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Analysis reporting tool user guide

As a self-funded employer group, you can use Analysis to gauge monthly and year-to-date changes in membership, claims payments and billed fees. This interactive tool lets you sort and compare data in three areas:
  • Membership
    Identify enrollment trends and review membership detail by product, gender distribution and age group.
  • Claims
    Use detailed reports to determine your highest cost diagnostic categories, most widely used health care providers (including doctors, hospitals, pharmacies, etc.) and highest cost prescription drugs based on claims information.
  • Billing
    Compare current fees to your prior plan year and identify all stop-loss and administrative fees.
More information about:

How to use Analysis

Analysis is a fully interactive tool. You can drill down to get more detailed reports and information, print reports or export them to Excel.

Watch the demonstration: 

 Using Analysis (4 min. 30 sec.) 

Refresh data

All data in Analysis is real-time, so you can get the latest numbers while you're in the tool.
  1. Click the Refresh Data icon located at the top right of the screen.
  2. A Prompts window will open. Choose the parameters you would like to run. You must choose something for each of the three fields:
    • Employer Group Id - Your group name. You should only see your group in the list.
    • Membership Month - Select a month and year.
    • Comp Membership Month - Select a month a year to compare with.
  3. Click Run Query.
  4. A window labeled Processing Data will appear while the data is being refreshed.

Drill

Drilling allows you to get more detailed reports about specific information.
  1. Click on a green link to drill.
  2. The screen will refresh to show the next level of information. You've started a "drill path."
  3. Keep clicking on links to get more specific information. The more you click, the more specific the information gets.

Print

  1. Click View.
  2. Choose PDF mode.
  3. The report will open in Adobe Reader. Click the printer icon to print the report.

Export to Excel

  1. Click Document.
  2. Choose Save to My Computer As, then Excel.
  3. Select Open or Save.
  4. Navigate, sort or filter the information as you normally would in Excel.

Analysis FAQs

Q: What reports do I see in Analysis, and which ones do I see in Filemart? Why can't I see them all in one place?
Analysis reports provide an "at-a-glance" view of membership, claims paid and billed fees. You can interact with these reports and drill down in them to find detailed information. Filemart reports are in PDF format, so you can't interact with them. You request them from your sales representative, and they are automatically delivered to you via Filemart on a certain day. Analysis and Filemart reports can't be combined.

 

Q: When I enter specific months to compare, does that mean I'll only see information from those months?
No. Analysis provides overall numbers for your entire plan year, to date. Entering specific months (such as January 2011 and January 2010) only populates the comparison graphs shown in the Membership tab.

Q: What are drill paths?
A drill path includes the clicks you take to move from general information to more specific information. Use this map (150KB PDF) to see the different drill paths you can take in the Analysis tool.

Q: What claims are included in the different drill paths?
The major practice category drill path includes medical claims (there are no diagnosis codes on pharmacy claims). The top provider drill path includes all medical and pharmacy claims. The in- or out-of-network includes medical claims only because all pharmacy, dental or vision claims are considered in-network and would make that information incorrect.

Q: There seems to be a lot of claims listed under "Unspecified." What does that mean?
Unspecified claims are pharmacy or medical claims that do not have enough related clinical information to identify them with one major practice category. Most of the claims listed under Unspecified will be from the most current month because they aren't yet attached to other claims that help diagnose the member. For example, if a claim for a chest x-tray comes in before the physician office visit claim does, the system has no way to know why the member received a chest x-ray and no diagnosis to give. The system will identify the claim as "unspecified" until a related claim comes in and a diagnosis can be found. 

Q: Where do major practice categories come from?
Each major practice category represents a particular physician specialty, such as urology or dermatology, or a body system, such as circulatory.

Q: How do you know which major practice category a claim or group of claims fits in?
We use an illness classification and episode building system called Episode Treatment Groups™ (ETG). ETG software separates claims or service information gathered during a patient's treatment, such as prescriptions or doctor visits, and separates it based on major practice category.

Q: I'm confused by some terms listed in the major practice category list. What do they mean?
Here is a list of layman’s terms used to describe major practice categories:

  • Cardiology – Dealing with the heart and veins
  • Chemical dependency - Includes alcoholism, drug/alcohol addiction, substance abuse, substance dependence, drug habit, etc.
  • Dermatology – Dealing with skin, the scalp, hair and nails
  • Endocrinology - Dealing with the endocrine glands/ tissues (pituitary, thyroid, adrenals, ovaries, testes and pancreas) and their secretions
  • Gastroenterology –Study of the digestive system, which includes the organs from mouth to anus
  • Gynecology – Dealing with the female reproductive system (uterus, vagina and ovaries)
  • Hematology – Study of blood, blood-forming organs and blood diseases
  • Hepatology – Dealing with the liver, gallbladder, bile ducts and pancreas
  • Infectious diseases – Diseases caused by pathogenic microbial agents, including viruses, bacteria, fungi, protozoa, multicellular parasites, and microscopic protein particles
  • Isolated signs & symptoms – Cannot be linked to a specific disease, condition or category
  • Late effects, environmental trauma and poisonings – Symptoms or conditions that occur as a result of environmental trauma or poisoning
  • Neonatology - Care of newborn infants, especially those who are ill or premature
  • Nephrology – Study of kidney function and diseases
  • Neurology – Dealing with the central, peripheral, and autonomic nervous systems
  • Obstetrics - Care of women and their children during and after pregnancy and childbirth
  • Ophthalmology – Study and care of the eye 
  • Orthopedics & rheumatology – Dealing with the musculoskeletal system and joints, soft tissues and connective tissues
  • Otolaryngology – Dealing with the ear, nose, throat, head and neck
  • Preventative and administrative – Preventive care not associated with a specific condition
  • Psychiatry – Dealing with mental and emotional  disorders
  • Pulmonology – Dealing with the lungs and respiratory tract
  • Urology – Study of the urinary tract

Q: Are ALL pharmacy claims listed?
No. Only the claims paid by Priority Health and processed through Argus, our internal pharmacy system, are included. As of November 2009, claims from Medco, Haworth Pharmacy and Express Scripts are excluded.

Q: How often is the information found in the Analysis tool updated?
Monthly. The system will check for new information on the 3rd, 4th, 5th and 6th of every month, and it will update if it finds new claims information available.

Last modified: 11/4/2013
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