Claimant Reports
Claimant reports return information based on items showing in the Claimant Summary list, so perform a claimant search before running the reports.
Claimant Report Process
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Claims Claimant Log Query Feed (Excel Only) – Reports a log of claimant queries. Available as an excel spreadsheet only. Includes producer, policyholder, treaty, contract number, diagnosis, claim ID, etc.
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Denial Summary by Reason – Provides summary information on denials. Includes year, quarter, reason and denial amount.
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Lasered Individuals Specific Reserves – Reports claim payment and reserve information for lasered individuals. Includes policy information and diagnosis as well as paid, reimbursed, requested, adjusted, pending, outstanding, and reserve amounts.
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Loss Adjustment Expense Summary – Provides summary information on loss adjustments. Includes policy information and loss adjustment amount.
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Over Reimbursed Claims (Negative Outstanding) – Reports claims with negative outstanding balances. Includes Policyholder, contract number, claimant name and membership number, outstanding balance, and reimbursed amount.
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Specific Claims 25 Percent of Standard Maximum – Reports claims where claim amount is within 25 percent of the standard maximum. Includes policy and payment information.
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Specific Claims Denied Charges – Reports detailed information on claim denials. Includes policy information, denial amount, and reason for the denial.
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Specific Claims Denied Charges Summary – Provides summary information on denied charges. Includes denial reason, amounts denied, number of denials and percentage of claim that is denied.
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Specific Claims Diagnosis Category Summary – Reports total reimbursements and average claim amounts for various diagnoses.
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Specific Claims Lag Triangle – Charts incurred vs. paid dates.
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Specific Claims Lag Triangle with Detail – Lists incurred vs. paid dates with additional claim information, including policy and claimant name.
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Specific Claims Lag Triangle with Loss Adjustment Expenses – Charts incurred vs. paid dates with loss adjustment expenses.
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Specific Claims Multiple Year Claimants – Reports claim information for claimants over multiple years. Includes policy information, underwriter, diagnosis, allowed amounts, total billed amounts, pended amounts, deductibles, etc.
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Specific Claims Negotiated Discount Summary – Reports summary information on negotiated discounts applied to claims.
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Specific Claims Paid to Date – Reports details on claims paid to date. Includes effective date, policyholder, and claimant as well as incurred dates, payment dates, pended/denied amounts, outstanding, and reserves.
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Specific Claims Pended Charges – Reports details on pended charges including auditor, pend reason, pend amount and days pended.
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Specific Claims 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.
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Specific Claims PPO Network Discount Summary – Reports summary information on PPO network discounts applied to claims.
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Specific Claims Recommendation Overrides – Reports overrides on claims. Includes claimant, underwriter, who reviewed the claim, TPA paid amounts, reimbursed amounts, etc.
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Specific Claims Reimbursement Summary – Reports summary information for various reimbursement ranges. Includes third-party paid amounts, deductible, disallowed, pending, split funding, outstanding, reserves, etc.
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Specific Claims Reserves Variance – Reports variances in reserves. Closing periods and variance threshold are configurable prior to running the report. Includes policy information, claimant, diagnosis, reserve changes, who set the new reserve, etc.
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Specific Paid Claims – Reports paid specific claims. Includes policy information, tpa paid amounts, allowed and disallowed amounts, reserves, outstanding balance, etc.
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Specific Paid Claims with No Notices – Detailed claim payment information for claims without notices. Includes policy holder, payment and reimbursement data and producer and TPA name.
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Specific Reserve Summary – Reports summary information for various reserve ranges. Includes third-party paid amounts, deductible, disallowed, pending, split funding, outstanding, reserves, etc.
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Specific Reserves – Reports payment details for claims, including reserve amounts.
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Specific TPA Paid Date Summary By Treaty – Reports when TPAs were paid, sorted by treaty. Includes effective date, paid month, and specific deductible.