DATAFIKASI · APLN CLAIM ANALYTICS
Claim Overview
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PLN Insurance
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This Month's Summary 16 indicators
Total PICA Payment
—
paid out via PICA
Total Datafikasi Payment
—
computed via datafikasi
Total PICA Claim Amount
—
claim amount submitted
Total Datafikasi Claim Amount
—
capped, excl. OCR outlier
Total PICA Excess
—
excess input by PICA
Total Datafikasi Excess
—
excess detected via OCR
Total Datafikasi Discount
—
total discount applied
Average Datafikasi Discount %
—
avg discount rate
Total Claims
—
claims this period
Average Readability Score
—
OCR accuracy avg
Mismatched Items
—
items mismatch detected
Mismatched Items %
—
of total line items
Overcharged Items
—
items charged > tariff
Overcharged Items %
—
overcharge rate
Total Datafikasi Overcharge
—
excess overcharged amount
Total Items
—
total line items processed
Geographic Distribution Total PICA Paid by Province
GEO DISTRIBUTION
Total Paid Distribution Map by Province
Province color = total paid (PICA); darker red = higher.
Claims & Payment Trend Full Period
VOLUME
Stable claim volume — 1.2–2K claims per day
No anomaly spike detected. Provider activity remains consistent.
ACCURACY
Datafikasi accuracy consistently ~93% throughout the month
Dashed line = 95% target. Small but consistent gap.
PICA
Total Claim & Total Paid (IDR) PICA by Pooling Date
Claims vs PICA payment by pooling date.
DATAFIKASI
Total Claim & Total Paid (IDR) Datafikasi by Pooling Date
Claims vs Datafikasi payment by date (OCR outliers excluded).
Invoice Item Match Status Breakdown: overcharge vs undercharge
FWA AREA
34% items overcharged — priority area for FWA review
BENEFIT VOLUME
RJTP dominates volume (17K)
Focus initial documentation efforts on the dominant RJTP benefit.
Diagnosis & Disease Distribution ICD-10 Distribution
TOP DIAGNOSIS
Top 10 ICD-10 by Total Claims
The 10 diagnoses with the highest claim volume this period.
ICD-10 DETAIL
ICD-10 Detail — All Diagnoses
ICD-10 Code Diagnosis Name Total Claims Total Datafikasi Claim Amount
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