Gain an understanding of what you can review, analyze, and track with the reports in HealthAnalytIQ's Medical Module.
Below is a list of the reports, analyses, and groups that can be tracked using the Medical Module of HealthAnalytIQ.
- Large Claims Report – A comprehensive, deep dive into claims activity involving user-defined criteria for Large Claims. Provides drill down into the number of claims occurring per individual or group, claims detail such as primary and secondary diagnoses, procedures, and place of service for any selected time period. Also shows premiums collected over the same period as well as profit and loss indicators per group.
- Large Claims Watchlist – This tracking watchlist is fully customizable to a client’s specific definitions but generally allows the ongoing monitoring of claims activity meeting certain set criteria, such as groups with claims exceeding $50K, members with individual claims exceeding $25K, groups or individuals with total Rx cost exceeding 25% of their paid premiums, or other client-specified monitoring criteria.
- Claims Profile – A series of analyses with regard to claims, payments, and denials presented across multiple dimensions such as age, gender, provider, specialty, condition, service location, revenue code, length of stay, and more. Also provides a focus on large claims as defined by the client.
- ED and Urgent Care Utilization – A detailed look at Emergency Room and Urgent Care utilization patterns by individual members and groups. This dashboard includes a “Frequent Flier” list of the highest users of these high-cost services as well as their geographical locations and clinical profiles.
- Special Cases – A comprehensive look at high-cost groups that may require more proactive case management. Groups such as maternity patients, frail patients, and members with unusual cases are profiled and presented for care coordination and case management.