This report categories Procedure (CPT and HCPCS) codes by Category, Sub-Category, PCP and Patients.  This allows for review of utilization and cost by billed procedures with PCP and Patient level details.

 

Note: Both reports provide the same table and field level detail.  The All report includes all procedures and the Injectibles/Infusion report only includes “J” type procedure codes.

 

 

Target Audience for this Report 

Chief Medical Officer, Finance Department and CFO, Leadership Team, Medical management/Care Management Department, Physician Relations, Quality Management, and Utilization Management.

 

Business Impacts of this Report

Categorized data that details professional services billed by providers, provides an overview of cost and utilization by service provided.  The CMO and Medical Management department can understand costs and utilization by services provided to review cost centers and potential savings in cost centers.  

 

Category

  • Category
  • Total #
  • Total Cost

 

SubCategory

  • SubCategory
  • Total #
  • Total Cost

 

PCP

  • PCP NPI
  • PCP Name
  • Total Patients
  • Total #
  • Total Cost

 

Member Details

  • Member Number
  • Member Name
  • Current PCP
  • Total #
  • Total Costs

Member Line Level Details

  • Member Number
  • Service Date
  • Proc Code
  • Proc Description
  • Category
  • SubCategory
  • POS
  • Total #
  • Total Cost