Claims In Progress
The Claims In Progress operational report allow operations users (for example, managers and supervisors) analyze the current inventory of claims that are in progress.
Objective
Use this report for scenarios such as:
-
Reviewing claims pending for a hospital or provider group.
-
Finding claims with a total claimed amount greater than a threshold (for example, greater than 1000).
-
Reviewing claims pending for members in an employer group.
Reporting View Fields
The following table lists the fields available in the Claims In Progress operational reporting view.
| To include single-value dynamic fields related to the base entity for a specific view, generate the reporting view. Generation automatically includes the single-value dynamic fields. |
| Field | Description | Searchable? |
|---|---|---|
Claim ID |
Unique identifier of the claim. |
Yes |
Claim Code |
External or business-facing claim reference/code. |
Yes |
Claim Type |
Type classification of the claim. |
Yes |
Claim Status |
Current status of the claim. |
Yes |
Claim Start Date |
Date the claim coverage/service period starts (as defined for the claim). |
Yes |
Claim Intake Date |
Date the claim was received/entered into the system. |
Yes |
Total Claimed Amount |
Total amount claimed on the claim (stored as a currency amount). |
No |
Claim Lines Count |
Number of claim lines associated with the claim. |
Yes |
Member Code |
Member identifier/code for the serviced entity on the claim. |
Yes |
Member Name |
Member full name for the serviced entity on the claim. |
Yes |
Member Gender |
Member gender display value. |
Yes |
Member DOB |
Member date of birth. |
Yes |
Identifier |
Member identifier value (for example, subscriber ID or national ID), depending on identifier type. |
Yes |
Identifier Type |
Type of the identifier (for example, Subscriber ID, National ID). |
Yes |
Billing Provider Code |
Code for the billing/claimant provider. |
Yes |
Billing Provider Name |
Name of the billing/claimant provider. |
Yes |
Service Provider Code |
Code for the servicing provider. |
Yes |
Service Provider Name |
Name of the servicing provider. |
Yes |
Service Facility Code |
Code for the service facility/location provider. |
Yes |
Service Facility Name |
Name of the service facility/location provider. |
Yes |
Brand |
Brand code and description associated with the claim context. |
Yes |
Pend Reasons Code |
Pend reason code(s) associated with the claim. If multiple reasons are supported, this can be a multi-value field. |
No |
Pend Reason Description |
Pend reason description text. |
No |