Appendix_C_(4-_Embassy_Egypt_CS_Claims_Analysis__1MAY2016_through_30APR2017).pdf
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Appendix C (4- Embassy Egypt CS Claims Analysis__1MAY2016 through 30APR2017)
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CS Claims Analysis by Client and Sub office Client code: 0312* Paid date from : 2016-5-1 to : 2017-4-30
Claims Paid by Benefit Category
Client / Suboffice Inpatient Outpatient Op Medication
Maternity Dental Optical Other Services
Total % of Total
0312A 001 AMERICAN EMBASSY 2,185,839 1,783,833 2,914,401 76,343 177,098 76,430 346 7,214,289 38% 0312B 001 AMERICAN EMBASSY 1,971,551 2,344,928 2,623,089 565,631 239,889 110,862 9,646 7,865,598 41% 0312C 001 AMERICAN EMBASSY 893,047 119,377 375,823 2,181 3,750 2,400 0 1,396,578 7%
0312D 001 AMERICAN EMBASSY 127,398 124,578 282,732 2,786 17,066 8,000 562,560 3%
0312E 001 AMERICAN EMBASSY 234,195 251,968 311,017 37,865 21,201 8,000 0 864,246 4%
0312G 001 AMERICAN EMBASSY 6,449 14,575 1,906 22,929 0%
0312H 001 AMERICAN EMBASSY 62,960 22,745 23,366 1,207 760 111,038 1%
0312I 001 AMERICAN EMBASSY USAID 107,953 169,442 208,599 18,950 37,671 11,395 554,010 3% 0312J 001 AMERICAN EMBASSY USAID 63,526 118,555 133,943 21,126 43,674 11,240 2,082 394,145 2%
0312F 001 AMERICAN EMBASSY 8,776 10,360 204,966 224,102 1%
0312K 001 AMERICAN EMBASSY 2,619 3,860 6,479 0%
Total 5,655,244 4,954,854 7,096,372 726,088 543,015 228,328 12,074 19,215,974 100% Inpatient
29%
Outpatient 26%
Op Medication 37%
Maternity 4%
Dental 3%
Optical 1%
Other Ser...
0%
Inpatient 29%
Outpatient 26%
Op Medication 37%
Maternity 4%
Dental 3%
Optical 1%
Other Ser...
0%
PercentagePaid_usd
Inpatient Outpatient Op Medication Maternity Dental Optical Other Services
Cash vs. PPO Claims
Client / Suboffice CASH PPO Total % of Total
0312A 001 AMERICAN EMBASSY 488,555 6,725,734 7,214,289 38%
0312B 001 AMERICAN EMBASSY 791,469 7,074,128 7,865,598 41%
0312C 001 AMERICAN EMBASSY 26,107 1,370,470 1,396,578 7%
0312D 001 AMERICAN EMBASSY 35,932 526,627 562,560 3%
0312E 001 AMERICAN EMBASSY 47,454 816,792 864,246 4%
0312F 001 AMERICAN EMBASSY 238 223,865 224,102 1%
0312G 001 AMERICAN EMBASSY 1,906 21,024 22,929 0%
0312H 001 AMERICAN EMBASSY 1,299 109,739 111,038 1%
0312I 001 AMERICAN EMBASSY USAID 107,516 446,494 554,010 3%
0312J 001 AMERICAN EMBASSY USAID 107,464 286,681 394,145 2%
0312K 001 AMERICAN EMBASSY 210 6,269 6,479 0%
Total 1,608,151 17,607,823 19,215,974 100%
CASH
8%
PPO
92%
CASH
8%
PPO
92%
CASH
PPO
User: Maged Hamdy 1 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Cash Claims by Benefit Category
Client / Suboffice Inpatient Outpatient Op Medication
Maternity Dental Optical Other Services
Total % of Total
0312A 001 AMERICAN EMBASSY 31,779 158,835 14,796 29,404 176,965 76,430 346 488,555 30% 0312B 001 AMERICAN EMBASSY 88,379 98,870 65,282 178,669 239,761 110,862 9,646 791,469 49%
0312C 001 AMERICAN EMBASSY 9,276 4,704 5,977 3,750 2,400 26,107 2%
0312D 001 AMERICAN EMBASSY 2,140 5,719 221 2,786 17,066 8,000 35,932 2%
0312E 001 AMERICAN EMBASSY 7,437 5,796 846 4,175 21,201 8,000 47,454 3%
0312G 001 AMERICAN EMBASSY 1,906 1,906 0%
0312H 001 AMERICAN EMBASSY 343 81 114 760 1,299 0%
0312I 001 AMERICAN EMBASSY USAID 15,792 29,918 4,489 8,252 37,671 11,395 107,516 7% 0312J 001 AMERICAN EMBASSY USAID 5,959 32,000 3,536 8,974 43,674 11,240 2,082 107,464 7%
0312F 001 AMERICAN EMBASSY 27 211 238 0%
0312K 001 AMERICAN EMBASSY 210 210 0%
Total 160,762 336,422 95,439 232,374 542,753 228,328 12,074 1,608,151 100%
Inpatient 10%
Outpatient 21%
Op Medication 6%
Maternity 14%
Dental 34%
Optical 14%
Other Ser...
1%
Inpatient 10%
Outpatient 21%
Op Medication 6%
Maternity 14%
Dental 34%
Optical 14%
Other Ser...
1%
Op Medication Maternity Dental Optical Other Services
PPO Claims by Benefit Category
Client / Suboffice Inpatient Outpatient Op Medication
Maternity Dental Other Services
Total % of Total
0312A 001 AMERICAN EMBASSY 2,154,060 1,624,998 2,899,605 46,939 133 0 6,725,734 38% 0312B 001 AMERICAN EMBASSY 1,883,172 2,246,058 2,557,807 386,962 129 0 7,074,128 40%
0312C 001 AMERICAN EMBASSY 883,770 114,673 369,846 2,181 0 1,370,470 8%
0312D 001 AMERICAN EMBASSY 125,258 118,859 282,511 526,627 3%
0312E 001 AMERICAN EMBASSY 226,759 246,172 310,171 33,690 0 816,792 5%
0312F 001 AMERICAN EMBASSY 8,776 10,333 204,755 223,865 1%
0312H 001 AMERICAN EMBASSY 62,960 22,402 23,285 1,092 109,739 1%
0312I 001 AMERICAN EMBASSY USAID 92,161 139,524 204,110 10,699 446,494 3%
0312J 001 AMERICAN EMBASSY USAID 57,566 86,555 130,407 12,152 286,681 2%
0312G 001 AMERICAN EMBASSY 6,449 14,575 21,024 0%
0312K 001 AMERICAN EMBASSY 2,409 3,860 6,269 0%
Total 5,494,482 4,618,431 7,000,933 493,714 262 0 17,607,823 100% Inpatient
31%
Outpatient 26%
Op Medication 40%
Maternity 3%
Dental 0%
Inpatient 31%
Outpatient 26%
Op Medication 40%
Maternity 3%
Dental 0%
Op Medication Maternity Dental Other Services
User: Maged Hamdy 2 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Monthly Claims Paid Amount
Year- Month
Inpatient Outpatient Op Medication
Maternity Dental Optical Other Services
Total
May-2016 452,314 384,955 535,256 54,026 56,721 28,275 449 1,511,994 Jun-2016 178,192 295,514 525,038 56,424 56,503 20,605 1,367 1,133,643 Jul-2016 394,179 287,623 579,343 57,932 18,750 11,740 875 1,350,441 Aug-2016 465,682 355,833 597,791 69,974 33,635 9,535 1,302 1,533,752 Sep-2016 372,276 366,301 527,029 61,437 25,737 11,265 1,175 1,365,220 Oct-2016 592,457 365,967 470,216 55,648 39,951 23,265 790 1,548,294 Nov-2016 692,101 368,905 789,227 68,372 55,003 24,110 2,827 2,000,545 Dec-2016 667,498 601,183 556,209 61,210 43,812 21,480 3,318 1,954,709 Jan-2017 593,074 426,188 577,352 72,000 62,649 26,665 252 1,758,179 Feb-2017 477,691 595,655 535,905 81,637 39,657 12,945 0 1,743,490 Mar-2017 489,908 462,220 820,389 53,971 42,990 19,788 -280 1,888,986 Apr-2017 279,874 444,511 582,616 33,458 67,606 18,655 1,426,720 Total 5,655,244 4,954,854 7,096,372 726,088 543,015 228,328 12,074 19,215,974
-400,000
400,000
800,000
1,200,000
1,600,000
2,000,000
2,400,000
May-2016 Jun-2016
Jul-2016 Aug-2016
Sep-2016 Oct-2016
Nov-2016 Dec-2016
Jan-2017 Feb-2017
Mar-2017 Apr-2017
Benefit_Category Inpatient Outpatient Op Medication Maternity Dental Optical Other Services
Year-Month
Pa id
_u sd
Monthly Claims Count
Year-Month Inpatient Outpatient Op Medication Maternity Dental Optical Other Services May-2016 55 2,393 2,819 99 101 38 2 Jun-2016 39 1,921 2,686 142 110 27 3 Jul-2016 47 1,829 2,574 114 41 16 2 Aug-2016 55 2,070 2,326 146 75 16 3 Sep-2016 43 1,904 2,777 97 59 20 4 Oct-2016 50 2,200 2,235 85 77 33 5 Nov-2016 58 2,083 3,075 106 122 35 10 Dec-2016 46 2,717 2,183 114 68 31 11 Jan-2017 66 2,524 2,867 91 104 37 7 Feb-2017 70 3,175 2,913 111 89 18 3 Mar-2017 45 2,345 3,950 99 85 29 1 Apr-2017 32 1,963 2,468 64 118 26 Total 606 27,124 32,873 1,268 1,049 326 51
1,000
2,000
3,000
4,000
5,000
6,000
7,000
May-2016 Jun-2016
Jul-2016 Aug-2016
Sep-2016 Oct-2016
Nov-2016 Dec-2016
Jan-2017 Feb-2017
Mar-2017 Apr-2017
Benefit_Category Inpatient Outpatient Op Medication Maternity Dental Optical Other Services
Year-Month
Cl ai m _c ou nt
User: Maged Hamdy 3 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Claims based on Paid Amount Range
Paid Amount Range No.of claims %of total claims Paid Amount % of Total
<= 250 48,824 78% 4,573,281 24%
251-500 7,342 12% 2,596,831 14%
501-1000 4,682 7% 3,300,323 17%
1001-2500 1,123 2% 1,635,897 9%
2501-5000 338 1% 1,231,667 6%
5001-10000 218 0% 1,533,649 8%
>=10000 173 0% 4,344,326 23%
Total 62,700 100% 19,215,974 100%
Top 10 Daignosis Codes based on Paid Amount
Top 10 Diagnosis Number of Claimant
Paid Amount % to Total
HYPERTENSION 635 1,666,960 9%
DIABETES MELLITUS (DM) 454 1,097,240 6%
LUMBAGO / LOW BACK PAIN 1,209 637,648 3%
DENTAL 811 543,108 3%
CAESAREAN SECTION DELIVERY (MEDICALLY NECESSARY) - MATERNITY 81 460,834 2%
CHEST PAIN (UNSPECIFIC REASON) 332 403,644 2%
ISCHEMIC HEART DISEASE (IHD) 149 388,639 2%
HYPERLIPIDEMIA 482 375,778 2%
OSTEOARTHRITIS 453 365,627 2%
BRONCHITIS, ACUTE 1,521 342,502 2%
Top 10 6,281,980 33%
Others 12,933,994 67%
Summary 19,215,974 100%
User: Maged Hamdy 4 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Top 10 Claimant based on Paid Amount
Top 10 Claimant
Paid Amount % of Total
Major Conditions
1 252,466 1% CEREBROVASCULAR DISEASE ( STROKE )
2 200,000 1% ABDOMINAL PAIN
ARTHROPATHY / ARTHRITIS
CARBUNCLE / FURUNCLE
CONJUNCTIVITIS, ACUTE
CRAMP OF LIMB
DERMATITIS (& CONTACT) / ECZEMA
DERMATOLOGY /SKIN GENERAL
ESOPHAGAL REFLUX
FEVER
GASTRITIS
HEPATITIS C
HYPERLIPIDEMIA
HYPERTENSION
ILLNESS OF UNKNOWN REASON / UNSPECIFIED CONDITIONS
ISCHEMIC HEART DISEASE (IHD)
KERATITIS
KERATODERMA (ACQUIRED) / HYPERKERATOSIS / KERATOSIS
LIVER TUMOR - MALIGNANT
LUMBAGO / LOW BACK PAIN
MYOFASCITIS / MYALGIA
REFLUX ESOPHAGITIS
RENAL COLIC
SHOULDER PAIN
SKIN HYPERTROPHY
UPPER RESPIRATORY INFECTION (URTI / URI)
3 197,826 1% ABDOMINAL PAIN
ABNORMAL LEVEL OF BLOOD / LIVER ENZYME.
ANGIODYSPLASIA OF INTESTINE (WITHOUT MENTION OF HEMORRHAGE)
BRONCHUS / LUNG TUMOR - MALIGNANT
CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS
CHEST PAIN (UNSPECIFIC REASON)
COLON / LARGE INTESTINE TUMOR - MALIGNANT
DIABETES MELLITUS (DM)
GASTRITIS
HEPATITIS C
HYPERTENSION
User: Maged Hamdy 5 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Top 10 Claimant based on Paid Amount
Top 10 Claimant
Paid Amount % of Total
Major Conditions
3 197,826 1% IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)
LARGE BOWEL / COLON TUMOR - BENIGN
LUMBAGO / LOW BACK PAIN
PELVIC PAIN / LOWER ABDOMINAL PAIN
SMALL BOWEL / INTESTINE TUMOR - MALIGNANT
TESTICULAR DYSFUNCTION
TUMOR OF UNSPECIFIED SITE
UNSPECIFIED GASTRITIS AND GASTRODUODENITIS WITHOUT MENTION OF HEMORRHAGE
UPPER RESPIRATORY INFECTION (URTI / URI)
VENOUS THROMBOSIS / DEEP VENOUS THROMBOSIS (DVT)
VERTIGO / DIZZINESS / GIDDINESS
4 190,650 1% ABDOMINAL PAIN
ANAEMIA IRON DEFICIENCY
ARTHROPATHY / ARTHRITIS
BREAST MASS / LUMP
BREAST TUMOR - MALIGNANT -FEMALE
CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS
CORNEAL ULCER UNSPECIFIED
DERMATITIS (& CONTACT) / ECZEMA
DERMATOMYCOSIS / SKIN FUNGUS INFECTION
DIABETES MELLITUS (DM)
DRY EYE
FEVER
GASTRITIS
GASTROENTERITIS / ENTERITIS OR COLITIS
GINGIVITIS
GLAUCOMA
HEADACHE / HEAD PAIN
HYPERTENSION
ILLNESS OF UNKNOWN REASON / UNSPECIFIED CONDITIONS
INJURY TO RADIAL NERVE
IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)
ISCHEMIC HEART DISEASE (IHD)
LUMBAGO / LOW BACK PAIN
MALAISE / FATIGUE
MASTODYNIA / MASTALGIA / BREAST PAIN
NEURALGIA / NEURITIS
User: Maged Hamdy 6 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Top 10 Claimant based on Paid Amount
Top 10 Claimant
Paid Amount % of Total
Major Conditions
4 190,650 1% OPTICAL
OSTEOARTHRITIS
OTHER CONGENITAL ANOMALIES OF ANTERIOR SEGMENT
OTHER SPECIFIED AFTERCARE FOLLOWING SURGERY
REFLUX ESOPHAGITIS
SHOULDER PAIN
TINEA
UNSPECIFIED INFLAMMATION OF EYELID
VOMITING
WOUND
5 186,434 1% ABDOMINAL PAIN
ACHILLES BURSITIS OR TENDINITIS
ALLERGY
ANAEMIA IRON DEFICIENCY
ANAEMIA UNSPECIFIC
ANAL / RECTAL SPASM
ANEMIA UNSPECIFIED
ARTHROPATHY / ARTHRITIS
BEHCET'S SYNDROME
BRONCHIAL ASTHMA
BRONCHITIS, ACUTE
CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS
CHONDROMALACIA
CONJUNCTIVITIS, ACUTE
CONJUNCTIVITIS, UNSPECIFIC
COUGH
DACRYOPS
DENTAL
DERMATITIS (& CONTACT) / ECZEMA
DERMATOLOGY /SKIN GENERAL
DIABETES MELLITUS (DM)
DIGESTIVE SYSTEM / G.I. TRACT GENERAL SYMPTOMS
DRY EYE
FATTY LIVER
GASTRITIS
GASTROENTERITIS / ENTERITIS OR COLITIS
HAEMORRHOIDS THROMBOSES - EXTERNAL (PILES)
User: Maged Hamdy 7 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Top 10 Claimant based on Paid Amount
Top 10 Claimant
Paid Amount % of Total
Major Conditions
5 186,434 1% HYPERTENSION
HYPOCALCEMIA
HYPOTHYROIDISM - ACQUIRED
ILLNESS OF UNKNOWN REASON / UNSPECIFIED CONDITIONS
INTESTINAL OBSTRUCTION
IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)
ISCHEMIC HEART DISEASE (IHD)
JOINT PAIN
LARYNGITIS, ACUTE
LUMBAGO / LOW BACK PAIN
MELASMA /CHLOASMA / LEUKODERMA / LEUKODERMIA / MILIA
MINERAL DEFICIENCY
NECK PAIN / CERVICALGIA
OSTEOARTHRITIS
OSTEOPOROSIS
OTITIS MEDIA
PALPITATIONS
PEPTIC ULCER
PNEUMONIA / PNEUMONITIS
REFLUX ESOPHAGITIS
RENAL COLIC
RENAL UNSPECIFIC DISORDER
RHEUMATOID ARTHRITIS
SINUSITIS, ACUTE
SORE THROAT / PHARYNGITIS, ACUTE
TACHYCARDIA
THROMBOCYTOPENIA
TRAUMA DUE TO ANY CAUSE
ULCERATIVE COLITIS
UNSPECIFIED GASTRITIS AND GASTRODUODENITIS WITHOUT MENTION OF HEMORRHAGE
UVEITIS / IRIDOCYCLITIS UNSPECIFIC
VAGINITIS / VULVO-VAGINITIS / VULVITIS
VITAMIN D DEFICIENCY (RICKETS)
VOMITING
6 183,074 1% ANAEMIA IRON DEFICIENCY
ANAEMIA UNSPECIFIC
CHEST PAIN (UNSPECIFIC REASON)
User: Maged Hamdy 8 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Top 10 Claimant based on Paid Amount
Top 10 Claimant
Paid Amount % of Total
Major Conditions
6 183,074 1% COLON / LARGE INTESTINE TUMOR - MALIGNANT
COUGH
DIABETES MELLITUS (DM)
DIABETES WITH UNSPECIFIED COMPLICATION TYPE II OR UNSPECIFIED TYPE NOT STATED AS
UNCONTROLLED
GASTRITIS
HYPERLIPIDEMIA
HYPERTENSION
HYPOTHYROIDISM - ACQUIRED
ILLNESS OF UNKNOWN REASON / UNSPECIFIED CONDITIONS
IRRITABLE COLON / IRRITABLE BOWEL SYNDROME (IBS)
LARGE BOWEL / COLON TUMOR - BENIGN
OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF TRUNK WITHOUT MENTION OF COMPLICATION
RENAL COLIC
TUMOR - MALIGNANT (UNSPECIFIED)
7 164,627 1% ABDOMINAL OR PELVIC SWELLING MASS OR LUMP UNSPECIFIED SITE
ABDOMINAL PAIN
ABSCESS / CELLULITIS
ALLERGY
ANAEMIA UNSPECIFIC
ANEMIA UNSPECIFIED
ANTERIOR CRUCIATE LIGAMENT TEAR (ACL)
ARTHROPATHY / ARTHRITIS
ASTHMAUNSPECIFIED TYPE UNSPECIFIED
BRONCHIAL ASTHMA
BRONCHITIS, ACUTE
CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS
CHEST PAIN (UNSPECIFIC REASON)
CHRONIC KIDNEY DISEASE UNSPECIFIED
CONTUSION / SKIN HAEMATOMA
COUGH
DERMATITIS (& CONTACT) / ECZEMA
DIGESTIVE SYSTEM / G.I. TRACT GENERAL SYMPTOMS
GASTRITIS
GOUT / HYPERURICEMIA
HYPERTENSION
HYPOTHYROIDISM - ACQUIRED
User: Maged Hamdy 9 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Top 10 Claimant based on Paid Amount
Top 10 Claimant
Paid Amount % of Total
Major Conditions
7 164,627 1% ILLNESS OF UNKNOWN REASON / UNSPECIFIED CONDITIONS
INTERVERTEBRAL DISC
KIDNEY CALCULUS
KNEE PAIN
LIPOMA
LUMBAGO / LOW BACK PAIN
MALAISE / FATIGUE
MALIGNANT NEOPLASM OF RETROPERITONEUM
NEPHRITIS, ACUTE
NEURALGIA / NEURITIS
OSTEOARTHRITIS
OTHER RETROPERITONEAL INFECTIONS
PALPITATIONS
PITYRIASIS / TINEA VERSICOLOR
RENAL COLIC
RENAL FAILURE UNSPECIFIC
RHEUMATOID ARTHRITIS
SHORTNESS OF BREATH (SOB) / DYSPNEA
STOMATITIS
TINEA PEDIS
TUMOR OF UNSPECIFIED SITE
UNSPECIFIED GASTRITIS AND GASTRODUODENITIS WITHOUT MENTION OF HEMORRHAGE
URETER CALCULUS
URINARY TRACT INFECTION (UTI)
URINARY TRACT OR KIDNEY TUMOR - MALIGNANT
URINE INCONTINENCE / ENURESIS
VARICOCELE
VENOUS THROMBOSIS / DEEP VENOUS THROMBOSIS (DVT)
WARTS / VERRUCA
WOUND
8 156,399 1% ABDOMINAL PAIN
ANAEMIA IRON DEFICIENCY
CATARRH / COLD / CORYZA / NASOPHARYNTIGIS /RHINOPHARINGITIS
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING
CONVULSIONS
FEVER
GASTRITIS
User: Maged Hamdy 10 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Top 10 Claimant based on Paid Amount
Top 10 Claimant
Paid Amount % of Total
Major Conditions
8 156,399 1% GASTROENTERITIS / ENTERITIS OR COLITIS
GENERALIZED WEAKNESS
GOUT / HYPERURICEMIA
HEPATITIS
HEPATITIS C
HODGKIN'S DISEASE /LYMPHOMA
HYPERTENSION
ILLNESS OF UNKNOWN REASON / UNSPECIFIED CONDITIONS
ISCHEMIC HEART DISEASE (IHD)
LUMBAGO / LOW BACK PAIN
LYMPHADENITIS
LYMPHOMA
OTHER MALIGNANT LYMPHOMAS UNSPECIFIED SITE EXTRANODAL AND SOLID ORGAN SITES
SEBACEOUS CYST
TINEA
UPPER RESPIRATORY INFECTION (URTI / URI)
WOUND
9 126,411 1% CORONARY ARTERY DISEASE (CAD)/ CORONARY INSUFFICIENCY
DIABETES MELLITUS (DM)
HYPERLIPIDEMIA
HYPERTENSION
ISCHEMIC HEART DISEASE (IHD)
OPTICAL
PALPITATIONS
TACHYCARDIA
10 125,107 1% BACTERIAL INFECTION UNSPECIFIED
CHEST PAIN (UNSPECIFIC REASON)
HYPERTENSION
INTERVERTEBRAL DISC
ISCHEMIC HEART DISEASE (IHD)
LUMBAGO / LOW BACK PAIN
OPTICAL
SKIN HYPERTROPHY
URINARY TRACT INFECTION (UTI)
VENTRICULAR FIBRILLATION (VF)
Top 10 1,782,994 9%
Others 17,432,980 91%
User: Maged Hamdy 11 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Top 10 Claimant based on Paid Amount
Top 10 Claimant
Paid Amount % of Total
Major Conditions
Summary 19,215,974 100%
User: Maged Hamdy 12 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Top 10 Providers based on Paid Amount
Top 10 Providers Paid Amount Claim_Count % of Total
AS-SALAM INT'L HOSPITAL 2,390,382 803 14%
EZABY PHARMACY 2,348,089 6,393 13%
Al Nakheel Hospital 1,446,922 813 8%
Dr. El Hakim Pharmacy 1,126,012 2,916 6%
CLEOPATRA HOSPITAL 959,611 475 5%
AL SALAM HOSPITAL 832,213 571 5%
ANEES & RAMZY PHARMACY 731,990 2,360 4%
CAIRO MEDICAL CENTRER 710,337 262 4%
DR. KAMAL HUSSIEN PHARMACY 636,167 1,432 4%
SAUDI GERMAN HOSPITAL 464,053 208 3%
Top 10 11,645,775 66%
User: Maged Hamdy 13 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
001 AMERICAN EMBASSY
Top 10 Providers Paid Amount % of Total
AS-SALAM INT'L HOSPITAL 2,320,465 14%
EZABY PHARMACY 2,284,241 14%
Al Nakheel Hospital 1,428,481 8%
Dr. El Hakim Pharmacy 1,124,252 7%
CLEOPATRA HOSPITAL 884,062 5%
AL SALAM HOSPITAL 801,565 5%
CAIRO MEDICAL CENTRER 695,224 4%
DR. KAMAL HUSSIEN PHARMACY 632,200 4%
ANEES & RAMZY PHARMACY 526,040 3%
SAUDI GERMAN HOSPITAL 454,012 3%
Top 10 11,150,542 66%
Others 5,724,106 34%
001 AMERICAN EMBASSY 16,874,648 100%
001 AMERICAN EMBASSY USAID
Top 10 Providers Paid Amount % of Total
ANEES & RAMZY PHARMACY 205,950 28%
CLEOPATRA HOSPITAL 75,549 10%
AS-SALAM INT'L HOSPITAL 69,917 10%
EZABY PHARMACY 63,849 9%
AL SALAM HOSPITAL 30,648 4%
ROUSHDY PHARMACIES 30,078 4%
DR. MOAMENA KAMEL LABORA 24,661 3%
ALFA SCAN 23,582 3%
Alfa Lab 18,976 3%
Al Nakheel Hospital 18,441 3%
Top 10 561,650 77%
Others 171,524 23%
001 AMERICAN EMBASSY USAID 733,174 100%
User: Maged Hamdy 14 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
CASH Claims Detail CASH Claims - Paid Amount Paid Amount america 001 AMERICAN EMBASSY USAID 2,494
Sub total 2,494
Country 001 AMERICAN EMBASSY 1,393,171
AMERICAN EMBASSY USAID 212,487
Sub total 1,605,658
Total 1,608,151
CASH Claims - Claim Count Claim_Count america 001 AMERICAN EMBASSY USAID 4
Sub total 4
Country 001 AMERICAN EMBASSY 3,041
AMERICAN EMBASSY USAID 625
Sub total 3,666
Total 3,670
PPO Claims Detail PPO Claims - Paid Amount Paid Amount
Country 001 AMERICAN EMBASSY 16,874,648
AMERICAN EMBASSY USAID 733,174
Sub total 17,607,823
Total 17,607,823
PPO Claims - Claim Count Claim_Count
Country 001 AMERICAN EMBASSY 61,261
AMERICAN EMBASSY USAID 3,053
Sub Total 64,314
Total 64,314
User: Maged Hamdy 15 of 16 May 5, 2019 4:34:05 PM
Paid date from : 2016-5-1 to : 2017-4-30
Claims by Insured Type Insured Op Medication Outpatient Inpatient Maternity Dental Optical Other Services Total % of Total
Employees 4,018,645 2,290,166 3,006,278 99,527 243,615 100,625 346 9,759,201 51%
Spouse 2,127,023 1,487,678 1,683,366 624,917 156,389 52,315 0 6,131,688 32%
Child 950,703 1,177,011 965,601 1,644 143,010 75,388 11,728 3,325,085 17%
Total 7,096,372 4,954,854 5,655,244 726,088 543,015 228,328 12,074 19,215,974 100%
Claims by Age Range Age Range Paid Amount Claim count
Male Female Total Female Male Total
Under 21 1,378,420 1,091,267 2,469,686 7,289 8,832 16,121
21-25 242,294 506,606 748,900 1,422 689 2,111
26-30 188,030 572,108 760,138 1,790 642 2,432
31-35 436,895 712,092 1,148,987 2,905 1,701 4,606
36-40 634,481 1,104,797 1,739,278 3,720 2,841 6,561
41-45 1,224,599 1,232,519 2,457,118 3,420 4,151 7,571
46-50 1,508,519 871,838 2,380,357 2,988 4,128 7,116
51-55 1,021,920 1,011,866 2,033,787 2,386 3,235 5,621
56-60 2,979,388 681,987 3,661,375 2,034 5,171 7,205
61-65 1,308,200 410,394 1,718,595 743 2,374 3,117
66-69 64,274 13,033 77,307 61 120 181
70 and above 20,446 20,446 58 58
Total 11,007,467 8,208,507 19,215,974 28,758 33,942 62,700
Note: All amounts are in Policy Currency
User: Maged Hamdy 16 of 16 May 5, 2019 4:34:05 PM
File details come from the government source that posted it.