marisol.pdf

Submission #4 · 1 page(s) · 147.8 KB · Uploaded Mar 13, 2026 at 15:44 · ARS Yunen

COMPLETED incomplete
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Analysis complete.

Glosa Risk Assessment

HIGH RISK
60.0% Max discount: 15.0%

HIGH RISK. Significant issues found. Only proceed with substantial discount (>15%) and if issues can be resolved.

Risk Factors Detected

FactorCategorySeverityDetail
Ncf Missing Or Invalid administrative high Missing NCF.
Rnc Missing Or Invalid administrative high Missing RNC.
Authorization Missing administrative high Listed in missing elements
Dates Inconsistent administrative medium Prescription date is in the future; ID is expired.
Itbis Discrepancy tariff low No financial documents (invoices or vouchers) were provided to perform ITBIS analysis.

Overall Audit Result

INCOMPLETE

Confidence: 99.0%

Incomplete claim submission. The document contains patient identification (Cédula), an ARS Yunen insurance card, and a dental prescription. However, it completely lacks the required fiscal invoice, NCF, RNC, and insurance authorization voucher.

Amounts Extracted

ITBIS Reconciliation

Totals: Needs Review Copay: Needs Review
No financial documents (invoices or vouchers) were provided to perform ITBIS analysis.

Audit Checks

CheckStatusDetail
RNC (Registro Nacional de Contribuyentes) fail Missing RNC.
Show reasoning
No fiscal invoice or receipt was provided in the submission, therefore no RNC is available to verify.
NCF (Número de Comprobante Fiscal) fail Missing NCF.
Show reasoning
No fiscal invoice was provided. An NCF is strictly required by DGII and SISALRIL for any valid medical/pharmacy claim.
Dates fail Prescription date is in the future; ID is expired.
Show reasoning
The prescription is dated '30/9/26' (September 30, 2026), which is in the future relative to the current audit date of 2026-03-13. Additionally, the patient's Cédula shows an expiration date of '22 JUNIO 2024'.
Amounts, copay & ITBIS reconciliation not_applicable No financial documents provided.
Show reasoning
Cannot perform financial reconciliation because neither an invoice nor an insurance authorization voucher was included in the submission.
Provider info pass Provider info present on prescription.
Show reasoning
The prescription clearly lists the provider 'SABONESA Dental Clinic & Spa', address 'Av. Emma Balaguer #31, 2do. Nivel, Los Girasoles, D.N.', and phone '809-222-6823'.
Signatures & stamps pass Prescription is signed and stamped.
Show reasoning
The prescription contains the clinic's stamp and the handwritten signature of the prescribing dentist (Dra. Vertilia Genesis P.).
Prescription validity warning Missing diagnosis; invalid date.
Show reasoning
The prescription includes patient name, medication (Clorexidina 0.12% Enjuague), usage instructions, and doctor's exequatur (Exq: 523-22). However, it lacks a clinical diagnosis (required by Decreto 665-12) and the date is invalid (future-dated).
Cross-document consistency pass Patient identity is consistent.
Show reasoning
The name 'Marisol Valdez' on the ARS Yunen card matches 'Marisol Valdez Beriguete' on the Cédula and 'Marisol Valdez B.' on the prescription.

Warnings

  • Prescription date appears to be 30/9/26, which is in the future relative to the audit date of 2026-03-13.
  • Patient Cédula expired on 22 JUNIO 2024.
  • Prescription is missing a clinical diagnosis.

Missing Elements

  • Factura Fiscal (Invoice)
  • NCF (Número de Comprobante Fiscal)
  • RNC (Registro Nacional de Contribuyentes)
  • Autorización de la ARS (Insurance Voucher)

Identified Documents (1)

Prescription Pages 0–0

Prescription from SABONESA Dental Clinic & Spa for Marisol Valdez, including scanned copies of the patient's ID (Cédula) and ARS Yunen insurance card.

incomplete Confidence: 99.0%

Submission is missing critical financial documents (fiscal invoice with NCF and insurance authorization voucher). Furthermore, the supporting documents contain severe administrative errors: the patient's ID is expired, the prescription date is in the future, and the prescribed item (mouthwash) is likely excluded from basic PDSS coverage.

Checks (8)
  • RNC (Registro Nacional de Contribuyentes) [fail]: Missing
  • NCF (Número de Comprobante Fiscal) [fail]: Missing
  • Dates [fail]: Expired ID and future prescription date.
  • Amounts, copay & ITBIS reconciliation [not_applicable]: No financial documents provided.
  • Provider info [pass]: SABONESA Dental Clinic & Spa
  • Signatures & stamps [pass]: Doctor's stamp and signature present.
  • Prescription validity [warning]: Missing diagnosis and patient ID on Rx; prescribed item may not be covered.
  • Cross-document consistency [pass]: Patient identity is consistent.
Layout Features (7)
Page Feature Confidence Description
0 logo 95.0% Logo of ARS Yunen on the insurance card.
0 logo 95.0% Logo of SABONESA Dental Clinic & Spa on the prescription pad.
0 letterhead 90.0% Letterhead of SABONESA Dental Clinic & Spa with address and contact info.
0 rubber stamp 95.0% Circular rubber stamp of SABONESA Dental Clinic & Spa.
0 handwriting 95.0% Handwritten prescription details, patient name, age, and date.
0 signature handwritten 90.0% Handwritten signature of the doctor on the prescription.
0 form layout 85.0% Pre-printed prescription form with fields for patient name, age, and date.
Analysis Steps — Debug Log (4 steps)
Worker Step Status Duration Summary
page_decomposer document_decomposition completed 12009 ms Found 1 document(s)
Raw Output 
[{"type": "prescription", "page_start": 0, "page_end": 0, "description": "Prescription from SABONESA Dental Clinic & Spa for Marisol Valdez, including scanned copies of the patient's ID (Cédula) and ARS Yunen insurance card."}]
full_analyzer full_document_analysis completed 48932 ms Verdict: incomplete | Glosa risk: high (60.0%)
Raw Output 
{"verdict": "incomplete", "confidence": 0.99, "summary": "Incomplete claim submission. The document contains patient identification (Cédula), an ARS Yunen insurance card, and a dental prescription. However, it completely lacks the required fiscal invoice, NCF, RNC, and insurance authorization voucher.", "checks": [{"name": "RNC (Registro Nacional de Contribuyentes)", "status": "fail", "detail": "Missing RNC.", "reasoning": "No fiscal invoice or receipt was provided in the submission, therefore no RNC is available to verify."}, {"name": "NCF (Número de Comprobante Fiscal)", "status": "fail", "detail": "Missing NCF.", "reasoning": "No fiscal invoice was provided. An NCF is strictly required by DGII and SISALRIL for any valid medical/pharmacy claim."}, {"name": "Dates", "status": "fail", "detail": "Prescription date is in the future; ID is expired.", "reasoning": "The prescription is dated '30/9/26' (September 30, 2026), which is in the future relative to the current audit date of 2026-03-13. Additionally, the patient's Cédula shows an expiration date of '22 JUNIO 2024'."}, {"name": "Amounts, copay & ITBIS reconciliation", "status": "not_applicable", "detail": "No financial documents provided.", "reasoning": "Cannot perform financial reconciliation because neither an invoice nor an insurance authorization voucher was included in the submission."}, {"name": "Provider info", "status": "pass", "detail": "Provider info present on prescription.", "reasoning": "The prescription clearly lists the provider 'SABONESA Dental Clinic & Spa', address 'Av. Emma Balaguer #31, 2do. Nivel, Los Girasoles, D.N.', and phone '809-222-6823'."}, {"name": "Signatures & stamps", "status": "pass", "detail": "Prescription is signed and stamped.", "reasoning": "The prescription contains the clinic's stamp and the handwritten signature of the prescribing dentist (Dra. Vertilia Genesis P.)."}, {"name": "Prescription validity", "status": "warning", "detail": "Missing diagnosis; invalid date.", "reas
page_decomposer document_audit_6 completed 39119 ms Verdict: incomplete
Raw Output 
{"verdict": "incomplete", "confidence": 0.99, "summary": "Submission is missing critical financial documents (fiscal invoice with NCF and insurance authorization voucher). Furthermore, the supporting documents contain severe administrative errors: the patient's ID is expired, the prescription date is in the future, and the prescribed item (mouthwash) is likely excluded from basic PDSS coverage.", "checks": [{"name": "RNC (Registro Nacional de Contribuyentes)", "status": "fail", "detail": "Missing", "reasoning": "No fiscal invoice or receipt was provided in the submission, so no RNC can be verified."}, {"name": "NCF (Número de Comprobante Fiscal)", "status": "fail", "detail": "Missing", "reasoning": "No fiscal invoice was provided. An NCF is legally required by DGII and SISALRIL for any valid claim."}, {"name": "Dates", "status": "fail", "detail": "Expired ID and future prescription date.", "reasoning": "1) The patient's Cedula expired on 2024-06-22, which is well before the current date of 2026-03-13. 2) The prescription is dated '30/9/26' (September 30, 2026), which is in the future. Both are critical administrative failures."}, {"name": "Amounts, copay & ITBIS reconciliation", "status": "not_applicable", "detail": "No financial documents provided.", "reasoning": "Cannot perform reconciliation without an authorization voucher and a fiscal receipt."}, {"name": "Provider info", "status": "pass", "detail": "SABONESA Dental Clinic & Spa", "reasoning": "The prescription clearly lists the clinic name, address (Av. Emma Balaguer #31, 2do. Nivel, Los Girasoles, D.N.), and phone number (809-222-6823)."}, {"name": "Signatures & stamps", "status": "pass", "detail": "Doctor's stamp and signature present.", "reasoning": "The prescription includes the stamp of 'Dra. Vanthe Genesis P.' with Exequatur '523-22' and a physical signature over it."}, {"name": "Prescription validity", "status": "warning", "detail": "Missing diagnosis and patient ID on Rx; prescribed item may not be cov
layout_analyzer layout_analysis_doc_6 completed 6636 ms Found 7 feature(s) across 1 page(s)
Raw Output 
[{"feature_type": "logo", "confidence": 0.95, "description": "Logo of ARS Yunen on the insurance card."}, {"feature_type": "logo", "confidence": 0.95, "description": "Logo of SABONESA Dental Clinic & Spa on the prescription pad."}, {"feature_type": "letterhead", "confidence": 0.9, "description": "Letterhead of SABONESA Dental Clinic & Spa with address and contact info."}, {"feature_type": "rubber_stamp", "confidence": 0.95, "description": "Circular rubber stamp of SABONESA Dental Clinic & Spa."}, {"feature_type": "handwriting", "confidence": 0.95, "description": "Handwritten prescription details, patient name, age, and date."}, {"feature_type": "signature_handwritten", "confidence": 0.9, "description": "Handwritten signature of the doctor on the prescription."}, {"feature_type": "form_layout", "confidence": 0.85, "description": "Pre-printed prescription form with fields for patient name, age, and date."}]