HB
Hospital Billing
Claims Administrator

Case Trends Report

Case Categories Review— which cases get paid, returned to hospital, or denied.

Cases Tracked
25
₱ 1,321,526.00
categories across all transmittals
Highest Volume
Z38.00
₱ 146,595.50
Liveborn Infant (Newborn Care)
21 claims
Highest Denial Rate
J18.92
₱ 29,250.00
COMMUNITY-ACQUIRED PNEUMONIA III (THIS CLASSIFICATION UTILIZED THE AMERICAN THORACIC SOCIETY RECOMMENDATION. THIS IS EQUIVALENT TO CAP, MODERATE RISK IN THE PHILIPPINE CLINICAL PRACTICE GUIDELINES ON THE DIAGNOSIS, EMPIRIC MANAGEMENT, AND PREVENTION OF C
14.3% denied
Highest Return Rate
E11.9
₱ 7,800.00
NON-INSULIN-DEPENDENT DIABETES MELLITUS WITHOUT COMPLICATIONS
100% returned
Case Categories Outcome Breakdown
Share of claims paid, returned, or denied per case rate
Paid
Return
Denied
Z38.00 — Liveborn Infant (Newborn Care)
21 claims
J18.92 — COMMUNITY-ACQUIRED PNEUMONIA III (THIS CLASSIFICATION UTILIZED THE AMERICAN THORACIC SOCIETY…
7 claims
O80 — Normal Spontaneous Delivery
7 claims
O82 — Cesarean Section
5 claims
O03.4 — SPONTANEOUS ABORTION, INCOMPLETE, WITHOUT COMPLICATION
4 claims
A97.1 — DENGUE WITH WARNING SIGNS; DENGUE HAEMORRHAGIC FEVER WITH WARNING SIGNS
3 claims
J18.93 — Community Acquired Pneumonia IV
2 claims
K35 — Acute Appendicitis
2 claims
A09.0 — INFECTIOUS DIARRHEA
1 claims
A09.9 — ACUTE GASTROENTERITIS
1 claims
E11.9 — NON-INSULIN-DEPENDENT DIABETES MELLITUS WITHOUT COMPLICATIONS
1 claims
I24.8 — OTHER FORMS OF ACUTE ISCHAEMIC HEART DISEASE; CORONARY FAILURE; CORONARY INSUFFICIENCY
1 claims
I61.9 — Non-traumatic Intracerebral Hemorrhage, Unspecified
1 claims
K81.0 — ACUTE CHOLECYSTITIS; ABSCESS OF GALLBLADDER WITHOUT CALCULUS; ANGIOCHOLECYSTITIS WITHOUT CALCULUS…
1 claims
N10 — ACUTE TUBULO-INTERSTITIAL NEPHRITIS; PYELONEPHRITIS; ACUTE INFECTIOUS INTERSTITIAL NEPHRITIS; ACUTE…
1 claims
N93.9 — ABNORMAL UTERINE AND VAGINAL BLEEDING, UNSPECIFIED
1 claims
O00.1 — TUBAL PREGNANCY; FALLOPIAN PREGNANCY; RUPTURE OF FALLOPIAN TUBE DUE TO PREGNANCY
1 claims
O10.9 — UNSPECIFIED PRE-EXISTING HYPERTENSION COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM
1 claims
O21.1 — HYPEREMESIS GRAVIDARUM WITH METABOLIC DISTURBANCE; HYPEREMESIS GRAVIDARUM, STARTING BEFORE THE END…
1 claims
P23.9 — CONGENITAL PNEUMONIA
1 claims
S21.2 — Open Wound of Back Wall of Thorax Without Penetration into Thoracic Cavity
1 claims
S60 — Superficial Injury of Wrist, Hand and Fingers
1 claims
S61.01 — Laceration Without Foreign Body of Thumb Without Damage to Nail
1 claims
Z34.90 — Encounter for Supervision of Normal Pregnancy, Unspecified, Unspecified Trimester
1 claims
Z38.01 — Single Liveborn Infant, Delivered by Cesarean, Born in Hospital
1 claims
Case Category Share
Share of paid, and of returned/denied, claims by case rate
Paid Rate
52
Paid
Z38.00
26.9%
J18.92
9.6%
O03.4
7.7%
O80
7.7%
O82
7.7%
A97.1
5.8%
J18.93
3.8%
K35
3.8%
Other
26.9%
Return Rate
16
RTH + Denied
Z38.00
43.8%
O80
18.8%
J18.92
12.5%
O82
6.3%
Other
18.8%
Watchlist
Ranked by combined return + denial rate
1
E11.9
NON-INSULIN-DEPENDENT DIABETES MELLITUS WITHOUT…
100%
2
K81.0
ACUTE CHOLECYSTITIS; ABSCESS OF GALLBLADDER…
100%
3
S21.2
Open Wound of Back Wall of Thorax Without…
100%
4
O80
Normal Spontaneous Delivery
42.9%
5
Z38.00
Liveborn Infant (Newborn Care)
33.3%
ICD-10 Description Total Distribution Paid Rate Denial Rate Return Rate
Z38.00 Liveborn Infant (Newborn Care) 21
66.7% 14.3% 19%
J18.92 COMMUNITY-ACQUIRED PNEUMONIA III (THIS… 7
71.4% 14.3% 14.3%
O80 Normal Spontaneous Delivery 7
57.1% 0% 42.9%
O82 Cesarean Section 5
80% 0% 20%
O03.4 SPONTANEOUS ABORTION, INCOMPLETE, WITHOUT… 4
100% 0% 0%
A97.1 DENGUE WITH WARNING SIGNS; DENGUE HAEMORRHAGIC… 3
100% 0% 0%
J18.93 Community Acquired Pneumonia IV 2
100% 0% 0%
K35 Acute Appendicitis 2
100% 0% 0%
A09.0 INFECTIOUS DIARRHEA 1
100% 0% 0%
A09.9 ACUTE GASTROENTERITIS 1
100% 0% 0%
E11.9 NON-INSULIN-DEPENDENT DIABETES MELLITUS WITHOUT… 1
0% 0% 100%
I24.8 OTHER FORMS OF ACUTE ISCHAEMIC HEART DISEASE… 1
100% 0% 0%
I61.9 Non-traumatic Intracerebral Hemorrhage… 1
100% 0% 0%
K81.0 ACUTE CHOLECYSTITIS; ABSCESS OF GALLBLADDER… 1
0% 0% 100%
N10 ACUTE TUBULO-INTERSTITIAL NEPHRITIS… 1
100% 0% 0%
N93.9 ABNORMAL UTERINE AND VAGINAL BLEEDING, UNSPECIFIED 1
100% 0% 0%
O00.1 TUBAL PREGNANCY; FALLOPIAN PREGNANCY; RUPTURE OF… 1
100% 0% 0%
O10.9 UNSPECIFIED PRE-EXISTING HYPERTENSION… 1
100% 0% 0%
O21.1 HYPEREMESIS GRAVIDARUM WITH METABOLIC… 1
100% 0% 0%
P23.9 CONGENITAL PNEUMONIA 1
100% 0% 0%
S21.2 Open Wound of Back Wall of Thorax Without… 1
0% 0% 100%
S60 Superficial Injury of Wrist, Hand and Fingers 1
100% 0% 0%
S61.01 Laceration Without Foreign Body of Thumb Without… 1
100% 0% 0%
Z34.90 Encounter for Supervision of Normal Pregnancy… 1
100% 0% 0%
Z38.01 Single Liveborn Infant, Delivered by Cesarean… 1
100% 0% 0%
Showing 25 of 25 case rates