The Medical Claims Detail by Servicing Provider report is designed to show medical claims detail based on the combination selected Servicing Provider in the Servicing Providers panel and the member’s PCP selected in the PCP panel.
Navigation
All medical claims by Servicing Provider, PCP, and member are loaded by default. Page filters are available on every screen and may then be used to filter to the desired subset of data. The filters can be used to build a subset based on any field including: organizational entities, member/patient, provider/group, diagnoses, procedures, disease, time range, claim type, etc. Once a Servicing Provider is selected in the Servicing Providers panel, the respective PCPs are listed in the PCP panel. “Member PCP Name” field is a hyperlink that takes you to its profile. Next when a PCP is selected in the PCP panel, the respective members are listed in the Members panel. “Member Name” field is a hyperlink that takes you to the member’s profile. And then when a member is selected in the Members panel, the respective claim detail is shown in the Claim Detail panel.
Detail and Definitions
The header data is based on detailed reporting period, as are each panel (Servicing Providers, PCP, Members, and Claim Detail).
Servicing Provider Groups
- Servicing Group Name
- Total Patients
- Total Claims
- Total Paid
- Avg Risk
- Paid/Patient
PCP Group
- PCP Group
- PCP NPI
- PCP Name
- Total Paid
- Total Claims
- Avg Risk
- Avg PMPM
Members
- Member Number
- Member Name
- Total Claims
- Total Paid
- Risk
Claim Details
- Member Number
- Claim #
- Service Date
- POS
- Dx Code
- Dx Description
- Provider Billing Name
- Paid