Claim detail
All claim lines under the parent claim.
Claim summary
A one line per Claim ID summarization with multiple descriptive fields.
Cost and utilization summary by cost bucket
PMPM dollar amounts spread across the 7 cost and use buckets (lab, radiology, ER, hospital, pharmacy, specialty care, and primary care). Each bucket has PMPM's divided into 'with' and 'without' outlier categories.
Inpatient admission
Past and current inpatient admissions based on a supporting claim or census data. Information is presented one line per confinement with multiple descriptive fields.
Medical and pharmacy cost summary
PMPM data calculated in various fashions and at different groupings.
Medical and pharmacy financial summary
The summary displays PMPMs after applying stop loss, previous PMPMs after applying stop loss adjusted for change in risk, and risk index.
Patient opportunity detail
A member level detailing of a patient's opportunity through the use of a drill path. This report contains the following information: Practice/Facility/Site name, Provider name, Patient name, Patient age, Opportunity type, Opportunities, Opportunity due date, Opportunity status, Star measure, etc.
Patient opportunity summary
After filtering on the standard combo boxes, a patient-by-patient listing of various opportunities are provided (total open opportunities, total number of open HCCs, open HCCs suspected, open HCCs missing, open care, actionable opportunities, open Star, and number of deviations) along with counts for each category. Patient birth date, gender, and age are provided along with their practice/facility/site name and provider name.
Patient panel
A patient listing with the following attributes: Attributed PCP name, age of patient, line of business code, total member cost (with and without outliers), etc.
Patient profile
A patient listing with the following attributes: Attributed PCP name, age of patient, line of business code, total member cost (with and without outliers), etc.
Pharmacy detail
A one line per claim ID summarization with information on medications and prescriptions.
Prescribing pattern
Various pharmacy data metrics. From an overall perspective, total units and costs for data versus the peer. Also, an NDC summarized list with multiple metrics including specialty drug indicator, generic name, drug type, total cost, total scripts, and generic available indicator.
Quality opportunity summary
A listing of quality measures with the following metrics: contract flag, number of Medicare Advantage Star opportunities, number of quality opportunities unmet per measure, number of quality opportunities met per measure (numerator), number of quality opportunities per measure (denominator), and capture rate.
Top 10 performing providers by cost bucket
Risk adjusted PMPM dollar amounts spread across the seven cost and use buckets (ED, hospital services, lab, pharmacy, primary care, radiology, and specialty care) with a top 10 provider listing by actual risk adjusted PMPM. Other metrics include: total cost, total visits, and percentage of total cost bucket. An eleventh category titled "other" encompasses the remaining providers.
Top 10 performing providers by specialty
Risk adjusted PMPM dollar amounts for the top 10 providers under specialty groupings. Other metrics include peer risk adjusted PMPM, index, total cost, total visit, percent of total cost bucket, and percent of total specialty bucket. An eleventh category titled "other" encompasses the remaining providers.
