# - Cov

Measure	Definition	Occurrence
# of mail order prescriptions filled	Number of 30 day equivalent prescriptions filled by mail.	Prescribing Pattern - Action Reports
# of Prescriptions Filled	Number of 30 day equivalent prescriptions filled.	Prescribing Pattern - Action Reports
# of retail prescriptions filled	Number of 30 day equivalent prescriptions filled in a retail setting.	Prescribing Pattern - Action Reports
% Dollars In-Network	The percent of total dollars paid to in network providers.	Network Utilization Summary - Action Report
% Dollars Out-Network	The percent of total dollars paid to out of network providers.	Network Utilization Summary - Action Report
% Employees	Percent of total members that are employees.	Executive Report- Action Report
% of Females	Percentage of active members who are female.	% of Females - Population Measures
% of Males	Percentage of active members who are male.	% of Males -Population Measures
% of Plan Population - Non-Outliers	Percentage of the plan's members, who are not cost outliers, with the condition in the current reporting period.	Condition Hierarchy Summary - Action Report
% of Plan Population - Outliers	Percentage of the plan's members, who are cost outliers, with the condition in the current reporting period.	Condition Hierarchy Summary - Action Report
% of Plan Population - Total for Plan	Percentage of the plan's members with the condition in the current reporting period.	Condition Hierarchy Summary - Action Report
% of Total Cost Bucket	The percentage of dollars that the detail line has associated with it.	Top 10 Performing Providers by Cost Bucket, Top 10 Performing Providers by Specialty - Action Report
% of Total Specialty Bucket	The percentage of Specialty dollars that the detail line has associated with it.	Top 10 Performing Providers by Specialty - Action Report
1st Top Major Diagnostic Group	Top 5 Diagnoses by Volume within 1st Top Major Diagnostic Group	CE Executive Report – Top Major Diagnostic Groups by Volume Page - Action Report
1st Top Major Diagnostic Group	Top 5 Diagnoses by Cost within 1st Top Major Diagnostic Group	CE Executive Report – Top Major Diagnostic Groups by Cost Page - Action Report
2nd Top Major Diagnostic Group	Top 5 Diagnoses by Volume within 2nd Top Major Diagnostic Group	CE Executive Report – Top Major Diagnostic Groups by Volume Page - Action Report
2nd Top Major Diagnostic Group	Top 5 Diagnoses by Cost within 2nd Top Major Diagnostic Group	CE Executive Report – Top Major Diagnostic Groups by Cost Page - Action Report
30 Day Equivalent Count	A calculated measure that provides for a consistent per month comparison of pharmacy Utilization and costs.	Pharmacy Detail - Action Report
30 Day Readmission Flag	A flag indicating if the claim was for a readmission.	Inpatient Admission -Action Report
3rd Top Major Diagnostic Group	Top 5 Diagnoses by Volume within 3rd Top Major Diagnostic Group	CE Executive Report – Top Major Diagnostic Groups by Volume Page - Action Report
3rd Top Major Diagnostic Group	Top 5 Diagnoses by Cost within 3rd Top Major Diagnostic Group	CE Executive Report – Top Major Diagnostic Groups by Cost Page - Action Report
4th Top Major Diagnostic Group	Top 5 Diagnoses by Volume within 4th Top Major Diagnostic Group	CE Executive Report – Top Major Diagnostic Groups by Volume Page - Action Report
4th Top Major Diagnostic Group	Top 5 Diagnoses by Cost within 4th Top Major Diagnostic Group	CE Executive Report – Top Major Diagnostic Groups by Cost Page - Action Report
5th Top Major Diagnostic Group	Top 5 Diagnoses by Volume within 5th Top Major Diagnostic Group	CE Executive Report – Top Major Diagnostic Groups by Volume Page - Action Report
5th Top Major Diagnostic Group	Top 5 Diagnoses by Cost within 5th Top Major Diagnostic Group	CE Executive Report – Top Major Diagnostic Groups by Cost Page - Action Report
Active Participant	A flag, provided by the client, indicating that the member was an active participant in the program. The definition of active is determined by NCQA requirements.	Program Detail -Action Report
Actual Dental /1000	Utilization per 1,000 members for dental services for the plan. Completion factors are applied.	Utilization Overview -Dashlet
Actual ED/1000	Utilization per 1,000 members for emergency department services for the plan. Completion factors are applied.	Utilization Overview -Dashlet
Actual Hospital Service/1000	Utilization per 1,000 members for hospital services for the plan. Completion factors are applied.	Utilization Overview -Dashlet
Actual Lab/1000	Utilization per 1,000 members for laboratory services for the plan. Completion factors are applied.	Utilization Overview -Dashlet
Actual Pharmacy/1000	Utilization per 1,000 members for pharmacy services for the plan. Completion factors are applied.	Utilization Overview -Dashlet
Actual PMPM- Norm	The PMPM for the normative population's claims categorized by provider Specialty and provider. Capitation payments are included and completion factors are applied.	Top 10 Performing Providers by Specialty - Action Report
Actual PMPM Pharmacy	Pharmacy cost per member per month for the current rolling 12 month period for the plan. Completion factors are applied. This value is displayed in the Bar Chart that is part of the Action Report.	Payment Overview - Dashlet
Actual PMPM-Actual	The PMPM for the plan's population categorized by cost bucket and provider. Capitation payments are included and completion factors are applied.	Top 10 Performing Providers by Cost Bucket, Top 10 Performing Providers by Specialty - Action Report
Actual PMPM-Index	The ratio of the actual PMPM - actual amounts to the actual PMPM - Book of Business amounts for the given provider within the given cost bucket. Capitation payments are included and completion factors are applied.	Top 10 Performing Providers by Cost Bucket, Top 10 Performing Providers by Specialty - Action Report
Actual PMPM-Norm	The PMPM for the normative population's claims categorized by cost bucket and provider. Capitation payments are included and completion factors are applied.	Top 10 Performing Providers by Cost Bucket -Action Report
Actual Primary Care Visits/1000	Utilization per 1,000 members for primary care services for the plan. Completion factors are applied.	Utilization Overview -Dashlet
Actual Radiology/1000	Utilization per 1,000 members for radiology services for the plan. Completion factors are applied.	Utilization Overview -Dashlet
Actual Specialty/1000	Utilization per 1,000 members for specialty services for the plan. Completion factors are applied.	Utilization Overview -Dashlet
Actual Vision /1000	Utilization per 1,000 members for vision services for the plan. Completion factors are applied.	Utilization Overview -Dashlet
Acute Admits /1000 - Actual	Admissions per 1000 members to an acute care setting.	Inpatient Utilization -Dashlet
Acute Admits/1000 - Norm	Admissions per 1000 members to an acute care setting for the normative population.	Inpatient Utilization -Dashlet
Acute Flag	Flag indicating if the admission was for an acute condition.	Inpatient Admission -Action Report
Admission Status Code	Code describing the status of the admission.	Inpatient Admission -Action Report
Admission Status Description	Description of the Admission Source code.	Inpatient Admission -Action Report
Admission Type	Code describing the type of admission.	Inpatient Admission - Action Report
Admission Type Description	Description of the Admission Type code.	Inpatient Admission - Action Report
Admit Date	The date a member was admitted to a facility.	Inpatient Admission -Action Report
Admitting Diagnosis Code	The diagnosis code for which the member was admitted to the facility.	Claim Summary, Inpatient Admission - Action Report
Admitting Diagnosis Description	The description of the diagnosis code for which the member was admitted to the facility.	Claim Summary, Inpatient Admission - Action Report
Admitting Provider Name	Name of the provider who admitted a patient to a facility.	Inpatient Admission - Action Report
Allowed $	The dollars a plan allows for the service(s). It represents the maximum a health plan will pay.	Network Utilization Summary - Action Report
Allowed Amount	The dollars a plan allows for the service(s). It represents the maximum a health plan will pay.	Claim Detail, Claim Summary, Inpatient Admission, Pharmacy Detail - Action Report
Allowed PMPM $	A per member per month representation of the plan's allowed dollars for services.	Network Utilization Summary - Action Report
Amount Paid	Total Dental Costs paid by the Plan in the current rolling 12 months. Capitation Payments are included and Completion Factors are applied	Dental Payment Summary -Action Report
Amount Paid	Total Vision Costs paid by the Plan in the current rolling 12 months. Capitation Payments are included and Completion Factors are applied.	Vision Payment Summary -Action Report
Attributed Health System ID	The carrier assigned id for the health system the attributed provider is part of.	Member Summary -Action Report
Attributed Health System Name	The name of the health system the attributed provider is part of.	Member Summary -Action Report
Attributed Provider - Practice ID	The unique identifier of the practice associated with the member's attributed provider.	Claim Summary - Action Report
Attributed Provider - Practice Name	The name of the practice of the provider who was selected by the member or appears to be managing the member's care, based on claims.	Claim Summary - Action Report
Attributed Provider ID	The unique identifier for the provider who was selected by the member or appears to be managing the member's care, based on claims.	Claim Detail, Claim Summary, Inpatient Admission, Pharmacy Detail, Member Summary, Program Detail - Action Report
Attributed Provider Name	The name of the provider who was selected by the member or appears to be managing the member's care, based on claims.	Claim Detail, Claim Summary, Inpatient Admission, Member Opportunity Summary, Member Summary, Pharmacy Detail -Action Report
Attributed Provider Name	The unique identifier of the practice associated with the member's attributed provider.	Member Opportunity Detail -Action Report
Attributed Provider Practice ID	The unique identifier of the practice associated with the member's attributed provider.	Claim Detail, Inpatient Admission, Pharmacy Detail -Action Report
Attributed Provider Practice Name	The name of the practice of the provider who was selected by the member or appears to be managing the member's care, based on claims.	Claim Detail, Inpatient Admission, Pharmacy Detail, Member Opportunity Detail, Member Opportunity Summary -Action Report
Auth ID	Carrier supplied number used to track service authorizations.	Inpatient Admission -Action Report
Average Age	Average age of members as of the last day of the reporting period.	Average Age -Population Measures
Average Membership	Average number of members.	Executive Report- Action Report
Average Wholesale Price Amount	The average price at which the prescribed drug is purchased at the wholesale level.	Pharmacy Detail - Action Report
Benchmark	Measuring the performance of a target population against the normative population.	Executive Report- Action Report
Billed	Total dollars charged on claims incurred during the appropriate month.	Expense and Cost Summary by Incurred Date,Expense and Cost Summary by Paid Date -Action Report
Billing Provider ID	Identification number assigned to the billing provider.	Claim Detail, Claim Summary -Action Report
Billing Provider Name	Name of the provider who is billing for the service.	Claim Detail, Claim Summary -Action Report
Brand Formulary Current Scripts	Volume of scripts for brand formulary drugs filled in the current rolling 12 month period. Script count is based on a 30-day equivalent calculation.	Utilization by Drug Type -Dashlet
Brand Formulary Drug Current Plan Paid Amount	Plan payments for brand formulary drugs filled in the current rolling 12 month period.	Payment by Drug Type -Dashlet
Brand Formulary Drug Previous Plan Paid Amount	Plan payments for brand formulary drugs filled in the previous rolling 12 month period.	Payment by Drug Type -Dashlet
Brand Formulary Previous Scripts	Volume of scripts for brand formulary drugs filled in the previous rolling 12 month period. Script count is based on a 30-day equivalent calculation.	Utilization by Drug Type -Dashlet
Brand Generic Description	Indicates if the generic version of the prescribed drug was dispensed.	Pharmacy Detail -Action Report
Brand Non-Formulary Current Scripts	Volume of scripts for brand non-formulary drugs filled in the current rolling 12 month period. Script count is based on a 30-day equivalent calculation.	Utilization by Drug Type -Dashlet
Brand Non-Formulary Drug Current Plan Paid Amount	Plan payments for brand non-formulary drugs filled in the current rolling 12 month period.	Payment by Drug Type -Dashlet
Brand Non-Formulary Drug Previous Plan Paid Amount	Plan payments for brand non-formulary drugs filled in the previous rolling 12 month period.	Payment by Drug Type -Dashlet
Brand Non-Formulary Previous Scripts	Volume of scripts for brand non-formulary drugs filled in the previous rolling 12 month period. Script count is based on a 30-day equivalent calculation.	Utilization by Drug Type -Dashlet
Cap Type Amount	The amount in dollars of the capitation payment made.	Capitation Summary -Action Report
Cap Type Code	A client defined code indicative of the type of capitation payment made.	Capitation Summary -Action Report
Cap Type Description	A client defined description of the Capitation Type Code. Some examples are: Total Lab and Total PCP	Capitation Summary -Action Report
Capitated Indicator	Indicates whether or not the services are paid for via a capitation arrangement.	Claim Detail, Claim Summary -Action Report
Capitation Paid	Total Capitation amount paid during the appropriate month.	Expense and Cost Summary by Incurred Date, Expense and Cost Summary by Paid Date -Action Report
Capture Rate	The percentage of care opportunities where the member received the required service(s).	Quality Opportunity Summary -Action Report
Care Manager	The name of the medical care coordinator assigned to manage the member's care.	Program Detail -Action Report
Case Close Reason Code	A code that indicates the reason participation in the medical care coordination program was discontinued.	Program Detail -Action Report
Case Close Reason Description	A description that indicates the reason participation in the medical care coordination program was discontinued.	Program Detail -Action Report
CCS Multi Level 1 Code	Clinical Classification Software - hierarchical code grouping like diagnoses.	Claim Detail -Action Report
CCS Multi Level 1 Description	Description of Clinical Classification Software Level 1 code.	Claim Detail -Action Report
CCS Multi Level 2 Code	Clinical Classification Software - hierarchical code grouping like diagnoses.	Claim Detail -Action Report
CCS Multi Level 2 Description	Description of Clinical Classification Software Level 2 code.	Claim Detail -Action Report
CCS Multi Level 3 Code	Clinical Classification Software - hierarchical code grouping like diagnoses.	Claim Detail -Action Report
CCS Multi Level 3 Description	Description of Clinical Classification Software Level 3 code.	Claim Detail -Action Report
CCS Multi Level 4 Code	Clinical Classification Software - hierarchical code grouping like diagnoses.	Claim Detail -Action Report
CCS Multi Level 4 Description	Description of Clinical Classification Software Level 4 code.	Claim Detail -Action Report
CCS Single Level Code	Clinical Classification Software - Single level code grouping like diagnoses.	Claim Detail -Action Report
CCS Single Level Description	Description of Clinical Classification Software Single Level Code.	Claim Detail -Action Report
Channel	Method by which the prescription was filled.	Pharmacy Detail -Action Report
Charged $	Total dollars charged on incurred claims.	Network Utilization Summary - Action Report
Charged Amount	Total dollars charged on the claim line.	Claim Detail, Claim Summary -Action Report
Charged PMPM $	A per member per month representation of the charged dollars.	Network Utilization Summary - Action Report
Claim ID	Description of Clinical Classification Software Level 1 code.	Claim Detail -Action Report
Claim ID	Client assigned id which is used to further refine groupings of members.	Claim Summary - Action Report
Claim ID	Carrier assigned number uniquely identify a health care claim.	Pharmacy Detail -Action Report
Claim Line Number	Carrier assigned sequence number for each claim line associated with a claim.	Claim Detail -Action Report
Claim Sub-Type	A further classification of claim type.	Claim Detail, Claim Summary -Action Report
Claim Type	A high level classification of medical claims. Typically Facility and Professional.	Claim Detail, Claim Summary, Network Utilization Summary -Action Report
Class	Description of the Class ID as assigned by the client.	Cost and Utilization Summary by Cost Bucket - Action Report
Class	Client assigned id which is used to further refine groupings of members.	Financial Summary -Action Report
Class Description	Client developed definition of Class ID, which is used to further refine groupings of members.	Capitation Summary -Action Report
Class Description	Description of the Class ID as assigned by the client.	Claim Detail, Claim Summary, Enrollment Detail, Enrollment Summary, Inpatient Admission, Pharmacy Detail -Action Report
Class ID	Client assigned id which is used to further refine groupings of members.	Capitation Summary, Claim Detail, Claim Summary, Enrollment Detail, Enrollment Summary -Action Report
Class ID	Client assigned id which is used to further refine groupings of members.	Expense and Cost Summary by Incurred Date, Expense and Cost Summary by Paid Date, Inpatient Admission, Pharmacy Detail -Action Report
Clinician	Servicing provider's name.	Top 10 Performing Providers by Cost Bucket, Top 10 Performing Providers by Specialty - Action Report
Coins/Copay	Total Coinsurance and Copay Amounts for Dental claims in the current rolling 12 month period	Dental Payment Summary, Vision Payment Summary -Action Report
Coinsurance - Dental	Total Coinsurance Amounts for Dental claims in the current rolling 12 month period.	Member Responsibility Overview -Dashlet
Coinsurance - Medical	Total Coinsurance Amounts for Medical claims in the current rolling 12 month period.	Member Responsibility Overview -Dashlet
Coinsurance - Pharmacy	Total Coinsurance Amounts for Pharmacy claims in the current rolling 12 month period.	Member Responsibility Overview -Dashlet
Coinsurance - Vision	Total Coinsurance Amounts for Vision claims in the current rolling 12 month period.	Member Responsibility Overview -Dashlet
Co-Morbidity Managed Indicator	Indicates whether the member is participating in more than one medical care coordination program.	Program Detail -Action Report
Condition Hierarchy	Description of Condition Hierarchy	Condition Hierarchy Summary - Action Report
Condition Hierarchy Amount	The total of the claim payments made for the condition hierarchy for which a member has incurred the highest costs.	Member Summary -Action Report
Condition Hierarchy Code	The code associated to the condition hierarchy (a high level classification of diagnoses) for which the claim line is assigned.	Claim Detail -Action Report
Condition Hierarchy Description	Description of the condition hierarchy (a high level classification of diagnoses) for which a member has incurred the highest costs.	Claim Detail. Member Summary, Network Utilization Summary -Action Report
Condition Risk Score	A member-level risk score calculated based upon the member's clinical condition as represented in the claims history.	Member Summary -Action Report
Confinement Number	Theon generated number assigned to inpatient stays.	Inpatient Admission -Action Report
Contact Count	Count of the contracts for which the capitation payment was made.	Capitation Summary -Action Report
Contact Months	Total Subscriber Months for the appropriate month.	Expense and Cost Summary by Incurred Date,Expense and Cost Summary by Paid Date -Action Report
Contact Type	The code indicative of the types of persons covered under the subscriber's contract.	Enrollment Summary -Action Report
Contact Type	The description of the types of persons covered under the subscribers contract.	Member Summary, Program Detail -Action Report
Contact Type Code	The code indicative of the types of persons covered under the subscriber's contract.	Claim Summary - Action Report
Contact Type Code	The description of the types of persons covered under the subscribers contract.	Enrollment Detail -Action Report
Contact Type Current %	The percentage of members at each contract benefit coverage type enrolled in the last month in the reporting period.	Member Enrollment by Contract Type -Dashlet
Contact Type Current %	The percentage of subscribers at each contract benefit coverage type enrolled in the last month in the reporting period.	Subscriber Enrollment by Contract Type -Dashlet
Contact Type Current Count	The count of all members by contract type (For example: Employee, Family, Employee and Spouse, etc.) enrolled in the last month in the reporting period. Note: The contract type description can be payer specific. The values will be established during implementation.	Member Enrollment by Contract Type -Dashlet
Contact Type Current Count	The percentage of members (contract holder, spouse, and/or dependent) at each contract benefit coverage type enrolled in the month one year prior to the last month in the current rolling 12 month period.	Member Enrollment by Contract Type -Dashlet
Contact Type Current Count	The count of subscribers (contract holder) at each contract benefit coverage type enrolled in the last month in the reporting period.	Subscriber Enrollment by Contract Type -Dashlet
Contact Type Description	Client provided description of the type of contract for which the payment was made. Some examples are: Single, Employee and Spouse and Family.	Capitation Summary -Action Report
Contact Type Description	The description of the types of persons covered under the subscribers contract.	Claim Detail, Claim Summary, Enrollment Detail, Inpatient Admission, Pharmacy Detail -Action Report
Contact Type Previous %	The percentage of subscribers (contract holder) at each contract benefit coverage type enrolled in the month one year prior to the last month in the reporting period.	Subscriber Enrollment by Contract Type -Dashlet
Contact Type Previous Count	The total count of members (contract holder, spouse, and/or dependent) across all contract benefit coverage type and enrolled in the month one year prior to the last month in the current rolling 12 month period.	Member Enrollment by Contract Type -Dashlet
Contact Type Previous Count	The count of subscribers (contract holder) at each contract benefit coverage type enrolled in the month one year prior to the last month in the reporting period.	Subscriber Enrollment by Contract Type -Dashlet
Contact Type Total Current Count	The total count of all members (contract holder, spouse, and/or dependent) across all contract benefit coverage type and enrolled in the last month in the reporting period.	Member Enrollment by Contract Type -Dashlet
Contact Type Total Previous Count	The count of all members (contract holder, spouse, and/or dependent) at each contract benefit coverage type enrolled in the month one year prior to the last month in the current rolling 12 month period.	Member Enrollment by Contract Type -Dashlet
Contact Type Total Previous Count	The total count of subscribers (contract holder, spouse, and/or dependent) across all contract benefit coverage type and enrolled in the month one year prior to the last month in the current rolling 12 month period.	Subscriber Enrollment by Contract Type -Dashlet
Copay - Dental	Total Copay Amounts for Dental claims in the current rolling 12 month period.	Member Responsibility Overview -Dashlet
Copay - Medical	Total Copay Amounts for Medical claims in the current rolling 12 month period.	Member Responsibility Overview -Dashlet
Copay - Pharmacy	Total Copay Amounts for Pharmacy claims in the current rolling 12 month period.	Member Responsibility Overview -Dashlet
Copay - Vision	Total Copay Amounts for Vision claims in the current rolling 12 month period.	Member Responsibility Overview -Dashlet
Cost Bucket	Theon defined cost bucket to which the service is assigned.	Claim Detail, Top 10 Performing Providers by Cost Bucket -Action Report
Cost Bucket Utilization	Theon defined cost bucket to which the service is assigned.	Claim Detail -Action Report
Coverage Status	The coverage status as of the last day of the previous month.	Enrollment Detail, Member Opportunity Detail,Member Opportunity Summary -Action Report
Coverage Status	This indicates if the members medical coverage is currently effective or terminated.	Member Summary, Program Detail -Action Report
Coverage Type Code	Indicates the type of coverage the record refers to.	Enrollment Detail- Action Report
Coverage Type Description	Describes the type of insurance product the record is for.	Enrollment Detail -Action Report