# - Cov

# of mail order prescriptions filled

Number of 30 day equivalent prescriptions filled by mail.

Prescribing Pattern - Action Reports

# of Prescriptions Filled (N.º de recetas surtidas)

Number of 30 day equivalent prescriptions filled.

Prescribing Pattern - Action Reports

# of retail prescriptions filled

Number of 30 day equivalent prescriptions filled in a retail setting.

Prescribing Pattern - Action Reports

% Dollars In-Network

The percent of total dollars paid to in network providers.

Network Utilization Summary - Action Report

% Dollars Out-Network

The percent of total dollars paid to out of network providers.

Network Utilization Summary - Action Report

% Employees

Percent of total members that are employees.

Executive Report- Action Report

% of Females

Percentage of active members who are female.

% of Females - Population Measures

% of Males

Percentage of active members who are male.

% of Males -Population Measures

% of Plan Population - Non-Outliers

Percentage of the plan's members, who are not cost outliers, with the condition in the current reporting period.

Condition Hierarchy Summary - Action Report

% of Plan Population - Outliers

Percentage of the plan's members, who are cost outliers, with the condition in the current reporting period.

Condition Hierarchy Summary - Action Report

% of Plan Population - Total for Plan

Percentage of the plan's members with the condition in the current reporting period.

Condition Hierarchy Summary - Action Report

% of Total Cost Bucket (% del total de costos)

The percentage of dollars that the detail line has associated with it.

Top 10 Performing Providers by Cost Bucket, Top 10 Performing Providers by Specialty - Action Report (Los diez principales proveedores de servicios por categoría de costos, Los diez principales proveedores de servicios por especialidad - Informe de acción)

% of Total Specialty Bucket (% del total de especialidades)

The percentage of Specialty dollars that the detail line has associated with it.

Top 10 Performing Providers by Specialty - Action Report (Los diez principales proveedores de servicios por especialidad - Informe de acciones)

1st Top Major Diagnostic Group

Top 5 Diagnoses by Volume within 1st Top Major Diagnostic Group

CE Executive Report – Top Major Diagnostic Groups by Volume Page - Action Report

1st Top Major Diagnostic Group

Top 5 Diagnoses by Cost within 1st Top Major Diagnostic Group

CE Executive Report – Top Major Diagnostic Groups by Cost Page - Action Report

2nd Top Major Diagnostic Group

Top 5 Diagnoses by Volume within 2nd Top Major Diagnostic Group

CE Executive Report – Top Major Diagnostic Groups by Volume Page - Action Report

2nd Top Major Diagnostic Group

Top 5 Diagnoses by Cost within 2nd Top Major Diagnostic Group

CE Executive Report – Top Major Diagnostic Groups by Cost Page - Action Report

30 Day Equivalent Count

A calculated measure that provides for a consistent per month comparison of pharmacy Utilization and costs.

Pharmacy Detail - Action Report (Detalle de farmacia - Informe de acción)

30 Day Readmission Flag (Indicador de nueva hospitalización en 30 días)

A flag indicating if the claim was for a readmission.

Inpatient Admission -Action Report

3rd Top Major Diagnostic Group

Top 5 Diagnoses by Volume within 3rd Top Major Diagnostic Group

CE Executive Report – Top Major Diagnostic Groups by Volume Page - Action Report

3rd Top Major Diagnostic Group

Top 5 Diagnoses by Cost within 3rd Top Major Diagnostic Group

CE Executive Report – Top Major Diagnostic Groups by Cost Page - Action Report 

4th Top Major Diagnostic Group

Top 5 Diagnoses by Volume within 4th Top Major Diagnostic Group

CE Executive Report – Top Major Diagnostic Groups by Volume Page - Action Report

4th Top Major Diagnostic Group

Top 5 Diagnoses by Cost within 4th Top Major Diagnostic Group

CE Executive Report – Top Major Diagnostic Groups by Cost Page - Action Report 

5th Top Major Diagnostic Group

Top 5 Diagnoses by Volume within 5th Top Major Diagnostic Group

CE Executive Report – Top Major Diagnostic Groups by Volume Page - Action Report

5th Top Major Diagnostic Group

Top 5 Diagnoses by Cost within 5th Top Major Diagnostic Group

CE Executive Report – Top Major Diagnostic Groups by Cost Page - Action Report 

Active Participant (Participante activo)

A flag, provided by the client, indicating that the member was an active participant in the program. The definition of active is determined by NCQA requirements.

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

Actual Dental /1000

Utilization per 1,000 members for dental services for the plan. Completion factors are applied.

Utilization Overview - Dashlet (Resumen de utilización - Dashlet)

Actual ED/1000 (Departamento de emergencias actual/1000)

Utilization per 1,000 members for emergency department services for the plan. Completion factors are applied.

Utilization Overview - Dashlet (Resumen de utilización - Dashlet)

Actual Hospital Service/1000

Utilization per 1,000 members for hospital services for the plan. Completion factors are applied.

Utilization Overview - Dashlet (Resumen de utilización - Dashlet)

Actual Lab/1000 (Laboratorio actual/1000)

Utilization per 1,000 members for laboratory services for the plan. Completion factors are applied.

Utilization Overview - Dashlet (Resumen de utilización - Dashlet)

Actual Pharmacy/1000 (Farmacia actual/1000)

Utilization per 1,000 members for pharmacy services for the plan. Completion factors are applied.

Utilization Overview - Dashlet (Resumen de utilización - Dashlet)

Actual PMPM- Norm

The PMPM for the normative population's claims categorized by provider Specialty and provider. Capitation payments are included and completion factors are applied.

Top 10 Performing Providers by Specialty - Action Report (Los diez principales proveedores de servicios por especialidad - Informe de acciones)

Actual PMPM Pharmacy

Pharmacy cost per member per month for the current rolling 12 month period for the plan. Completion factors are applied. This value is displayed in the Bar Chart that is part of the Action Report.

Payment Overview - Dashlet

Actual PMPM-Actual

The PMPM for the plan's population categorized by cost bucket and provider. Capitation payments are included and completion factors are applied.

Top 10 Performing Providers by Cost Bucket, Top 10 Performing Providers by Specialty - Action Report (Los diez principales proveedores de servicios por categoría de costos, Los diez principales proveedores de servicios por especialidad - Informe de acción)

Actual PMPM-Index

The ratio of the actual PMPM - actual amounts to the actual PMPM - Book of Business amounts for the given provider within the given cost bucket. Capitation payments are included and completion factors are applied.

Top 10 Performing Providers by Cost Bucket, Top 10 Performing Providers by Specialty - Action Report (Los diez principales proveedores de servicios por categoría de costos, Los diez principales proveedores de servicios por especialidad - Informe de acción)

Actual PMPM-Norm

The PMPM for the normative population's claims categorized by cost bucket and provider. Capitation payments are included and completion factors are applied.

Top 10 Performing Providers by Cost Bucket -Action Report

Actual Primary Care Visits/1000 (Visitas de atención primaria actuales/1000)

Utilization per 1,000 members for primary care services for the plan. Completion factors are applied.

Utilization Overview - Dashlet (Resumen de utilización - Dashlet)

Actual Radiology/1000 (Radiología actual/1000)

Utilization per 1,000 members for radiology services for the plan. Completion factors are applied.

Utilization Overview - Dashlet (Resumen de utilización - Dashlet)

Actual Specialty/1000 (Especialidad actual/1000)

Utilization per 1,000 members for specialty services for the plan. Completion factors are applied.

Utilization Overview - Dashlet (Resumen de utilización - Dashlet)

Actual Vision /1000

Utilization per 1,000 members for vision services for the plan. Completion factors are applied.

Utilization Overview - Dashlet (Resumen de utilización - Dashlet)

Acute Admits /1000 - Actual

Admissions per 1000 members to an acute care setting.

Inpatient Utilization -Dashlet

Acute Admits/1000 - Norm

Admissions per 1000 members to an acute care setting for the normative population.

Inpatient Utilization -Dashlet

Acute Flag (Indicador de cuidados agudos)

Flag indicating if the admission was for an acute condition.

Inpatient Admission -Action Report

Admission Status Code

Code describing the status of the admission.

Inpatient Admission -Action Report

Admission Status Description

Description of the Admission Source code.

Inpatient Admission -Action Report

Admission Type

Code describing the type of admission.

Inpatient Admission - Action Report (Admisión de paciente hospitalizado - Informe de acción)

Admission Type Description

Description of the Admission Type code.

Inpatient Admission - Action Report (Admisión de paciente hospitalizado - Informe de acción)

Admit Date

The date a member was admitted to a facility.

Inpatient Admission -Action Report

Admitting Diagnosis Code

The diagnosis code for which the member was admitted to the facility.

Claim Summary, Inpatient Admission - Action Report

Admitting Diagnosis Description

The description of the diagnosis code for which the member was admitted to the facility.

Claim Summary, Inpatient Admission - Action Report

Admitting Provider Name

Name of the provider who admitted a patient to a facility.

Inpatient Admission - Action Report (Admisión de paciente hospitalizado - Informe de acción)

Allowed $

The dollars a plan allows for the service(s). It represents the maximum a health plan will pay.

Network Utilization Summary - Action Report

Allowed Amount

The dollars a plan allows for the service(s). It represents the maximum a health plan will pay.

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

Allowed PMPM $

A per member per month representation of the plan's allowed dollars for services.

Network Utilization Summary - Action Report

Monto pagado 

Total Dental Costs paid by the Plan in the current rolling 12 months. Capitation Payments are included and Completion Factors are applied

Dental Payment Summary -Action Report

Monto pagado 

Total Vision Costs paid by the Plan in the current rolling 12 months. Capitation Payments are included and Completion Factors are applied.

Vision Payment Summary -Action Report

Attributed Health System ID

The carrier assigned id for the health system the attributed provider is part of.

Member Summary -Action Report

Attributed Health System Name

The name of the health system the attributed provider is part of.

Member Summary -Action Report

Attributed Provider - Practice ID

The unique identifier of the practice associated with the member's attributed provider.

Claim Summary - Action Report

Attributed Provider - Practice Name

The name of the practice of the provider who was selected by the member or appears to be managing the member's care, based on claims.

Claim Summary - Action Report

Attributed Provider ID (ID del proveedor atribuido)

El identificador único del proveedor que fue seleccionado por el miembro o que parece estar administrando la atención del miembro, según las reclamaciones.

Claim Detail, Claim Summary, Inpatient Admission, Pharmacy Detail, Member Summary, Program Detail - Action Report

Attributed Provider Name (Nombre del proveedor atribuido)

El nombre del proveedor que fue seleccionado por el miembro o que parece estar administrando la atención médica del miembro, según las reclamaciones.

Claim Detail, Claim Summary, Inpatient Admission, Member Opportunity Summary, Member Summary, Pharmacy Detail -Action Report

Attributed Provider Name

The unique identifier of the practice associated with the member's attributed provider.

Member Opportunity Detail -Action Report

Attributed Provider Practice ID

The unique identifier of the practice associated with the member's attributed provider.

Claim Detail, Inpatient Admission, Pharmacy Detail -Action Report

Attributed Provider Practice Name

The name of the practice of the provider who was selected by the member or appears to be managing the member's care, based on claims.

Claim Detail, Inpatient Admission, Pharmacy Detail, Member Opportunity Detail, Member Opportunity Summary -Action Report

Auth ID

Carrier supplied number used to track service authorizations.

Inpatient Admission -Action Report

Average Age

Average age of members as of the last day of the reporting period.

Average Age - Population Measures (Edad promedio - Medidas de población)

Average Membership

Average number of members.

Executive Report- Action Report

Average Wholesale Price Amount

The average price at which the prescribed drug is purchased at the wholesale level.

Pharmacy Detail - Action Report (Detalle de farmacia - Informe de acción)

Benchmark

Measuring the performance of a target population against the normative population.

Executive Report- Action Report

Billed

Total dollars charged on claims incurred during the appropriate month.

Expense and Cost Summary by Incurred Date,Expense and Cost Summary by Paid Date -Action Report

Billing Provider ID

Identification number assigned to the billing provider.

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

Billing Provider Name

Name of the provider who is billing for the service.

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

Brand Formulary Current Scripts

Volume of scripts for brand formulary drugs filled in the current rolling 12 month period. El total de recetas surtida se basa en un cálculo equivalente de 30 días.

Utilization by Drug Type -Dashlet

Brand Formulary Drug Current Plan Paid Amount

Plan payments for brand formulary drugs filled in the current rolling 12 month period.

Payment by Drug Type -Dashlet

Brand Formulary Drug Previous Plan Paid Amount

Plan payments for brand formulary drugs filled in the previous rolling 12 month period.

Payment by Drug Type -Dashlet

Brand Formulary Previous Scripts

Volume of scripts for brand formulary drugs filled in the previous rolling 12 month period. El total de recetas surtida se basa en un cálculo equivalente de 30 días.

Utilization by Drug Type -Dashlet

Brand Generic Description

Indicates if the generic version of the prescribed drug was dispensed.

Pharmacy Detail -Action Report

Brand Non-Formulary Current Scripts

Volume of scripts for brand non-formulary drugs filled in the current rolling 12 month period. El total de recetas surtida se basa en un cálculo equivalente de 30 días.

Utilization by Drug Type -Dashlet

Brand Non-Formulary Drug Current Plan Paid Amount

Plan payments for brand non-formulary drugs filled in the current rolling 12 month period.

Payment by Drug Type -Dashlet

Brand Non-Formulary Drug Previous Plan Paid Amount

Plan payments for brand non-formulary drugs filled in the previous rolling 12 month period.

Payment by Drug Type -Dashlet

Brand Non-Formulary Previous Scripts

Volume of scripts for brand non-formulary drugs filled in the previous rolling 12 month period. El total de recetas surtida se basa en un cálculo equivalente de 30 días.

Utilization by Drug Type -Dashlet

Cap Type Amount

The amount in dollars of the capitation payment made.

Capitation Summary -Action Report

Cap Type Code

A client defined code indicative of the type of capitation payment made.

Capitation Summary -Action Report

Cap Type Description

A client defined description of the Capitation Type Code. Some examples are: Total Lab and Total PCP

Capitation Summary -Action Report

Capitated Indicator

Indicates whether or not the services are paid for via a capitation arrangement.

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

Capitation Paid

Total Capitation amount paid during the appropriate month.

Expense and Cost Summary by Incurred Date, Expense and Cost Summary by Paid Date -Action Report

Capture Rate (Índice de captación)

Porcentaje de oportunidades de atención en las que el miembro recibió el(los) servicio(s) requerido(s).

Quality Opportunity Summary -Action Report

Care Manager (Coordinador de atención)

El nombre del coordinador de atención médica asignado para manejar la atención del miembro.

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

Case Close Reason Code (Código del motivo de cierre del caso)

Un código que indica el motivo por el que se interrumpió la participación en el programa de coordinación de atención médica.

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

Case Close Reason Description (Descripción del motivo de cierre del caso)

Una descripción que indica el motivo por el que se interrumpió la participación en el programa de coordinación de atención médica.

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

CCS Multi Level 1 Code

Clinical Classification Software - hierarchical code grouping like diagnoses.

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

CCS Multi Level 1 Description

Description of Clinical Classification Software Level 1 code.

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

CCS Multi Level 2 Code

Clinical Classification Software - hierarchical code grouping like diagnoses.

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

CCS Multi Level 2 Description

Description of Clinical Classification Software Level 2 code.

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

CCS Multi Level 3 Code

Clinical Classification Software - hierarchical code grouping like diagnoses.

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

CCS Multi Level 3 Description

Description of Clinical Classification Software Level 3 code.

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

CCS Multi Level 4 Code

Clinical Classification Software - hierarchical code grouping like diagnoses.

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

CCS Multi Level 4 Description

Description of Clinical Classification Software Level 4 code.

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

CCS Single Level Code

Clinical Classification Software - Single level code grouping like diagnoses.

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

CCS Single Level Description

Description of Clinical Classification Software Single Level Code.

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

Channel

Method by which the prescription was filled.

Pharmacy Detail -Action Report

Charged $

Total dollars charged on incurred claims.

Network Utilization Summary - Action Report

Charged Amount

Total dollars charged on the claim line.

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

Charged PMPM $

A per member per month representation of the charged dollars.

Network Utilization Summary - Action Report

Claim ID

Description of Clinical Classification Software Level 1 code.

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

Claim ID

Client assigned id which is used to further refine groupings of members.

Claim Summary - Action Report

Claim ID

Carrier assigned number uniquely identify a health care claim.

Pharmacy Detail -Action Report

Claim Line Number

Carrier assigned sequence number for each claim line associated with a claim.

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

Claim Sub-Type

A further classification of claim type.

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

Tipo de reclamación

A high level classification of medical claims. Typically Facility and Professional.

Claim Detail, Claim Summary, Network Utilization Summary -Action Report

Clase

Description of the Class ID as assigned by the client.

Cost and Utilization Summary by Cost Bucket - Action Report

Clase

Client assigned id which is used to further refine groupings of members.

Financial Summary -Action Report

Class Description

Client developed definition of Class ID, which is used to further refine groupings of members.

Capitation Summary -Action Report

Class Description

Description of the Class ID as assigned by the client.

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

Class ID

Client assigned id which is used to further refine groupings of members.

Capitation Summary, Claim Detail, Claim Summary, Enrollment Detail, Enrollment Summary -Action Report

Class ID

Client assigned id which is used to further refine groupings of members.

Expense and Cost Summary by Incurred Date, Expense and Cost Summary by Paid Date, Inpatient Admission, Pharmacy Detail -Action Report

Clinician

Servicing provider's name.

Top 10 Performing Providers by Cost Bucket, Top 10 Performing Providers by Specialty - Action Report (Los diez principales proveedores de servicios por categoría de costos, Los diez principales proveedores de servicios por especialidad - Informe de acción)

Coins/Copay

Total Coinsurance and Copay Amounts for Dental claims in the current rolling 12 month period

Dental Payment Summary, Vision Payment Summary -Action Report

Coinsurance - Dental

Total Coinsurance Amounts for Dental claims in the current rolling 12 month period.

Member Responsibility Overview -Dashlet

Coinsurance - Medical

Total Coinsurance Amounts for Medical claims in the current rolling 12 month period.

Member Responsibility Overview -Dashlet

Coinsurance - Pharmacy

Total Coinsurance Amounts for Pharmacy claims in the current rolling 12 month period.

Member Responsibility Overview -Dashlet

Coinsurance - Vision

Total Coinsurance Amounts for Vision claims in the current rolling 12 month period.

Member Responsibility Overview -Dashlet

Co-Morbidity Managed Indicator (Indicador de comorbilidad manejada)

Indica si el miembro participa en más de un programa de coordinación de la atención médica.

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

Condition Hierarchy

Description of Condition Hierarchy

Condition Hierarchy Summary - Action Report

Condition Hierarchy Amount

The total of the claim payments made for the condition hierarchy for which a member has incurred the highest costs.

Member Summary -Action Report

Condition Hierarchy Code

The code associated to the condition hierarchy (a high level classification of diagnoses) for which the claim line is assigned.

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

Condition Hierarchy Description

Description of the condition hierarchy (a high level classification of diagnoses) for which a member has incurred the highest costs.

Claim Detail. Member Summary, Network Utilization Summary -Action Report

Condition Risk Score (Puntaje de riesgo de afección)

A member-level risk score calculated based upon the member's clinical condition as represented in the claims history.

Member Summary -Action Report

Confinement Number

Theon generated number assigned to inpatient stays.

Inpatient Admission -Action Report

Contact Count

Count of the contracts for which the capitation payment was made.

Capitation Summary -Action Report

Contact Months

Total Subscriber Months for the appropriate month.

Expense and Cost Summary by Incurred Date,Expense and Cost Summary by Paid Date -Action Report

Contact Type

The code indicative of the types of persons covered under the subscriber's contract.

Enrollment Summary -Action Report

Contact Type

The description of the types of persons covered under the subscribers contract.

Member Summary, Program Detail -Action Report

Contact Type Code

The code indicative of the types of persons covered under the subscriber's contract.

Claim Summary - Action Report

Contact Type Code

The description of the types of persons covered under the subscribers contract.

Enrollment Detail -Action Report

Contact Type Current %

The percentage of members at each contract benefit coverage type enrolled in the last month in the reporting period.

Member Enrollment by Contract Type -Dashlet

Contact Type Current %

The percentage of subscribers at each contract benefit coverage type enrolled in the last month in the reporting period.

Subscriber Enrollment by Contract Type -Dashlet

Contact Type Current Count

The count of all members by contract type (For example: Employee, Family, Employee and Spouse, etc.) enrolled in the last month in the reporting period. Note: The contract type description can be payer specific. The values will be established during implementation.

Member Enrollment by Contract Type -Dashlet

Contact Type Current Count

The percentage of members (contract holder, spouse, and/or dependent) at each contract benefit coverage type enrolled in the month one year prior to the last month in the current rolling 12 month period.

Member Enrollment by Contract Type -Dashlet

Contact Type Current Count

The count of subscribers (contract holder) at each contract benefit coverage type enrolled in the last month in the reporting period.

Subscriber Enrollment by Contract Type -Dashlet

Contact Type Description

Client provided description of the type of contract for which the payment was made. Some examples are: Single, Employee and Spouse and Family.

Capitation Summary -Action Report

Contact Type Description

The description of the types of persons covered under the subscribers contract.

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

Contact Type Previous %

The percentage of subscribers (contract holder) at each contract benefit coverage type enrolled in the month one year prior to the last month in the reporting period.

Subscriber Enrollment by Contract Type -Dashlet

Contact Type Previous Count

The total count of members (contract holder, spouse, and/or dependent) across all contract benefit coverage type and enrolled in the month one year prior to the last month in the current rolling 12 month period.

Member Enrollment by Contract Type -Dashlet

Contact Type Previous Count

The count of subscribers (contract holder) at each contract benefit coverage type enrolled in the month one year prior to the last month in the reporting period.

Subscriber Enrollment by Contract Type -Dashlet

Contact Type Total Current Count

The total count of all members (contract holder, spouse, and/or dependent) across all contract benefit coverage type and enrolled in the last month in the reporting period.

Member Enrollment by Contract Type -Dashlet

Contact Type Total Previous Count

The count of all members (contract holder, spouse, and/or dependent) at each contract benefit coverage type enrolled in the month one year prior to the last month in the current rolling 12 month period.

Member Enrollment by Contract Type -Dashlet

Contact Type Total Previous Count

The total count of subscribers (contract holder, spouse, and/or dependent) across all contract benefit coverage type and enrolled in the month one year prior to the last month in the current rolling 12 month period.

Subscriber Enrollment by Contract Type -Dashlet

Copay - Dental

Total Copay Amounts for Dental claims in the current rolling 12 month period.

Member Responsibility Overview -Dashlet

Copay - Medical

Total Copay Amounts for Medical claims in the current rolling 12 month period.

Member Responsibility Overview -Dashlet

Copay - Pharmacy

Total Copay Amounts for Pharmacy claims in the current rolling 12 month period.

Member Responsibility Overview -Dashlet

Copay - Vision

Total Copay Amounts for Vision claims in the current rolling 12 month period.

Member Responsibility Overview -Dashlet

Cost Bucket

Theon defined cost bucket to which the service is assigned.

Claim Detail, Top 10 Performing Providers by Cost Bucket - Action Report (Detalle de la reclamación, Los diez principales proveedores de servicios por categoría de costos - Informe de acción)

Cost Bucket Utilization

Theon defined cost bucket to which the service is assigned.

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

Coverage Status (Estado de la cobertura)

The coverage status as of the last day of the previous month.

Enrollment Detail, Member Opportunity Detail,Member Opportunity Summary -Action Report

Coverage Status (Estado de cobertura)

Indica si la cobertura médica del miembro actualmente está en vigencia o suspendida.

Member Summary, Program Detail -Action Report

Coverage Type Code

Indicates the type of coverage the record refers to.

Enrollment Detail- Action Report

Coverage Type Description

Describes the type of insurance product the record is for.

Enrollment Detail -Action Report