Claim Submission Reports

Claim Submission reports return information based on items showing in the Claim Submission log, so perform a claimant search before running reports.

Claim Submission Reports Process

1
Run the report.
2
Claims Submission Log Query Feed (Excel Only) – Reports a log of claim submissions. Available as an excel spreadsheet only. Includes effective date, policyholder, contract number, claimant, received date, submission type, etc.
3
Denial Summary by Reason – Reports a summary of denied claims by denial reason. Includes denied amount. Broken out by quarter with yearly totals.
4
Denied Charges Summary – Provides summary information on denied charges. Includes denial reason, number of denied charges, total denied amount and denials as a percentage of totals charges.
5
Diagnosis Category Summary – Reports total reimbursements and average claim amounts for various diagnoses.
6
Pended Charges Summary – Provides summary information on pended charges. Includes pend reason, amounts pended, number of pend charges, and percentage of claim that is pended.
7
Potential Duplicate Submissions – Reports potential duplicate submissions. Includes policy information, who entered the initial and potential duplicate claim, assigned auditors, received and created dates, and original request amount.
8
Specific Claim Denied Charges – Provides information on denied specific claims. Includes policy information, audit date, denial reason and amount, and auditor name.
9
Specific Claim Entry Statistics – Reports number of initial, supplemental, and total claims entered for each individual allowed to enter claims.
10
Specific Claim Negotiated Discount Summary – Reports summary information on negotiated discounts applied to claims.
11
Specific Claim Pended Charges – Reports details on pended charges including auditor, pend reason, pend amount and days pended.
12
Specific Claim PPO Network Discount Summary – Reports summary information on PPO network discounts applied to claims.
13
Specific Claim Submission Log – Provides information on claim submissions including policy, claim and diagnosis information, auditor, and date received.
14
Specific Claims TPA Turnaround – Reports TPA turnaround times. Includes policy information, payment information and time to process and pay the claim.
15
Specific Claims Turnaround – Reports processing times for specific claims. Includes policy information, payment information, and time to process and pay the claim.
16
Specific Manager Approval Reimbursement Requests – Reports reimbursement requests involving manager approval. Includes policy information, reimbursement amounts, and diagnosis.
17
Specific Outstanding Claims – Reports claims with outstanding amounts. Includes policy information, claimant, requested amount, and auditor.
18
Specific Reimbursement Request Statistics – Reports counts of reimbursement request results for all claims, initial claims, and supplemental claims. Includes counts of claims received, in process, reimbursed, not reimbursed, etc. Viewable by auditor, office, administrator, and producer.
19
Specific TPA Paid Date Summary By Treaty – Documentation pending.
20
TPA Paid Claim Summary (Top 10) – Reports the top ten amounts paid out by third party administrators for the current year, prior year, and 12 month rolling period.