Insurance Analysis Report

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Insurance Analysis Report

Purpose:


This is a Revenue Analysis Only report - selection of Services by Date Range. All payments for selected services will be used to calculate.


This report considers the Payer the claim is filed to on sequence 1 (Claim Sequence 1) as the Payer payments must match to to be calculated as Insurance Payments. Payments from others payers that do not match the primary filing payer are considered 'Other Insurance'. See Option Primary Filing Only.


Fundamentally, this report allows you to check up on Payers to see how they are paying your claims.

You can see:

  • Services (Procedures) that are not getting paid. (Average Payment)
  • Variations in the amount they are paying (Average Payment)
  • Verify that the Charge amount for any given procedure is not equal or lower than the amount being paid. (Average Charge vs Average Payment)
  • Verify that Payers are paying in a timely fashion. (Average Days to Pay)
  • Evaluate secondary and patient payments - are specific secondaries falling behind? (Average Days)


There are two purposes...

One - Show all procedures payers have paid on for the selected period. This allows a quick view on any procedures payers are -not- paying on.

Two - Compare Payer Payment Rates for specific Procedure Codes. e.g. Does Aetna pay more or less then BCBS for a 99213.


Directly Related Reports:

  • Payment Variance Report

Notes:

Used to be known as Insurance Report Card.

AKA Payer Payment Analysis Report


Report Criteria:

Filter Options

Date Range - Date range to select services.

Service Selection By - Selects which date to use - Service Entry Date, Service Batch Date or Date of Service (From Date)

Provider OR Provider Group - Filter by Provider/Provider Group

Location OR Location Group - Filter by Location/Location Group

Facility - Filter by Facility

Place of Service - Filter by Place of Service

User - Filter by User that created the Service (Payments from any user will be included)

Pay Code (Payment/Adjustment) - Filter Payment Selection to specific Pay Code

Payer (All, Self, Group, Single) - Filter Payers by Selection

Procedure Code (Old All or Range) -


Primary Filing Only - When yes - show all claims by Primary Filing Only. When no - Claims that have a Primary and a Secondary will be included two times. Once for each Filing. Setting this to No is useful to evaluate Secondary Payers. The report answers questions such as 'When Secondary X paid, how much did others payers and the patient pay for a given service.

Output Options

Show Procedure Details - Yes - includes procedure/payer breakout. No - shows totals only.

Order By - Payer then Procedure, Procedure then Payer


Report Output

PDF and Excel