Pro - Yea

Measure	Definition	Occurrence
Provider Group	Group the servicing provider is associated with.	Top 10 Performing Providers by Cost Bucket, Top 10 Performing Providers by Specialty -Action Report
Provider Specialty	The primary practicing specialty of the provider.	Claim Detail, Inpatient Admission -Action Report
Provider Specialty Code	Code describing the primary practicing Specialty of the provider.	Claim Summary -Action Report
Provider Specialty Description	The primary practicing specialty of the provider.	Claim Summary -Action Report
Provider Type Code	Code indicating the type of provider.	Claim Summary -Action Report
Provider Type Description	Description of the type of provider.	Claim Summary -Action Report
Quantity Dispensed	A measure of the quantity of the prescribed drug that was dispensed to the patient.	Pharmacy Detail -Action Report
Radiology Actual PMPM	Radiology cost per member per month for the plan for the current rolling 12 month period. Completion factors are applied and capitation payments are included.	Cost Overview -Dashlet
Radiology Actual PMPM	Radiology cost per member per month for the plan for the current rolling 12 month period where the cost does not exceed a threshold. Capitation payments are included and completion factors are applied.	Cost Overview w/o Outliers -Dashlet
Radiology Actual PMPM	Radiology cost per member per month for the plan for the current rolling 12 month period where the cost exceeds a threshold. Capitation payments are included and completion factors are applied.	Cost Overview w/o Outliers -Dashlet
Radiology Norm PMPM	Radiology cost per member per month for the normative population for the current rolling 12 month period. Completion factors are applied and capitation payments are included.	Cost Overview -Dashlet
Radiology Norm PMPM	Radiology cost per member per month for the normative population for the current rolling 12 month period where the cost does not exceed a threshold. Capitation payments are included and completion factors are applied.	Cost Overview w/o Outliers -Dashlet
Radiology Norm PMPM	Radiology cost per member per month for the normative population for the current rolling 12 month period where the cost exceeds a threshold. Capitation payments are included and completion factors are applied.	Cost Overview w/o Outliers -Dashlet
Radiology Visits/1000 Count	Utilization per 1,000 members for Radiology services for the plan population. Completion factors are applied.	Cost and Utilization Summary by Cost Bucket - Action Report
Radiology-All PMPM	Radiology services cost per member per month for the plan for the current rolling 12 month period. Completion factors are applied and capitation payments are included.	Cost and Utilization Summary by Cost Bucket - Action Report
Radiology-Outliers Only PMPM	Radiology services cost per member per month for the plan for the current rolling 12 month period. This measure includes only those members who have exceeded a client configured threshold. Completion factors are applied and capitation payments are include	Cost and Utilization Summary by Cost Bucket - Action Report
Radiology-w/o Outliers PMPM	Radiology services cost per member per month for the plan for the current rolling 12 month period. This measure excludes those members who have exceeded a client configured threshold. Completion factors are applied and capitation payments are included.	Cost and Utilization Summary by Cost Bucket - Action Report
RAF/CRA	The CRA is the member's risk scores commercial risk score. It is displayed if the member has a commercial insurance product. It is calculated using the current HCC risk model as defined in Affordable Care Act.	Member Summary -Action Report
RAF/CRA	The RAF is the member's Medicare risk score if they have a Medicare Advantage insurance product. The risk score is determined using the CMS risk adjustment model.	Member Summary -Action Report
Readmit Date	For a readmission claim, the date of the readmission.	Inpatient Admission -Action Report
Readmit Date	The start date of a patient's inpatient readmission confinement. The readmission must be less than 30 days after the discharge date of the previous inpatient admission. Substance abuse admissions are not considered as an original or readmission confinemment.	Member Summary -Action Report
Readmit Discharge Date	For a readmission claim, the date of the discharge from the readmission.	Inpatient Admission -Action Report
Readmit Discharge Date	If a patient was readmitted less than 30 days between discharge and readmission, then this is the end date of their readmission confinement. It will be null if the patient is still inpatient or the final bill closing the confinement has not been processed.	Member Summary -Action Report
Readmit Flag	A flag indicating if the claim was for a readmission.	Claim Summary -Action Report
Readmits/1000 - Actual	Readmissions per 1000 members for the plan.	Inpatient Utilization -Dashlet
Readmits/1000 - Norm	Readmissions per 1000 members for the plan for the normative population.	Inpatient Utilization -Dashlet
Readmitting Diagnosis Code	If a patient was readmitted less than 30 days between discharge and readmission, then this is the admitting diagnosis of their readmission confinement.	Inpatient Admission, Member Summary -Action Report
Readmitting Diagnosis Description	If a patient was readmitted less than 30 days between discharge and readmission, then this is the admitting diagnosis description of their readmission confinement.	Inpatient Admission -Action Report
Readmitting Facility	Carrier assigned identifier for the facility.	Inpatient Admission -Action Report
Readmitting Facility	If a patient was readmitted less than 30 days between discharge and readmission, then this is the facility of their readmission confinement.	Member Summary -Action Report
Readmitting ICD Type Code	A code indicating what type of ICD code is used (9 or 10).	Inpatient Admission -Action Report
Referral Close Reason Code	A code that indicates the reason the attempt to engage the member in a medical care coordination program was discontinued.	Program Detail -Action Report
Referral Close Reason Description	A description that indicates the reason the attempt to engage the member in a medical care coordination program was discontinued.	Program Detail -Action Report
Referred from Another Program Count	The count of members who were identified from another program's engagement or enrollment process.	Program Summary -Action Report
Referred From Another Program Indicator	Indicates the source that referred the member to the medical care coordination program.	Program Detail -Action Report
Rehab Admits/1000 - Norm	Admissions per 1,000 members to a rehabilitation setting for the normative population.	Inpatient Utilization -Dashlet
Rehab Flag	A flag indicating if the admission is for a Rehabilitation Facility.	Inpatient Admission -Action Report
Rehab/1000 - Actual	Admissions per 1,000 members to a rehabilitation setting.	Inpatient Utilization -Dashlet
Relationship Code	Code indicating the member's relationship to the subscriber.	Claim Detail, Claim Summary, Enrollment Detail, Inpatient Admission -Action Report
Relationship Code	A code describing the member's relationship to the subscriber.	Member Opportunity Detail, Member Opportunity Summary -Action Report
Relationship Code	Code indicating the member's relationship to the subscriber.	Member Summary, Pharmacy Detail, Program Detail -Action Report
Relationship Description	Description of the member's relationship to the subscriber.	Claim Detail, Claim Summary, Enrollment Detail, Inpatient Admission, Member Opportunity Detail, Member Opportunity Summary, Member Summary, Pharmacy Detail, Program Detail -Action Report
Retail % Paid	The percentage of retail channel pharmacy claim payment amount during the current reporting period.	Pharmacy Utilization Summary -Dashlet
Retail % Scripts	Percentage of scripts filled in the current reporting period through the retail channel. The script count is based on a 30-day equivalent calculation.	Pharmacy Utilization Summary -Dashlet
Retail Paid	Total retail channel pharmacy claim paid amount during the current reporting period.	Pharmacy Utilization Summary -Dashlet
Retail Scripts	Number of 30-day equivalent pharmacy scripts (prescriptions) filled through the retail channel during the current reporting period.	Pharmacy Utilization Summary -Dashlet
Revenue Code	The description of the types of persons covered under the subscribers contract.	Claim Detail -Action Report
Revenue Code Description	Description of the revenue code.	Claim Detail -Action Report
Service From Date	The earliest date associate with the billed service.	Claim Detail, Claim Summary -Action Report
Service To Date	The latest date associated with a billed service.	Claim Detail, Claim Summary -Action Report
Servicing Provider ID	Unique identifier for the provider who actually provides the service(s) billed on a claim.	Claim Detail, Claim Summary -Action Report
Servicing Provider Name	The name of the provider who actually provides the service(s) billed on a claim.	Claim Detail, Claim Summary -Action Report
Servicing Provider Name	The name of the provider who actually provides the service(s) billed on a claim.	Inpatient Admission -Action Report
Servicing Provider Practice ID	Unique identifier for practice of the provider who actually provides the service(s) billed on a claim.	Claim Detail, Claim Summary -Action Report
Servicing Provider Practice Name	The name of the practice of the provider who actually provides the service(s) billed on a claim.	Claim Detail, Claim Summary -Action Report
SNF Admits/1000 - Actual	Admissions per 1,000 members to Skilled Nursing Facility (SNF) setting.	Inpatient Utilization -Dashlet
SNF Admits/1000 - Norm	Admissions per 1,000 members to skilled nursing facility setting for the normative population.	Inpatient Utilization -Dashlet
SNF Flag	A flag indicating if the admission is for a Skilled Nursing Facility.	Inpatient Admission -Action Report
Specialty	Description of provider Specialty.	Top 10 Performing Providers by Specialty - Action Report
Specialty % Paid	The percentage of the specialty claim payment amount during the current reporting period.	Pharmacy Utilization Summary -Dashlet
Specialty % Scripts	Percentage of 30-day equivalent specialty scripts filled during the current reporting period.	Pharmacy Utilization Summary -Dashlet
Specialty Actual PMPM	Specialty services cost per member per month for the plan for the current rolling 12 month period. Completion factors are applied and capitation payments are included.	Cost Overview -Dashlet
Specialty Actual PMPM	Specialty services cost per member per month for the plan for the current rolling 12 month period where the cost does not exceed a threshold. Capitation payments are included and completion factors are applied.	Cost Overview w/o Outliers -Dashlet
Specialty Actual PMPM	Specialty services cost per member per month for the plan for the current rolling 12 month period where the cost exceeds a threshold. Capitation payments are included and completion factors are applied.	Cost Overview w/o Outliers -Dashlet
Specialty Care Visits/1000 Count	Utilization per 1,000 members for Specialty Care services for the plan population. Completion factors are applied.	Cost and Utilization Summary by Cost Bucket - Action Report
Specialty Care-All PMPM	Specialty Care services cost per member per month for the plan for the current rolling 12 month period. Completion factors are applied and capitation payments are included.	Cost and Utilization Summary by Cost Bucket - Action Report
Specialty Care-Outliers Only PMPM	Specialty Care services cost per member per month for the plan for the current rolling 12 month period. This measure includes only those members who have exceeded a client configured threshold. Completion factors are applied and capitation payments are in	Cost and Utilization Summary by Cost Bucket - Action Report
Specialty Care-w/o Outliers PMPM	Specialty Care services cost per member per month for the plan for the current rolling 12 month period. This measure excludes those members who have exceeded a client configured threshold. Completion factors are applied and capitation payments are include	Cost and Utilization Summary by Cost Bucket - Action Report
Specialty Drugs Account For - % of Plan Costs	% that Specialty Drugs account in Total Plan Paid costs.	CE Executive Report – Pharmacy Cost Summary Page - Action Report
Specialty Drugs Account For - % of Prescriptions	% of Prescriptions that are Specialty Drugs that are Specialty Drugs.	CE Executive Report – Pharmacy Cost Summary Page - Action Report
Specialty Norm PMPM	Specialty services cost per member per month for the normative population for the current rolling 12 month period. Completion factors are applied and capitation payments are included.	Cost Overview -Dashlet
Specialty Norm PMPM	Specialty services cost per member per month for the normative population for the current rolling 12 month period where the cost does not exceed a threshold. Capitation payments are included and completion factors are applied.	Cost Overview w/o Outliers -Dashlet
Specialty Norm PMPM	Specialty services cost per member per month for the normative population for the current rolling 12 month period where the cost exceeds a threshold. Capitation payments are included and completion factors are applied.	Cost Overview w/o Outliers -Dashlet
Specialty Paid	Total pharmacy cost during the current reporting period for specialty scripts.	Pharmacy Utilization Summary -Dashlet
Specialty Scripts	30-day equivalent script count of specialty scripts filled the current reporting period.	Pharmacy Utilization Summary -Dashlet
Spouse Membership Count	Membership Count of all members who are spouses of employees.	Executive Report- Action Report
Star Measure	Indicates if the opportunity is related to a STAR measure.	Member Opportunity Detail -Action Report
Sub Group	A concatenation of Sub-Group Name and Sub-Group Number	Cost and Utilization Summary by Cost Bucket, Financial Summary - Action Report
Subgroup Description	The Subgroup Name associated with the Subgroup Number.	Capitation Summary -Action Report
Subgroup ID	The Subgroup Number assigned by the carrier.	Claim Detail, Claim Summary, Enrollment Detail, Enrollment Summary, Inpatient Admission, Pharmacy Detail-Action Report
Subgroup Number	The Subgroup Number assigned by the carrier.	Capitation Summary, Expense and Cost Summary by Incurred Date, Expense and Cost Summary by Paid Date -Action Report
Subscriber Count	Count of subscribers.	Enrollment Summary -Action Report
Subscriber Member Month	Total member months for subscribers.	Enrollment Summary -Action Report
Subscriber Paid Amount	Total plan paid dollars made on behalf of subscribers.	Enrollment Summary -Action Report
Therapeutic Class Code	Hierarchical code grouping like drugs together.	Pharmacy Detail, Prescribing Pattern-Action Report
Therapeutic Class Description	Description of the Therapeutic Class Code.	Pharmacy Detail, Prescribing Pattern-Action Report
Top 10 Facilities by Payment	Total dollars of the Top 10 Facilities (as determined by paid dollars).	Executive Report- Action Report
Top 3 MDC Categories	Top 3 Major Diagnosis categories by cost.	Executive Report- Action Report
Total	Total dollars paid by the plan.	Network Utilization Summary -Action Report
Total Cost Amount	Total dollars paid by the plan.	Prescribing Pattern -Action Report
Total Current Count	The total count of subscribers (contract holder) across all contract benefit coverage type and enrolled in the last month in the reporting period.	Subscriber Enrollment by Contract Type -Dashlet
Total Dental	Total Dental Costs that Members are responsible for in the current year.	Member Responsibility Overview -Dashlet
Total Medical	Total Medical Costs that Members are responsible for in the current year.	Member Responsibility Overview -Dashlet
Total Member Cost Amount	Total plan paid dollars for a member in the current rolling 12 month period.	Member Summary -Action Report
Total Member Cost Amount	Sum of medical and pharmacy cost for members for the current rolling 12 month period. Capitation payments are included and completion factors are applied.	Member Summary -Action Report
Total Member Cost Share - Dental	% of Total Dental Costs paid by the Member in the current year. Capitation Payments are included and Completion Factors are applied.	Member Responsibility Overview -Dashlet
Total Member Cost Share - Medical	% of Total Medical Costs paid by the Member in the current year. Capitation Payments are included and Completion Factors are applied.	Member Responsibility Overview -Dashlet
Total Member Cost Share - Pharmacy	% of Total Pharmacy Costs paid by the Member in the current year. Capitation Payments are included and Completion Factors are applied.	Member Responsibility Overview -Dashlet
Total Member Cost Share - Vision	% of Total Vision Costs paid by the Member in the current year. Capitation Payments are included and Completion Factors are applied.	Member Responsibility Overview -Dashlet
Total Member Count	Total number of members.	Enrollment Summary -Action Report
Total Member Medical Cost Amount	Total adjusted paid amount for medical services received by the member in the current rolling 12 month period. Completion factors are applied and capitation payments are included when applicable.	Member Summary -Action Report
Total Member Month	Total number of member months.	Enrollment Summary -Action Report
Total Member Paid Amount	Total dollars paid by the members.	Enrollment Summary -Action Report
Total Member Pharmacy Cost Amount	Total adjusted paid amount for pharmacy services received by the member in the current rolling 12 month with Completion factors applied.	Member Summary -Action Report
Total Member Responsibility Amount	Total dollars the member was responsible for in the current period.	Member Summary -Action Report
Total Members	Number of unique members covered under the plan (contract holder, spouse, and/or dependent(s)) as of the last month in the reporting period.	Total Members - Population Measures
Total Number of Open HCCs	The number of HCCs a member is suspected of having or are missing based on Theon modeling algorithms and claims history.	Member Opportunity Summary -Action Report
Total Number of Open HCCs	For a given member the total number of suspect and missing Hierarchical Condition Category (HCC) codes, or chances where existing coding may indicate a gap in coding may exist.	Member Summary -Action Report
Total Number of Open HCCs Suspected	For a given member, the total number of situations where advanced algorithms have predicted a member may have a condition not present in their claims coding, due to the presence of other factors observed in the claims data and often seen with the suspected condition.	Member Summary -Action Report
Total Paid	Total dollars paid by the plan.	Top 10 Performing Providers by Cost Bucket, Top 10 Performing Providers by Specialty -Action Report
Total Pharmacy	Total Pharmacy Costs that Members are responsible for in the current year.	Member Responsibility Overview -Dashlet
Total Vision	Total Vision Costs that Members are responsible for in the current year.	Member Responsibility Overview -Dashlet
Total Visits	Total number of visits.	Top 10 Performing Providers by Cost Bucket, Top 10 Performing Providers by Specialty -Action Report
Type of Bill	Uniform Billing Committee defined bill type. Applies only to Facility claims.	Claim Summary -Action Report
Type of Service Level 2	Theon assigned classification of services performed.	Claim Detail, Inpatient Admission -Action Report
Type of Service Level 3	Theon assigned classification of services performed.	Claim Detail -Action Report
Type of Service Level 4	Theon assigned classification of services performed.	Claim Detail -Action Report
Utilization Per K	A per thousand representation of service utilization.	Network Utilization Summary - Action Report
Utilization Per K In-Network	A per thousand representation of service utilization.	Network Utilization Summary - Action Report
Utilization Per K Out of Network	A per thousand representation of service utilization.	Network Utilization Summary -Action Report
Variance Avg Dental Member Months	Percentage change between Average number of member months for the current vs. previous rolling 12 month period for the Dental plan.	Enrollment Overview -Dashlet
Variance Avg Dental Member Months - Norm	Percentage change between Average number of member months for the current vs. previous rolling 12 month period for the Dental plan normative population.	Norm Enrollment Overview -Dashlet
Variance Avg Medical Member Months	Percentage change between Average number of member months for the current vs. previous rolling 12 month period for the medical plan.	Enrollment Overview -Dashlet
Variance Avg Medical Member Months - Norm	Percentage change between Average number of member months for the current vs. previous rolling 12 month period for the medical plan normative population.	Norm Enrollment Overview -Dashlet
Variance Avg Pharmacy Member Months	Percentage change between Average number of member months for the current vs. previous rolling 12 month period for the Pharmacy plan.	Enrollment Overview -Dashlet
Variance Avg Pharmacy Member Months - Norm	Percentage change between Average number of member months for the current vs. previous rolling 12 month period for the Pharmacy plan normative population.	Norm Enrollment Overview -Dashlet
Variance Avg Vision Member Months	Percentage change between Average number of member months for the current vs. previous rolling 12 month period for the Vision plan.	Enrollment Overview -Dashlet
Variance Avg Vision Member Months - Norm	Percentage change between Average number of member months for the current vs. previous rolling 12 month period for the Vision plan normative population.	Norm Enrollment Overview -Dashlet
Variance Dental PMPM	Percentage change in Dental Cost per member per month in the current rolling 12 month period vs. previous rolling 12 month period for the Normative Population. Capitation Payments are included and Completion Factors are applied.	Norm Comparison - Dashlet
Variance Dental PMPM	Percentage change in Dental Cost per member per month in the current rolling 12 month period vs. previous rolling 12 month period for the plan.	Payment Overview - Dashlet
Variance Medical PMPM	Percentage change in medical cost per member per month in the current rolling 12 month period vs. previous rolling 12 month period for the normative population.	Norm Comparison - Dashlet
Variance Medical PMPM	Percentage change in medical cost per member per month in the current rolling 12 month period vs. previous rolling 12 month period for the plan.	Payment Overview - Dashlet
Variance Pharmacy PMPM	Percentage change in pharmacy cost per member per month in the current rolling 12 month period vs. previous rolling 12 month period for the normative population.	Norm Comparison - Dashlet
Variance Pharmacy PMPM	Percentage change in pharmacy cost per member per month in the current rolling 12 month period vs. previous rolling 12 month period for the plan.	Payment Overview - Dashlet
Variance Vision PMPM	Percentage change in Vision Cost per member per month in the current rolling 12 month period vs. previous rolling 12 month period for the Normative Population. Completion Factors are applied.	Norm Comparison - Dashlet
Variance Vision PMPM	Percentage change in Vision Cost per member per month in the current rolling 12 month period vs. previous rolling 12 month period for the plan.	Payment Overview - Dashlet
Vision Actual PMPM	Vision cost per member per month for the actual population for the current rolling 12 month period. Completion factors are applied and capitation payments are included.	Cost Overview -Dashlet
Vision Current	The total adjusted paid amount for Vision services in the current rolling 12 month period. Completion factors are applied then capitation payments are included.	Payment Summary -Dashlet
Vision Norm PMPM	Vision cost per member per month for the normative population for the current rolling 12 month period. Completion factors are applied and capitation payments are included.	Cost Overview -Dashlet
Vision Previous	The total adjusted paid amount for Vision services in the previous rolling 12 month period. Completion factors are applied then capitation payments are included.	Payment Summary -Dashlet
Vision Variance	The variance in the total adjusted paid amount for Vision services from the current period versus the previous one. Completion factors are applied then capitation payments are included.	Payment Summary -Dashlet
Weighted Risk Score	A calculation for the defined population of each individual members retrospective risk multiplied by the individual members medical member months for the current time period, divided by the total member months for the population measured.	Weighted Risk Score -Population Measures
Year Over Year Trend	Evaluating two or more measured events to compare the results at one time period with those of a comparable time period on an annualized basis.	Executive Report- Action Report