Total AR outstanding
RM 842,400
23 active claims
Submitted this month
RM 312,600
8 claims · avg 4.2 days
Collection rate
91.4%
↑ 3.2% vs last month
Rejection rate
4.7%
2 pending resubmission
Recent claims Live
CLM-0291
Lim Ah Kow
Cycle 3 · NSCLC III
ONC-02
RM 58,960
Submitted
2d ago
CLM-0290
Fatimah Binte Hamid
Cycle 6 · Breast II
ONC-05
RM 36,720
Approved
5d ago
CLM-0289
Rajan A/L Muthu
Cycle 2 · Colorectal III
ONC-08
RM 43,100
Part paid
8d ago
CLM-0288
Wong Siew Ling
Cycle 1 · Lymphoma III
ONC-10
RM 52,400
Rejected
10d ago
AR ageing
0–30 days
RM 521,800
31–60 days
RM 176,400
61–90 days
RM 84,200
90+ days
RM 60,000
Activity log
Today, 10:47
CLM-0291 submitted to AIA Medical · RM 58,960
Today, 09:15
CLM-0290 approved · Payment expected 14 May
Yesterday, 16:30
CLM-0289 partial payment — G-CSF queried by Prudential
8 May, 11:00
CLM-0288 rejected — missing pre-auth reference
Action required: resubmit with PA code
7 May, 14:00
Batch of 3 claims submitted to Great Eastern
1
Patient
Identity & cover
2
Episode
DRG & bundle
3
Validate
Rules engine
4
Submit
Payor transmission
Patient identity
Insurance coverage
Pending submission
7
RM 284,300 total
Awaiting EOB
11
RM 458,100 total
Action required
2
Rejection resubmissions
Claims queue — May 2026
| Claim ref | Patient | DRG | Payor | Submitted (RM) | Status | Age | Action |
|---|---|---|---|---|---|---|---|
| CLM-0291 | Lim Ah Kow | ONC-02 | AIA Medical | 58,960 | Submitted | 2d | |
| CLM-0290 | Fatimah Binte Hamid | ONC-05 | Prudential | 36,720 | Approved | 5d | |
| CLM-0289 | Rajan A/L Muthu | ONC-08 | Great Eastern | 43,100 | Part paid | 8d | |
| CLM-0288 | Wong Siew Ling | ONC-10 | AIA Medical | 52,400 | Rejected | 10d | |
| CLM-0287 | Chandra Sekaran | ONC-06 | Etiqa | 64,800 | Under review | 12d | |
| CLM-0286 | Nur Hazirah binti Aziz | ONC-04 | Allianz | 89,200 | Pending | 0d |
Explanation of Benefits — CLM-0291 Awaiting
Patient
Lim Ah Kow · MR-00291
Episode
NSCLC Stage III · Cycle 3 · ONC-02
Payor
AIA Medical — Hospital Income
Submitted
RM 58,960
Expected approval
RM 55,400 – 58,960
Estimated payment date
16–17 May 2026
Line-item EOB projection
Service component
Submitted
Est. approved
Notes
Chemotherapy drugs
28,400
28,400
Likely full
Oncologist consultation (×3)
8,400
8,400
Likely full
Infusion day care (×3)
3,600
3,600
Likely full
CT thorax + PET scan
6,200
5,800
PET may be queried
Lab tests (FBC, LFT)
2,400
2,400
Likely full
G-CSF filgrastim
3,200
2,800
Awaiting supp. PA
Antiemetics + supportive
1,400
1,400
Likely full
Overhead (ABC)
8,120
7,600
DRG-blended
Projected EOB total
61,720
60,000
Est. 96% approval
Variance analysis — rejected claim CLM-0288
Rejection reason: Missing pre-authorisation reference for lymphoma treatment commencement. AIA requires PA prior to cycle 1 for DRG ONC-10.
Resolution steps
1. Obtain retrospective PA from AIA medical team (call 03-2056 1111, ref: CLM-0288)
2. Attach PA approval letter to resubmission
3. Include clinical justification letter from Dr. Siti Aminah
4. Resubmit via RCMX with updated pre-auth field populated
5. Expected resubmission turnaround: 5–7 business days
2. Attach PA approval letter to resubmission
3. Include clinical justification letter from Dr. Siti Aminah
4. Resubmit via RCMX with updated pre-auth field populated
5. Expected resubmission turnaround: 5–7 business days
Payor directory — Malaysian insurance panels
| Payor | Panel status | Onco limit/year | Submission channel | Avg days to pay | Claims YTD |
|---|---|---|---|---|---|
| AIA Medical | Panelled | RM 500,000 | e-Claims API v3 | 14d | RM 342,400 |
| Prudential PRUmedic | Panelled | RM 400,000 | MedicalConnect Portal | 18d | RM 198,600 |
| Great Eastern | Panelled | RM 350,000 | GEIS Online Claims | 21d | RM 124,200 |
| Allianz Care | Negotiating | — | — | — | — |
| Etiqa Onco Shield | Panelled | RM 300,000 | Etiqa e-Claims | 16d | RM 87,800 |
| AXA Affin | Application sent | — | — | — | — |
Negotiated bundle tariffs — oncology From I-DRG costing model
| DRG | Bundle description | Episode cost | Our tariff (22%) | AIA agreed | Prudential | Status |
|---|---|---|---|---|---|---|
| ONC-01 | NSCLC chemo stage I/II | 22,000 | 26,840 | 26,840 | 25,500 | Agreed |
| ONC-02 | NSCLC chemo stage III | 48,320 | 58,950 | 58,950 | 54,000 | Agreed |
| ONC-04 | NSCLC immunotherapy stage IV | 96,000 | 117,120 | 110,000 | 105,000 | Negotiating |
| ONC-05 | Breast adjuvant chemo I/II | 30,100 | 36,720 | 36,720 | 36,720 | Agreed |
| ONC-10 | NHL R-CHOP 6 cycles | 46,200 | 56,364 | 56,364 | 52,000 | Agreed |
Tariffs sourced from I-DRG costing model. Payor-specific rates negotiated against DRG-ABC cost evidence. Evidence dossiers available per DRG code.
Revenue collected YTD
RM 1.24M
8 months · 2 oncologists
Avg claim value
RM 54,200
23 claims YTD
Avg days to collect
16.4d
Target: ≤15d
Net collection rate
91.4%
Industry avg: 87%
Denial analytics — root cause
| Denial reason | Frequency | Value at risk (RM) | Resolution |
|---|---|---|---|
| Missing pre-authorisation | 3 | 148,600 | Enforce PA workflow pre-cycle-1 |
| G-CSF not pre-approved | 2 | 6,400 | Add supplemental PA step in RCMX |
| ICD-10 / DRG mismatch | 1 | 43,100 | CyEMR-DRG code validation rule |
| Late submission (>90 days) | 1 | 28,400 | Auto-submit trigger at episode close |
Bank reconciliation — May 2026
| Date | Claim ref | Payor | Submitted | Paid | Variance | Status |
|---|---|---|---|---|---|---|
| 5 May | CLM-0290 | Prudential | 36,720 | 36,720 | 0 | Matched |
| 3 May | CLM-0285 | Great Eastern | 43,100 | 40,800 | –2,300 | Under-paid |
| 28 Apr | CLM-0284 | AIA Medical | 58,960 | 58,960 | 0 | Matched |
| 22 Apr | CLM-0283 | Etiqa | 52,400 | 52,400 | 0 | Matched |
CLM-0285 variance RM 2,300 — Great Eastern applied a co-insurance deduction not reflected in tariff schedule. Action: raise formal query with GE panel desk.