Enr - Lab

Current Avg Dental Member Months

Average number of member months for the current rolling 12 month period for the Dental plan.

Enrollment Overview -Dashlet

Current Avg Dental Member Months - Norm

Average number of member months for the current rolling 12 month period for the Dental plan normative population.

Norm Enrollment Overview -Dashlet

Current Avg Medical Member Months

Average number of member months for the current rolling 12 month period for the medical plan.

Enrollment Overview -Dashlet

Current Avg Medical Member Months - Norm

Average number of member months for the current rolling 12 month period for the medical plan normative population.

Norm Enrollment Overview -Dashlet

Current Avg Pharmacy Member Months

Average number of member months for the current rolling 12 month period for the Pharmacy plan.

Enrollment Overview -Dashlet

Current Avg Pharmacy Member Months - Norm

Average number of member months for the current rolling 12 month period for the Pharmacy plan normative population.

Norm Enrollment Overview -Dashlet

Current Avg Vision Member Months

Average number of member months for the current rolling 12 month period for the Vision plan.

Enrollment Overview -Dashlet

Current Avg Vision Member Months - Norm

Average number of member months for the current rolling 12 month period for the Vision plan normative population.

Norm Enrollment Overview -Dashlet

Current In-Network $

Total

Network Utilization Summary - Action Report

Current Member Month Count

A count of months for which the coverage was in effect for the current reporting period.

Enrollment Detail -Action Report

Current Out-Network $

Total plan paid for out of network benefits.

Network Utilization Summary - Action Report

Current PMPM

Current reporting period plan paid per member per month.

Financial Summary -Action Report

Current Risk

The current condition risk of the population selected. This is an enrollment weighted average of each member's condition risk.

Financial Summary -Action Report

Current Year Grand Total Plan Paid

Total costs (Inpatient/Outpatient Facility, Professional, and Pharmacy) paid by the Plan in the current year.

CE Executive Report – Total Medical & Pharmacy Cost Page -Action Report

Current Year Grand Total Plan Paid

Total costs (Inpatient/Outpatient Facility and Professional) paid by the Plan in the current year.

CE Executive Report – Total Medical Cost Page - Action Report

Current Year Inpatient Facility - Admissions

Number of Admissions to Inpatient Facility for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Inpatient Facility – Admissions/1000 Members

Admissions per 1000 members to Inpatient Facility for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Inpatient Facility – Average Length of Stay

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Inpatient Facility – Average Paid Per Admission

Average paid per Inpatient Facility admission for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Inpatient Facility – Paid PMPM

Plan Paid Per Member Per Month for Inpatient Facility services for current year. Value includes Capitation and Completion factors.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Inpatient Facility – Readmission Percentage

% of patients that were re-admitted to Inpatient Facility less than 30 days between initial discharge and re-admission for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Inpatient Facility % of Total Plan Paid

% of Total Inpatient Facility costs paid by the Plan in the current year.

CE Executive Report – Total Medical Cost Page, Total Medical & Pharmacy Cost Page - Action Report

Current Year Inpatient Facility Total Plan Paid

Total Inpatient Facility costs paid by the Plan in the current year.

CE Executive Report – Total Medical & Pharmacy Cost Page, CE Executive Report – Total Medical Cost Page -Action Report

Current Year Inpatient Professional – Average Paid Per Service

Average Paid per service for Inpatient Professional Services for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Inpatient Professional – Paid PMPM

Plan Paid Per Member Per Month for Inpatient Professional services for current year. Value includes Capitation and Completion factors.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Inpatient Professional - Services

Number of Services that are for Inpatient Professional Services for previous year for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Inpatient Professional – Services/1000 Members

Number of Inpatient Professional Services per 1000 members for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Medical Member Cost Share - Coinsurance

Total Medical Coinsurance costs that Members are responsible for in the current year.

CE Executive Report – Total Medical & Pharmacy Cost Page, CE Executive Report – Total Medical Cost Page -Action Report

Current Year Medical Member Cost Share - Copay

Total Medical Copay costs that Members are responsible for in the current year.

CE Executive Report – Total Medical & Pharmacy Cost Page, CE Executive Report – Total Medical Cost Page -Action Report

Current Year Medical Member Cost Share –Deductible

Total Medical Deductible costs that Members are responsible for in the current year.

CE Executive Report – Total Medical Cost Page - Action Report

Current Year Outpatient Facility – Average Paid Per Service

Average Paid per service for Outpatient Facility services for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Outpatient Facility – ED Cost/Visit

Outpatient Facility Emergency Department Costs per visit for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Outpatient Facility – ED Visits

Number of visits for Outpatient Facility Emergency Department services for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Outpatient Facility – ED Visits/1000 Members

Visits per 1,000 members for Outpatient Emergency Department services for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Outpatient Facility – Paid PMPM

Plan Paid Per Member Per Month for Outpatient Facility Services for current year. Value includes Capitation and Completion factors.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Outpatient Facility – Services/1000 Members

Outpatient Facility Services per 1000 members for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Outpatient Facility % of  Total Plan Paid

% of Total Outpatient Facility costs paid by the Plan in the current year.

CE Executive Report – Total Medical Cost Page, Total Medical & Pharmacy Cost Page - Action Report

Current Year Outpatient Facility Total Plan Paid

Total Outpatient Facility costs paid by the Plan in the current year.

CE Executive Report – Total Medical & Pharmacy Cost Page, CE Executive Report – Total Medical Cost Page -Action Report

Current Year Outpatient Professional – Average Paid Per Service

Average Paid per service for Outpatient Professional Services for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Outpatient Professional – Paid PMPM

Plan Paid Per Member Per Month for Outpatient Professional services for current year. Value includes Capitation and Completion factors.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Outpatient Professional - Services

Number of Services that are for Outpatient Professional Services for previous year for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Outpatient Professional – Services/1000 Members

Number of Outpatient Professional Services per 1000 members for current year.

CE Executive Report – Total Medical Cost Key Metrics Page - Action Report

Current Year Pharmacy % of Total Plan Paid

% of Total Pharmacy costs paid by the Plan in the current year.

CE Executive Report – Total Medical & Pharmacy Cost Page -Action Report

Current Year Pharmacy Member Cost Share - Coinsurance

Total Pharmacy Coinsurance costs that Members are responsible for in the current year.

CE Executive Report – Total Medical & Pharmacy Cost Page -Action Report

Current Year Pharmacy Member Cost Share - Copay

Total Pharmacy Copay costs that Members are responsible for in the current year.

CE Executive Report – Total Medical & Pharmacy Cost Page -Action Report

Current Year Pharmacy Member Cost Share –Deductible

Total Pharmacy Deductible costs that Members are responsible for in the current year.

CE Executive Report – Total Medical & Pharmacy Cost Page -Action Report

Current Year Pharmacy Total Plan Paid

Total Pharmacy costs paid by the Plan in the current year.

CE Executive Report – Total Medical & Pharmacy Cost Page -Action Report

Current Year Professional % of Total Plan Paid

% of Total Professional costs paid by the Plan in the current year.

CE Executive Report – Total Medical Cost Page,Total Medical & Pharmacy Cost Page - Action Report

Current Year Professional Total Plan Paid

Total Professional costs paid by the Plan in the current year.

CE Executive Report – Total Medical & Pharmacy Cost Page -Action Report

Current Year Professional Total Plan Paid

Total Professional costs paid by the Plan in the current year.

CE Executive Report – Total Medical Cost Page - Action Report

Current Yr Dental PMPM

Dental Cost per member per month for the current rolling 12 month period for the normative Population. Completion Factors are applied.

Norm Comparison - Dashlet

Current Yr Dental PMPM

Dental Cost per member per month for the current rolling 12 month period for the plan. Capitation Payments are included and Completion Factors are applied.

Payment Overview - Dashlet

Current Yr Medical PPMPM

Medical cost per member per month for the current rolling 12 month period for the normative population. Completion factors are applied then capitation payments are included.

Norm Comparison - Dashlet

Current Yr Medical PPMPM

Medical cost per member per month for the current rolling 12 month period for the plan. Completion factors are applied then capitation payments are included.

Payment Overview - Dashlet

Current Yr Pharmacy PMPM

Pharmacy cost per member per month for the current rolling 12 month period for the normative population. Completion factors are applied.

Norm Comparison - Dashlet

Current Yr Vision PMPM

Vision Cost per member per month for the current rolling 12 month period for the normative Population. Completion Factors are applied.

Norm Comparison - Dashlet

Current Yr Vision PMPM

Vision Cost per member per month for the current rolling 12 month period for the plan. Capitation Payments are included and Completion Factors are applied.

Payment Overview - Dashlet

Fecha de servicio

The date the prescription was filled.

Pharmacy Detail -Action Report

Date of Surgery

The date a surgical procedure was performed (applicable to facility claims only).

Inpatient Admission -Action Report

Days Supply Count

Number of days for which the prescribed drug has been dispensed.

Pharmacy Detail -Action Report

Deducible

Total Deductible Amount for Dental claims in the current rolling 12 month period

Dental Payment Summary -Action Report

Deducible

Total Deductible Amount for Vision claims in the current rolling 12 month period.

Vision Payment Summary -Action Report

Deductible - Dental

Total Deductible Amount for Dental claims in the current rolling 12 month period.

Member Responsibility Overview -Dashlet

Deductible - Medical

Total Deductible Amount for Medical claims in the current rolling 12 month period.

Member Responsibility Overview -Dashlet

Deductible - Pharmacy

Total Deductible Amount for Pharmacy claims in the current rolling 12 month period.

Member Responsibility Overview -Dashlet

Deductible - Vision

Total Deductible Amount for Vision claims in the current rolling 12 month period.

Member Responsibility Overview -Dashlet

Demographic Risk Score (Puntaje de riesgo demográfico)

A member-level risk score calculated based upon the member's demographic age and gender.

Member Summary -Action Report

Dental Actual PMPM

Dental services cost per member per month for the plan population for the current rolling 12 month period.

Cost Overview -Dashlet

Dental Actual PMPM

Dental cost per member per month for the actual population for the current rolling 12 month period. Completion factors are applied and capitation payments are included.

Cost Overview -Dashlet

Dental Current

The total adjusted paid amount for dental services in the current rolling 12 month period. Completion factors are applied then capitation payments are included.

Payment Summary -Dashlet

Dental Norm PMPM

Dental services cost per member per month for the normative population for the current rolling 12 month period.

Cost Overview -Dashlet

Dental Norm PMPM

Dental cost per member per month for the normative population for the current rolling 12 month period. Completion factors are applied and capitation payments are included.

Cost Overview -Dashlet

Dental Previous

The total adjusted paid amount for dental services in the previous rolling 12 month period. Completion factors are applied then capitation payments are included.

Payment Summary -Dashlet

Dental Variance

The variance in the total adjusted paid amount for dental services from the current period versus the previous one. Completion factors are applied then capitation payments are included.

Payment Summary -Dashlet

Dependent Count

Number of dependents associated with the enrollment record.

Enrollment Summary -Action Report

Dependent Member Month

Sum of member months for dependents associated with the enrollment record.

Enrollment Summary -Action Report

Dependent Paid Amount

Plan payments made on behalf of dependents of subscribers.

Enrollment Summary -Action Report

Dependents Membership Count

Membership Count of all members who are dependents of employees.

Executive Report- Action Report

Diagnosis 2 Code

The secondary diagnosis code associated with the service.

Claim Detail - Action Report (Detalle de la reclamación - Informe de acción)

Diagnosis 2 Description

The description of the secondary diagnosis code associated with the service.

Claim Detail - Action Report (Detalle de la reclamación - Informe de acción)

Diagnosis 3 Code

The tertiary diagnosis code associated with the service.

Claim Detail - Action Report (Detalle de la reclamación - Informe de acción)

Diagnosis 3 Description

The description of the tertiary diagnosis code associated with the service.

Claim Detail - Action Report (Detalle de la reclamación - Informe de acción)

Discharge Date

The date a member left a facility.

Inpatient Admission -Action Report

Discharge Status

Status of the patient at time of discharge.

Inpatient Admission -Action Report

Discharge Status Code

Status of the patient at time of discharge.

Claim Detail, Claim Summary - Action Report (Detalle de la reclamación, Resumen de la reclamación - Informe de acción)

Discharge Status Description

Status of the patient at time of discharge.

Claim Detail, Claim Summary - Action Report (Detalle de la reclamación, Resumen de la reclamación - Informe de acción)

Discharged in Last 10 Days

Number of members discharged from an inpatient facility within the last 10 days (based on discharge date). Este número de actualiza todos los días.

Discharged in Last 10 Days -Population Measures

Dispensed Unit of Measure

Description of the units used to measure the dispensed amount of the prescribed medication.

Pharmacy Detail -Action Report

DRG Código

Diagnostic Related Group code - A grouping of like inpatient claims. Used by CMS to determine payment.

Claim Summary, Inpatient Admission - Action Report (Resumen de la reclamación, Hospitalización - Informe de acción)

DRG Descripción

A description of the Diagnostic Related Group.

Claim Summary, Inpatient Admission - Action Report (Resumen de la reclamación, Hospitalización - Informe de acción)

DRG Peso

A number indicative of the resources needed to treat the DRG.

Claim Summary - Action Report (Resumen de la reclamación - Informe de acción)

ED Actual PMPM

Emergency department services cost per member per month for the plan population for the current rolling 12 month period. Completion factors are applied and capitation payments are included.

Cost Overview -Dashlet

ED Actual PMPM

Emergency department Services cost per member per month for the plan for the current rolling 12 month period where the cost does not exceed a threshold. Capitation payments are included and completion factors are applied.

Cost Overview w/o Outliers -Dashlet

ED Actual PMPM

Emergency department services cost per member per month for the plan population for the current rolling 12 month period where the cost exceeds a threshold. Capitation payments are included and completion factors are applied.

Cost Overview w/o Outliers -Dashlet

ED Norm PMPM

Emergency department services cost per member per month for the normative population for the current rolling 12 month period. Capitation payments are included and completion factors are applied.

Cost Overview -Dashlet

ED Norm PMPM

Emergency department services cost per member per month for the normative population for the current rolling 12 month period where the cost does not exceed a threshold. Capitation payments are included and completion factors are applied.

Cost Overview w/o Outliers -Dashlet

ED Norm PMPM

Emergency department services cost per member per month for the normative population for the current rolling 12 month period where the cost exceeds a threshold. Capitation payments are included and completion factors are applied.

Cost Overview w/o Outliers -Dashlet

ED Visits/1000 Count

Utilization per 1,000 members for Emergency Department services for the plan population. Completion factors are applied.

Cost and Utilization Summary by Cost Bucket - Action Report

ED-All PMPM

Emergency Department services cost per member per month for the plan for the current rolling 12 month period. Completion factors are applied and capitation payments are included.

Cost and Utilization Summary by Cost Bucket - Action Report

ED-Outliers Only PMPM

Emergency Department services cost per member per month for the plan for the current rolling 12 month period. This measure includes only those members who have exceeded a client configured threshold. Completion factors are applied and capitation payments

Cost and Utilization Summary by Cost Bucket - Action Report

ED-w/o Outliers PMPM

Emergency Department services cost per member per month for the plan for the current rolling 12 month period. This measure excludes those members who have exceeded a client configured threshold. Completion factors are applied and capitation payments are i

Cost and Utilization Summary by Cost Bucket - Action Report

Eligibility End Date

The last day a member's eligibility for coverage is in force.

Enrollment Detail -Action Report

Eligibility Start Date

The day a member's eligibility for coverage enters into force.

Enrollment Detail -Action Report

Eligible Participant

Whether or not the member is eligible to participate in the disease or condition management program.

Program Detail - Action Report (Detalle del programa - Informe de acción)

Employee Membership Count

Membership Count of all members who are employees.

Executive Report- Action Report

Employer Group

A concatenation of Group Name and Group Number

Cost and Utilization Summary by Cost Bucket - Action Report

Employer Group

A concatenation of Group Name and Group Number

Financial Summary -Action Report

Employer Group ID

Carrier assigned number uniquely identifying an employer group.

Claim Detail - Action Report (Detalle de la reclamación - Informe de acción)

Employer Group ID

The Group Number assigned by the carrier.

Claim Summary, Enrollment Detail, Enrollment Summary, Inpatient Admission, Pharmacy Detail - Action Report

Employer Group Name

Description of Clinical Classification Software Level 3 code.

Claim Detail - Action Report (Detalle de la reclamación - Informe de acción)

Employer Group Name

The Group Name associated with the Group Number.

Claim Summary, Enrollment Detail, Enrollment Summary, Inpatient Admission, Pharmacy Detail - Action Report

Engaged End Date

The date the member agreed to end their participation in the medical care coordination program.

Program Detail - Action Report (Detalle del programa - Informe de acción)

Engaged Indicator (Indicador de participación)

Indica el estado actual del miembro en el programa de coordinación de atención médica.

Program Detail - Action Report (Detalle del programa - Informe de acción)

Engaged Member Count

Of those members enrolled in the program, the subset of individuals who have chosen to participated (i.e. Those that are engaged in the program).

Program Summary -Action Report

Engaged Member Percentage

The percentage of enrolled members who chose to engage with the program.

Program Summary -Action Report

Engaged Start Date (Fecha de inicio de participación)

La fecha en que el miembro aceptó participar en el programa de coordinación de atención médica.

Program Detail - Action Report (Detalle del programa - Informe de acción)