Ori - Per

Original Admit Date

This date appears on an acute inpatient admission that occurred within 30 days of discharge of a previous inpatient admission and contains the admission date of the previous inpatient admission.

Inpatient Admission - Action Report

Original Admit Date

As of the most recent full data refresh, if the member had a readmission within the current reporting period, then this field contains the previous admission date related to the readmission. A readmission is defined as returning to an acute inpatient facility.

Patient Panel - Action Report

Original Admitting Diagnosis Code

This code appears on an acute inpatient admission that occurred within 30 days of discharge of a previous inpatient admission and contains the International Classification for Diseases (ICD) code for classifying the primary diagnosis reported on the previous inpatient admission.

Inpatient Admission - Action Report

Original Admitting Diagnosis Code

As of the most recent full data refresh, if the member had a readmission within the current reporting period, then this field contains the International Classification for Diseases (ICD) code for classifying the primary diagnosis reported on the previous inpatient admission.

Patient Panel - Action Report

Original Admitting Diagnosis Description

This description appears on an acute inpatient admission that occurred within 30 days of discharge of a previous inpatient admission and contains the admitting diagnosis descriptions reported on the previous inpatient admission.

Inpatient Admission - Action Report

Original Admitting Diagnosis Description

As of the most recent full data refresh, if the member had a readmission within the current reporting period, then this field contains the previous admitting diagnosis description related to the readmission. A readmission is defined as returning to an acute inpatient facility within 30 days of discharge from any type of inpatient facility.

Patient Panel - Action Report

Original Admitting Facility

As of the most recent full data refresh, if the member had a readmission within the current reporting period, then this field contains the previous facility name related to the readmission. A readmission is defined as returning to an acute inpatient facility

Patient Panel - Action Report

Original Discharge Date

This date appears on an acute inpatient admission that occurred within 30 days of discharge of a previous inpatient admission and contains the discharge date reported on the previous inpatient admission.

Inpatient Admission - Action Report

Original Discharge Date

As of the most recent full data refresh, if the member had a readmission within the current reporting period, then this field contains the previous discharge date related to the readmission. A readmission is defined as returning to an acute inpatient facility within 30 days of discharge from any type of inpatient facility.

Patient Panel - Action Report

Original ICD Type Code

This code appears on an acute inpatient admission that occurred within 30 days of discharge of a previous inpatient admission and contains the ICD version code reported on the previous inpatient admission.

Inpatient Admission - Action Report

Original ICD Type Code

As of the most recent full data refresh, if the member had a readmission within the current reporting period, then this field contains the previous ICD version code related to the readmission. A readmission is defined as returning to an acute inpatient fa

Patient Panel - Action Report

Originated in ED Indicator

Indicates if the inpatient admission originated in the emergency department.

General Definition

Outlier

A member who has total costs that exceed a specified dollar threshold.

General Definition

Paid Amount

The total amount paid for services rendered after denials, deductions, adjustments and cost-sharing provisions have been applied.

Claim Detail, Claim Summary, Inpatient Admission, Pharmacy Detail -Action Report

Paid Date

The date the claim was paid or processed.

Claim Summary, Pharmacy Detail -Action Report

Paid LOB

The high level description of the benefit coverage that was active at the time the claim was paid.

Claim Detail -Action Report

Paid Product

The category of product, as defined by the traditionally referenced types of insurance plans that was active at the time the claim was paid.

Claim Detail -Action Report

Patient Address

The primary address for the member.

Patient Profile - Action Report

Patient Age

The age of the member as of the last day of the previous month.

Patient Opportunity Detail,Patient Opportunity Summary, Patient Panel, Program Detail - Action Report

Patient Birth Date

The date the patient was born.

Patient Opportunity Detail,Patient Opportunity Summary, Patient Panel - Action Report

Patient Date of Birth

The date the patient was born.

Patient Profile - Action Report

Patient Gender

The biological and physiological characteristics that define men and women.

Patient Opportunity Summary, Patient Profile - Action Report

Patient ID

The member identifier from their original data source.

Claim Detail, Claim Summary, Pharmacy Detail, Inpatient Admission, Patient Panel, Patient Opportunity Summary, Patient Opportunity Detail -Action Report

Patient Name

The member's full name.

Claim Detail, Claim Summary, Pharmacy Detail, Inpatient Admission, Patient Panel, Patient Opportunity Summary, Patient Opportunity Detail, Patient Profile -Action Report

Patient Phone Number

The member's primary telephone number.

Patient Panel, Patient Profile - Action Report

Patient Responsibility Amount

The total member liability for the service.

Claim Detail, Claim Summary, Pharmacy Detail -Action Report

Patients Currently Admitted

The number of members in the panel during the current period who are currently admitted to an inpatient hospital. This number is updated daily.

Patients Currently Admitted -Population Measures

Patients in Panel

The number of unique patients who were enrolled in a health plan during the measurement period. Based on the users view this may include current attributed members, newly attributed members & non-attributed members.

Patients in Panel, Executive Summary -Population Measures

Patients in Panel

Count of the number of patients in the selected health system and practice.

Executive Detail - Action Report

Payer

The name of the entity administering the benefits related to the reported item.

Patient Opportunity Detail, Patient Opportunity Summary, Quality Deviation Summary, Quality Opportunity Summary - Action Report

Payer Specialty Drug Indicator

A flag that indicates whether a drug is classified as a specialty drug under the plans formulary.

Prescribing Pattern -Action Report

PBM Formulary Indicator

Indicates whether or not the prescribed drug is on the Pharmacy Benefit Manager's (PBM) list of preferred pharmaceutical product.

Pharmacy Detail - Action Report

PEDS Enrollment -Case Mgt

The number of members 17 years of age and younger who were identified for a case management program during the current period.

Program Management - Dashlet

PEDS Enrollment -Disease Mgt

The number of members 17 years of age and younger who were identified for a disease management program during the current period.

Program Management - Dashlet

Peer

For the peer comparison population, the number of members who selected a provider to manage their care or, based on claims, a provider was determined to be managing the member's care.

Attributed Population -Dashlet

Peer

Primary care physicians not within the selected population parameters who provide services to a similar population.

General Definition

Peer Acute Admits/1000

For members of any age within the peer comparison population, the number of acute inpatient stays during the current period. Exclusions include: 1) A place or service, type of bill and/or revenue code indicating the stays was in a skilled nursing facility

Inpatient Utilization - Dashlet

Peer Brand Total Costs

The maximum amount on which payment is based for covered brand drug prescriptions to members in the peer comparison population.

Prescribing Pattern -Action Report

Peer Brand Total Scripts

The peer comparison population's number of 30 day equivalent prescription for brand drug.

Prescribing Pattern -Action Report

Peer ED Visits/1000

For members of any age within the peer comparison population, the number of emergency department visits during the current period. Exclusions: Emergency department visits that are associated with an inpatient stay.

Acute Care Utilization -Dashlet

Peer ED/1000

The peer comparison population's encounter count per 1,000 members for emergency department services during the current period.

Utilization Overview -Dashlet

Peer Generic Fill Ratio

The percentage of total prescriptions that were filled with a generic drug for members to the peer comparison population in the current period.

Prescribing Pattern -Action Report

Peer Generic Total Costs

The maximum amount on which payment is based for covered generic drug prescriptions to members to the peer comparison population.

Prescribing Pattern -Action Report

Peer Generic Total Scripts

The peer comparison population's number of 30 day equivalent prescription for generic drug.

Prescribing Pattern -Action Report

Peer Hospital Services/1000

The peer comparison population's encounter count per 1,000 members for hospital services during the current period.

Utilization Overview -Dashlet

Peer IP Admits via ED/1000

For members of any age within the peer comparison population, the number of inpatient stays during the current period that had an associated emergency department visit.

Acute Care Utilization -Dashlet

Peer Lab/1000

The peer comparison population's encounter count per 1,000 members for laboratory services during the current period.

Utilization Overview -Dashlet

Peer MHSA Admits/1000

For members of any age within the peer comparison population, the number of mental health or substance abuse inpatient stays during the current period. Inclusion in this measure is based on diagnosis code, Clinical Classification Software (CCS) category, Diagnosis Related Group (DRG) code and/or revenue code.

Inpatient Utilization - Dashlet

Peer Observations/1000

For members of any age within the peer comparison population, the number of observation room visits during the current period. Observation room care on this dashlet is based on revenue code and procedure code. Excluded are observation room visits that are

Acute Care Utilization -Dashlet

Peer Pharmacy/1000

The peer comparison population's encounter count per 1,000 members for pharmacy services during the current period.

Utilization Overview -Dashlet

Peer Primary Care Visits/1000

The peer comparison population's encounter count per 1,000 members for primary care services during the current period.

Utilization Overview -Dashlet

Peer Radiology/1000

The peer comparison population's encounter count per 1,000 members for radiology services during the current period.

Utilization Overview -Dashlet

Peer Readmits/1000

For members of any age within the peer comparison population, the number of inpatient stays during the current period that were followed by an unplanned acute admission for any diagnosis within 30 days. Additional exclusions include: 1) The member died during the initial admission, 2) A discharge status indicating the member was discharged against medical advice on the initial admission, 3) A principal diagnosis of pregnancy on readmission, 4) A principal diagnosis of perinatal conditions on readmission, 5) A principal diagnosis of maintenance chemotherapy on readmission, 6) A principal diagnosis of maintenance radiation treatment on readmission, 7) A principal diagnosis of maintenance dialysis treatment on readmission, 8) Direct transfers from one facility to another, 9) Inpatient stays where the admission and discharge dates are equal

Inpatient Utilization - Dashlet

Peer Rehab Admits/1000

For members of any age within the peer comparison population, the number of rehab facility inpatient stays during the current period. Inclusion in this measure is based on place or service and/or revenue code.

Inpatient Utilization - Dashlet

Peer SNF Admits/1000

For members of any age within the peer comparison population, the number of skilled nursing facility inpatient stays during the current period. Inclusion in this measure is based on place or service, type of bill and/or revenue code.

Inpatient Utilization - Dashlet

Peer Specialty/1000

The peer comparison population's encounter count per 1,000 members for specialty services during the current period.

Utilization Overview -Dashlet

Peer Time Period 1

The PMPM for the peer population as determined by the Global Prompts for the first time period selected by the user.

Variable Time Period Cost Overview -Dashlet

Peer Time Period 1

The Utilization/1000 for the peer population as determined by the Global Prompts for the first time period selected by the user.

Variable Time Period Utilization Overview- Dashlet

Peer Time Period 2

The PMPM for the peer population as determined by the Global Prompts for the second time period selected by the user.

Variable Time Period Cost Overview -Dashlet

Peer Time Period 2

The Utilization/1000 for the peer population as determined by the Global Prompts for the second time period selected by the user.

Variable Time Period Utilization Overview -Dashlet

Peer Urgent Care Visits/1000

For members of any age within the peer comparison population, the number of urgent care visits during the current period. Urgent care on this dashlet is based on procedure code.

Acute Care Utilization -Dashlet

Per Member Per Month (PMPM)

A measurement that represents the average cost for the member for each month of active coverage.

General Definition