SOLUTIONS // HEALTHCARE

Healthcare

Claims reconciled before filing, and a live operational picture across the hospital.

S-01 // SOLUTION

Claims reconciliation

Metron reconciles claims against service records and tariff schedules before filing, maintains the claims workbook, and drafts corrected submissions, each linked to the underlying record.

CLAIMS UNITSFINANCE DIRECTORS

F11=SUM(F2:F10)

	A	B	C	D	E	F	G
1	Claim ID	Ward	Service code	Tariff (Rp k)	Billed (Rp k)	Variance (Rp k)	Status
2	CLM-88112	W-3A	K1-208	4,250	4,250	0	Clear
3	CLM-88117	W-2B	K2-114	7,800	8,450	650	Flagged
4	CLM-88121	ICU	K4-071	21,400	21,400	0	Clear
5	CLM-88124	W-1A	K1-095	3,150	3,150	0	Clear
6	CLM-88129	OR	K3-220	15,600	14,900	-700	Review
7	CLM-88133	W-3A	K1-208	4,250	4,980	730	Flagged
8	CLM-88136	W-2A	K2-118	6,400	6,400	0	Clear
9	CLM-88140	ICU	K4-102	18,750	18,750	0	Clear
10	CLM-88144	W-1B	K1-110	2,900	2,900	0	Clear
11	TOTAL			84,500	85,180	680	2 FLAGGED · 1 REVIEW

SummaryClaimsTariff scheduleServicesChange log

CLAIMS SYSTEM READ IN PLACETARIFF SCHEDULE 2026CHECKED BEFORE FILINGEVERY EDIT LOGGED

CLAIMS-RECON.XLSX · RECONCILED AGAINST SERVICES AND TARIFFS BEFORE FILING, NOT AFTER REJECTION · REPRESENTATIVE DATA

S-02 // SOLUTION

Hospital operations brief

Metron assembles a live operational picture from hospital systems (occupancy, theatre utilization, discharge documentation) and prepares the morning brief with the items that require a decision.

HOSPITAL DIRECTORSOPERATIONS

Metron Portal · Hospital operations

Hospital operations All wards14 daysLive Refreshed 06:00 WIB

Bed occupancy87%+2 pts

Avg length of stay4.2 days-0.3

OR utilization74%+5 pts

Claims pending386 aging

Admissions vs discharges · 14 daysPatients / day

Occupancy by ward (%)Limit 90%

Flagged items4 open

Item	Ward	Detail	Status
Occupancy above 90%	W-2	3 days running	Flagged
Claim CLM-88117	W-2B	Tariff variance	At gate
Discharge summaries	W-3A	4 pending	Watching
OR schedule	OR-2	Within plan	Clear

WATCHER 06:05 · W-2 OCCUPANCY ABOVE 90% FOR 3 DAYS · BRIEF DRAFTED FOR MORNING HANDOVER · SOURCE: ADT FEED

Audit trail All actions7 days Exportable

Time	Actor	Action	Status
06:00	Scheduler	Morning handover brief drafted	At gate
06:05	Watcher	W-2 occupancy above 90% · 3 days	Flagged
08:12	Claims unit	Corrected submissions · 14 of 14	Approved
08:40	Agent 05	Claims batch filed	Recorded
09:02	Memory	Rejection pattern recorded	Recorded

SERVED INSIDE THE HOSPITAL NETWORK · THE SIDEBAR WORKS · OVERVIEW AND AUDIT ARE LIVE VIEWS · REPRESENTATIVE DATA

03 // THE WORKING CYCLE

A case, end to end

S-01

Situation

Claims are reconciled against services at month-end; discrepancies surface weeks after discharge, and documentation lives across three systems.

Metron Portal · Claims

Claims reconciliationMonth-end

Item	Where	State
Claims reconciliation	Month-end batch	Weeks after discharge
Documentation	3 systems	Split
Rejections last cycle	31 claims	Refiled late

WATCHER 06:05 · CLM-88117 BILLED RP 650 K OVER TARIFF SCHEDULE · SOURCE: CLAIMS-RECON.XLSX ROW 3

DISCREPANCIES SURFACE WEEKS AFTER DISCHARGE · REPRESENTATIVE DATA

S-02

Question

"Which of this month’s claims will be rejected, and why?"

ChatMetron

Which of this month’s claims will be rejected, and why?

S-03

Sourced answer

Metron reconciles claims against service records and flags 14 submissions with tariff mismatches or missing documentation before filing.

ChatMetron

Which of this month’s claims will be rejected, and why?

MetronFourteen submissions will fail as filed: nine tariff mismatches (including CLM-88117, billed Rp 650 k over schedule) and five with missing documentation. Each is linked to its medical record. CLAIMS SYSTEM · 1,204 ROWSTARIFF SCHEDULE 2026MEDICAL RECORDS

S-04

Proposed action

Corrected submissions, each linked to the underlying medical record and tariff basis, routed to the claims unit.

ChatMetron

MetronCorrected submissions are ready for the claims unit.

Approval requested

Fourteen corrected submissions, each citing the medical record and tariff basis, routed to the claims unit for review.

Hold

S-05

Approved outcome

The claims unit reviews and approves; rejection rates fall, and the pattern joins the record for the next cycle.

Corrections approvedclaims unit · 14 of 14

Done

Claims filedbefore the deadline

Done

Rejection pattern recordedmemory · next cycle

Recorded

Rejection rate trackedoperations dashboard

Live

EVERY STEP GATED AND RECORDED · REPRESENTATIVE DATA

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