Efforts to involve men in teaching young children is aimed at disrupting gender-specific occupational segregation and the feminization of teaching. This paper foregrounds the reasons a group of South African male preservice teachers chose to specialise in Early Childhood Education (ECE). We deploy hybrid masculinity as a lens to unpack how men reconfigure male power as prospective ECE teachers. Male authority and intergenerational relations in ECE and the avoidance of sexual misconduct permit male teachers to strategically mediate power and claim status as prospective ECE teachers. Highlighting these gendered complexities is vital in developing a gender equitable ECE landscape.

Health literacy and recovery following a non-catastrophic road traffic injury

BackgroundHealth literacy (HL) is rarely addressed in rehabilitation research and practice but can play a substantial role in the recovery process after an injury. We aimed to identify factors associated with low HL and its relationship with 6-month health outcomes in individuals recovering from a non-catastrophic road traffic injury.MethodsFour hundred ninety-three participants aged ≥17 years who had sustained a non-catastrophic injury in a land-transport crash, underwent a telephone-administered questionnaire. Information was obtained on socio-economic, pre-injury health and crash-related characteristics, and health outcomes (quality of life, pain related measures and psychological indices). Low HL was defined as scoring < 4 on either of the two scales of the Health Literacy Questionnaire that covered: ability to actively engage with healthcare providers (‘Engagement’ scale); and/or understanding health information well enough to know what to do (‘Understanding’ scale).ResultsOf the 493, 16.9 and 18.7% scored < 4 on the ‘Understanding’ and ‘Engagement’ scale (i.e. had low HL), respectively. Factors that were associated with low HL as assessed by both scales were: having pre-injury disability and psychological conditions; lodging a third-party insurance claim; experiencing overwhelming/great perceived sense of danger/death during the crash; type of road user; low levels of social satisfaction; higher pain severity; pain catastrophizing; and psychological- and trauma-related distress. Low HL (assessed by both scales) was associated with poorer recovery outcomes over 6 months. In these longitudinal analyses, the strongest association was with disability (p < 0.0001), and other significant associations were higher levels of catastrophizing (p = 0.01), pain severity (p = 0.04), psychological- (p ≤ 0.02) and trauma-related distress (p = 0.003), lower quality of life (p ≤ 0.03) and physical functioning (p ≤ 0.01).ConclusionsA wide spectrum of factors including claim status, pre-injury and psychological measures were associated with low HL in injured individuals. Our findings suggest that targeting low HL could help improve recovery outcomes after non-catastrophic injury.

Beryllium disease among construction trade workers at Department of Energy nuclear sites: A follow-up.

Construction workers at U.S. Department of Energy (DOE) nuclear weapons facilities are screened to identify DOE-related occupational illnesses, including beryllium sensitization (BeS) and chronic beryllium disease (CBD). The study objectives were to estimate beryllium disease risks and the CBD claims acceptance rate in the energy workers' benefits program. Workers diagnosed with BeS via beryllium lymphocyte proliferation test (BeLPT) included in screening examinations were interviewed about subsequent diagnosis of CBD. We estimated the proportion who developed CBD based on the ratio of CBD cases, based on self-reported compensation claim status, to all workers with BeS interviewed. We used stratified analyses to explore trends in disease frequency by age, race, sex, DOE employment duration, site, trade group, and cigarette smoking history. Between 1998 and 2020, 21,854 workers received a BeLPT; 262 (1.20%) had BeS (two abnormals or one abnormal plus one borderline test); 212 (0.97%) had a single abnormal BeLPT. Of 177 BeS workers interviewed, 35 (19.8%) reported an accepted CBD compensation claim. The claims acceptance rate among BeS workers increased with years of DOE employment, from 8.4% with <5 years to 33.3% for >25 or more years. Five of 68 interviewed workers with a single positive BeLPT reported CBD claim acceptance; an additional CBD case was confirmed by chart review (8.8%). Years of DOE work predict the risk of developing CBD among those sensitized and getting a claim for CBD accepted. Ongoing surveillance and increased awareness of the risk of beryllium exposure and CBD as an occupational disease among construction workers are needed.

Phenomenology, abduction, and argument: avoiding an ostrich epistemology

Phenomenology has been described as a “non-argumentocentric” way of doing philosophy, reflecting that the philosophical focus is on generating adequate descriptions of experience. But it should not be described as an argument-free zone, regardless of whether this is intended as a descriptive claim about the work of the “usual suspects” or a normative claim about how phenomenology ought to be properly practiced. If phenomenology is always at least partly in the business of arguments, then it is worth giving further attention to the role and form of phenomenological argumentation, how it interacts with its more strictly descriptive component, and the status of phenomenological claims regarding conditions for various kinds of experience. I contend that different versions of phenomenological reasoning encroach upon argument forms that are commonly thought to be antithetical to phenomenology, notably abductive reasoning, understood in terms of its role in both hypothesis generation and in terms of justification. This paper identifies two main steps to making this case. The first step takes seriously the consequences of the intrinsically dialectical aspect of phenomenology in intersection with other modes of philosophy, the natural attitude, and non-philosophy. The second step focuses on transcendental reflection and arguments about the conditions/structures they contain. Together, these two steps aim to rescue phenomenology from the objection that it has an “ostrich epistemology” with regard to the ostensible purity of description, the intuition of essences, or the “conditions” ascertained through transcendental reflection.