<xs:simpleType name="ClaimGross">
<xs:annotation>
<xs:documentation>
- Is the total AED amount of the charges included on the Claim.
- ClaimGross includes any patient financial responsibility for the Claim, such as co-pays and deductibles, as well as charges made to other insurers for the Encounter(s) covered by the Claim.
- The prices on which ClaimGross are based should reflect the general agreement between the payer and provider for the Claim items for insured member.
- Example 1: A patient visits a clinic for a hip operation. The published list price is AED 8000. However, the insurer has negotiated with the provider a general discount of 10% on the published list price. ClaimGross is AED 7200.
- Example 2: A patient visits a clinic for a routine physical exam which costs AED 2000.The patient pays a co-pay of AED 250. ClaimGross is AED 2000.
- Example 3: A patient visits a clinic for a physical exam (AED 500) and an expensive diagnostic test (AED 1500) in one Encounter. The patient pays a co-pay of AED 250 and claims the diagnostic test from a supplementary insurance, because the primary insurance does not cover this diagnostic test. ClaimGross is AED 2000.
- Note: If the claimed amount is not in AED, then value should be converted to AED on the date of ClaimDateSubmission
- Restrictions: Non-negative and greater than or equal to ClaimPatientShare + ClaimNet.
</xs:documentation>
</xs:annotation>
<xs:restriction base="xs:float" />
</xs:simpleType>
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