This is a high-level view of member/patient medical data.   While this report is normally accessed via a hyperlink from elsewhere in the platform the user can also navigate here directly from the menus, and type a member number into to the “Member” blank, and tab to query a member/patient record.



Target Audience for this Report 

Finance Department and CFO, and Medical management/Care Management Department.


Business Processes Impacted by this Report

This report provides an individual, patient/member level view that is relevant for care and cost management.


Detail and Definitions

Navigation on this report is limited, in that it is provided as member/patient level detail for inspection and validation.   Users can navigate to other aspects of the member/patient record via the buttons in the header; “Medical”, “Pharmacy”, “Gaps in Care”, and “Claim Detail”.



  • Member Number
  • Member Name
  • Age
  • Gender
  • Risk Score
  • PCP
  • Paid Medical
  • ER Visits
  • Office Visits
  • Inpatient Days
  • Admissions
  • Readmissions
  • ALOS
  • Period (Date range of claims in detailed reporting period)


Cost by Provider (Top 10) (Graph)

  • Servicing Provider
  • Total Paid


Cost by Place of Service (Graph)

  • Place of Service
  • Total Paid


Cost by Provider Type

  • Provider Specialty
  • Total Paid


Cost by Diagnosis

  • Diagnosis Description (Primary billed)
  • Paid
  • Claims


Cost by Procedures (Professional)

  • Procedure Category
  • Procedure Description
  • Paid
  • Claims


Cost by Revenue Code (Facility)

  • Revenue Code
  • Category
  • Paid
  • Claims