ClaimBook MIS Report 2- Operations (Ops) Performance MIS Report
2Operations (Ops) Performance MIS Report Operation Performance Report is categorized into Insurance Desk & Claim Desk.
- Insurance Desk category has Workload Report, TAT Report, Quality Report & Query Analysis Report.
- Claim Desk category has Workload Report & TAT Report.
Insurance Desk Operations Performance MIS Report:
- Work Load Report: This report shows the Insurance Desk user workload for Submissions, Query Responses, Rejection & Cancellation Workload for the selected month.
- Submissions Work Load Report shows the number of Initial (New Preauth) Submissions, Enhancement and Discharge submissions per day in horizontal axis for the selected month. Total count of Submissions will be provided at the bottom of the chart.
- Submissions Work Load Report shows the number of Initial (New Preauth) Submissions, Enhancement and Discharge submissions per day in horizontal axis for the selected month. Total count of Submissions will be provided at the bottom of the chart.
- Query Response Work Load Report shows the No. of Queries responded (Initial and Enhancement /Discharge and Revision) for each day of the selected month with total count of responded Queries showing at the bottom of the chart.
- Rejection Work Load Report shows the No. of Rejections (Initial and Enhancement/Discharge and Revision) for each day of the selected month with total count of Rejections showing at the bottom of the chart.
- Cancellations Work Load Report shows the No. of Cancellations (Initial, Enhancement/ Discharge) for the each day of the selected month with total count of Cancellations showing at the bottom of the chart.
- TAT Report shows the Initial, Enhancement & Discharge & Revision Query response TAT report, which is the time taken the by user to respond to the Query once the Query was received. The report has time intervals in hours in the horizontal axis. Total number of Queries responded in Count along the vertical axis.
- Quality Report shows the First Response for Initial (New Preauth), Enhance & Discharge submissions with percentage of Approval (First Time Right), Query & Rejection. The Quality Report also shows the Best in Class for the Approval for all three submission types and Average Approval percentage for the three submissions.
- Query Analysis Report shows the Queries in percentage grouped into defined categories.
- There are three types of Query Analysis Reports - Initial, Enhancement & Discharge/Revision request types.
Below mentioned are the Query categories
The different categories are:
- Demographics related
- Policy related
- Tariff related
- Diagnosis and investigations related
- Treatment and past history related
- Legal information related
- Final bill and discharge summary related
- Incorrect and Incomplete queries
- Othe
Claim Desk Operations Performance MIS Report:
- Work Load Report: This report shows the Claim Desk user workload for Forward to Claims, Claim Submission, Claim Query Response & Reconciliation Workload for the selected month.
- Forward to Claims (FTC) & Claim Submission work load report shows the number of FTC & Claim Submissions done per day in horizontal axis for the selected month with total count of FTC & Claim Submissions showing at the bottom of the chart.
- Forward to Claims (FTC) & Claim Submission work load report shows the number of FTC & Claim Submissions done per day in horizontal axis for the selected month with total count of FTC & Claim Submissions showing at the bottom of the chart.
- Claim Query Response work load report shows the number of Claim Queries responded per day in horizontal axis for the selected month with total count Query Response showing at the bottom of the chart.
- Billing Workload report shows number of cases Reconciled & Disputed per day in horizontal axis for the selected month with total count of Reconciled & Disputed showing at the bottom of the chart.
- Claim Desk TAT Report shows the TAT for Claim Submission, Claim Query Response & Reconciliation. The report has time intervals in days in the horizontal axis. Total number of cases in Count along the vertical axis.
- Claim Submission TAT report shows the time taken for Claim Submission after Forward to Claims was done with case count.
- Claim Query Response TAT report shows the time taken for hospital user to respond to the Claim Query after the Claim Query was Raised.
- Claim Submission TAT report shows the time taken for Claim Submission after Forward to Claims was done with case count.
- Claim Reconciliation TAT Report shows the number of cases Reconciled for the selected month. The report has time intervals in days in the horizontal axis. Total number of cases in Reconciled along the vertical axis.
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