Skip to main content

Military Health System

Utility Navigation Links

TRICARE Systems Manual 7950.3-M, April 1, 2015
TRICARE Duplicate Claims System (DCS) - TRICARE Encounter Data (TED) Version
Chapter 4
Addendum B
Report Descriptions And Examples
Revision:  C-14, May 30, 2018
Report Category:
Set Report
Report Menu Hierarchy And Format Name:
REPORT => SET REPORTS => BASIC
Printed Report Title:
Duplicate Claim System Sets Grouped by Set Number
Report Description:
This report provides set-level information regarding all of the sets loaded in the Duplicate Claim System. The fields displayed on the report are: Institutional/Non-Institutional Indicator; Set Number; Status; Set Match Type; Multi-Contractor Set? (Y/N); Owner FI; Region; Initial Load Date; Current Load Date; Last Update Date; Adjustments? (Y/N); Total Amount Identified For Recoupment; Total Amount Actually Recouped; Total TED Adjustment Amount; and Set Level User Defined Code.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Set Level User Defined Codes.
Report Notes:
The data used by this report format is set level data.
Description of Duplicate Claims Systerm Sets, Grouped by Set Number Report - This report provides set-level information regarding all of the sets loaded in the Duplicate Claim System.
Report Category:
Set Report
Report Menu Hierarchy And Format Name:
REPORT => SET REPORTS => BASIC BY USER CODE
Printed Report Title:
Duplicate Claim System Sets Grouped by User Code
Report Description:
This report provides set-level information regarding all of the sets loaded in the Duplicate Claim System grouped by Set Level User Defined Codes. The fields displayed on the report are: Institutional/Non-Institutional Indicator; Set Number; Status; Set Match Type; Multi-Contractor Set? (Y/N); Owner FI; Region; Initial Load Date; Current Load Date; Last Update Date; Adjustments? (Y/N); Total Amount Identified For Recoupment; Total Amount Actually Recouped; Total TED Adjustment Amount; and Set Level User Defined Code.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Set Level User Defined Codes.
Report Notes:
The data used by this report format is set level data.
Description of Duplicate Claim System Sets, Grouped by User Code Report (page 1 of 2) - This report provides set-level information regarding all of the sets loaded in the Duplicate Claim System grouped by Set Level User Defined Codes.
Description of Duplicate Claim System Sets, Grouped by User Code Report (page 2 of 2) - This report provides set-level information regarding all of the sets loaded in the Duplicate Claim System grouped by Set Level User Defined Codes.
Report Category:
Set Report
Report Menu Hierarchy And Format Name:
REPORT => SET REPORTS => USER LOG REPORT
Printed Report Title:
User Log Grouped By Set Number (Transaction History)
Report Description:
This report identifies the users who made changes to a set and the dates on which the changes occurred. The fields displayed on the report are: Set Number; Status; Owner FI; Region; Initial Load Date; Current Load Date; Transaction Date; User ID; Total Amount Identified For Recoupment; Total Amount Actually Recouped; and Total TED Adjustment Amount. The report will identify all of the sets meeting the criteria selected on the report parameter screen and list all of the changes made to those sets along with the associated User Ids. The system detects changes to: the status of a set; the Owner FI; the Region; and the three total dollar amount fields. Whenever a change to one or more of these fields occurs, a “log” record is created and will appear on this report along with the User ID associated with the change(s). The report will not show log entries generated as a result of: sets to which claims have been added during the monthly load process; or sets that have been archived out of the active database to history. Users may see entries with an “System” or “CLAIMADD” as the User ID. These two User IDs are used by the DCS for set management purposes. These User Ids may appear when the system makes a change to a set. The report groups the data by Set Number in ascending order.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus User IDs.
Report Notes:
The data used by this report format is set level data.
Description of User Log Grouped by Set Number (Transaction History) Report This report identifies the users who made changes to a set and the dates on which the changes occurred.
4
Report Category:
Set Report
Report Menu Hierarchy And Format Name:
REPORT => SET REPORTS => EXPLANATION REPORT => NOTEPAD
Printed Report Title:
Explanations Notepad
Report Description:
This report provides a listing of the notepad entries made on selected sets. The fields displayed on this report are: Set Number; Status; Match Type; Owner FI; Region; Initial Load Date; Current Load Date; and Notepad Entries.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region).
Report Notes:
The data used by this report format is set level data.
Description of Explanations Notepad Report - This report provides a listing of the notepad entries made on selected sets.
Report Category:
Set Report
Report Menu Hierarchy And Format Name:
REPORT => SET REPORTS => EXPLANATION REPORT => VALIDATE
Printed Report Title:
Validate Status Explanations
Report Description:
This report provides a listing of the explanations entered when sets are resolved to a Validate status. The Duplicate Claims System requires that an explanation be entered when a set is resolved to a Validate status. One of the required Validate explanations describes why the amount actually recouped and the paid amount of the TED adjustments submitted do not equal the amount identified for recoupment. The other required Validate explanation describes why all of the identified line-items of a non-institutional actual duplicate claim have not been adjusted. The fields displayed on this report are: Set Number; Status; Match Type; Owner FI; Region; Initial Load Date; Current Load Date; and Validate Explanations.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Claim Set Status (Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region).
Report Notes:
The data used by this report format is set level data.
Description of Validate Status Explanations Report - This report provides a listing of the explanations entered when sets are resolved to a Validate status.
Report Category:
Set Report
Report Menu Hierarchy And Format Name:
REPORT => SET REPORTS => EXPLANATION REPORT => MODIFY
Printed Report Title:
Modify FI Explanations
Report Description:
This report provides a listing of the explanations entered when the Owner FI is changed on multi-contractor sets. The Duplicate Claims System requires that an explanation be entered when ownership of a multi-contractor set is changed from one contractor to another. The explanation entered should indicate who changed set ownership, who the change was discussed with at the receiving contractor, the date the discussions and the change took place, and why ownership was changed. The fields displayed on the report are: Set Number; Status; Match Type; Owner FI; Region; Initial Load Date; Current Load Date; and the Modify FI Explanations.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Owner Type (Claim Set Status; Adjustments, Claim Type, Match Type, Date Type, Set Range, FI, Region).
Report Notes:
The data used by this report format is set level data.
Description of Modify FI Explanations Report - This report provides a listing of the explanations entered when the Owner FI is changed on multi-contractor sets.
  
Report Category:
Set Report
Report Menu Hierarchy And Format Name:
REPORT => SET REPORTS => REGION UNASSIGNED
Printed Report Title:
Multi-Contractor Sets
Region Missing
Report Description:
This report provides a listing of the multi-contractor sets in the Duplicate Claims System for which a region has not been assigned. All sets are assigned a region when they are loaded into the system and when mass changes occur. When ownership of a multi-contractor set is changed from one contractor to another, the receiving contractor must assign the applicable region to the set. If the receiving contractor does not assign a region, the set cannot be associated with a particular contract. This report will provide receiving contractors with a listing of the sets which have not had regions assigned. The fields displayed on the report are: Set Number; Status; Initial Load Date; Current Load Date; and Owner FI.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Owner Type and Set Range (Claim Set Status; Adjustments, Claim Type, Match Type, Date Type, FI, Region).
Report Notes:
The data used by this report format is set level data.
Description of Multi Contractor Sets, Regeion Missing Report - This report provides a listing of the multi-contractor sets in the Duplicate Claims System for which a region has not been assigned.
Report Category:
Set Report
Report Menu Hierarchy And Format Name:
REPORT => SET REPORTS => SET COUNTS BY REGION
Printed Report Title:
Set Counts By Region
Report Description:
This report provides the numbers of sets of each match type by contract region. The report shows the number of sets of each match type, the percentage each match type represents of the total number of sets for the region, the number of sets for each match type which have associated adjustments, and the percentage of each match type which have been adjusted. This report will show the distribution of sets for a region across match types. It will also show the user how many sets in a given match type category have associated adjustments and the percentage of that match type category which have adjustments. This report can serve as a tool for contractors to help diagnose causes for duplicate payments and to help determine workload and needed resources.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Match Type and Set Range (Claim Set Status; Adjustments, Claim Type, Date Type, FI, Region) plus Set Level User Defined Codes.
Report Notes:
The data used by this report format is set level data.
Description of Set Counts By Region Report (page 1 of 2)  - This report provides the numbers of sets of each match type by contract region.
Description of Set Counts By Region Report (page 2 of 2)  - This report provides the numbers of sets of each match type by contract region.
Report Category:
Set Report
Report Menu Hierarchy And Format Name:
REPORT => SET REPORTS => SET LEVEL USER CODES
Printed Report Title:
Set Level User Defined Field Definitions
Report Description:
This report displays the Owner FI, the Set Level User Defined Codes, their definitions, and whether they are active or inactive.
Report Parameter Options:
Users may not customize this report.
Report Notes:
The data used by this report format is set level data.
Description of Set Level User Defined Field Definitions Report - This report displays the Owner FI, the Set Level User Defined Codes, their definitions, and whether they are active or inactive.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => BASIC
Printed Report Title:
Basic Duplicate Claim Report
Institutional and Non-Institutional
Claim and Line Item Level Data
Report Description:
This report lists all of the claims loaded in the system grouped by claim number. The report will show institutional and non-institutional claims. This report format will allow the user to select by Duplicate Flag values. The fields displayed on the report are: Owner FI; ICN; Claim Level User Defined Code; Solicited Indicator; Set Number; Duplicate Flag Value; Reason Code; Processed-To-Completion Date; Responsible FI Number; Sponsor ID; Patient ID; Patient Name; Amount Billed; Amount Paid; Amount Identified For Recoupment; Amount Actually Recouped. For Non-Institutional claims, line item data will also be displayed. The line item fields displayed include: Line Item Number; Line Item Match Type; Procedure Code; Provider Tax ID; Provider Sub-ID; Place of Service; Type of Service; Care Begin Date; Care End Date; Line Item Amount Billed for the Procedure; and Amount Paid for the Procedure. The report identifies and prints all of the claims occurring in sets meeting the criteria selected on the report parameter screen.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Dupe Flag Indicator; Solicited Indicator; Exclude Base; PTC Date; Set Level User Defined Codes; Claim Level User Defined Codes; Responsible FI; Region; and Enrollment Codes.
Report Notes:
The data used by this report format is claim level and line item level data. If a non-institutional claim exists in more than one set, it will print for each set in which it exists. Each instance of these non-institutional claims existing in multiple sets will contain a different set number on the report.
Description of Basic Duplicate Claim Report (Institutional and Non-Institutional Claim & Line Item Level Data) - This report lists all of the claims loaded in the system grouped by claim number. The report will show institutional and non-institutional claims. This report format will allow the user to select by Duplicate Flag values.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => BASIC BY SET
Printed Report Title:
Basic Duplicate Claim Report By Set
Institutional and Non-Institutional
Claim and Line Item Level Data
Report Description:
This report lists all of the claims loaded in the system grouped by set number. The report will show institutional and non-institutional claims. This report format will allow the user to select by Duplicate Flag values. The fields displayed on the report are: Owner FI; ICN; Claim Level User Defined Code; Solicited Indicator; Set Number; Duplicate Flag Value; Reason Code; Processed-To-Completion Date; Responsible FI Number; Sponsor ID; Patient ID; Patient Name; Amount Billed; Amount Paid; Amount Identified For Recoupment; Amount Actually Recouped. For Non-Institutional claims, line item data will also be displayed. The line item fields displayed include: Line Item Number; Line Item Match Type; Procedure Code; Provider Tax ID; Provider Sub-ID; Place of Service; Type of Service; Care Begin Date; Care End Date; Line Item Amount Billed for the Procedure; and Amount Paid for the Procedure. The report identifies and prints all of the claims occurring in sets meeting the criteria selected on the report parameter screen.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Dupe Flag Indicator; Solicited Indicator; Exclude Base; PTC Date; Set Level User Defined Codes; Claim Level User Defined Codes; Responsible FI; and Region.
Report Notes:
The data used by this report format is claim level and line item level data. If a non-institutional claim exists in more than one set, it will print for each set in which it exists. Each instance of these non-institutional claims existing in multiple sets will contain a different set number on the report.
Description of Basic Duplicate Claim Report By Set (Institional and Non-Institutional Claim & Line Item Level Data) - This report lists all of the claims loaded in the system grouped by set number.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => INSTITUTIONAL
Printed Report Title:
Institutional Claims
Report Description:
This report lists institutional claims grouped by current set status. This report lists institutional claims within their respective sets. The fields displayed on the report are: Owner FI; Institutional Indicator; Status Code; Set Number; ICN; Claim Level User Defined Code; Solicited Indicator; Dupe Flag Indicator; Processed to Completion Date; Responsible FI Number; Sponsor ID; Patient ID; Patient Name; Date of Birth; Provider Nbr; Provider Sub-ID; Amount Billed; Amount Allowed; and Government Paid Amount. The report identifies and prints all of the sets meeting the criteria selected on the report parameter screen. The report groups the claims in ascending set number order.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Claim Type (Claim Set Status, Adjustments, Set Owner Type, Match Type, Date Type, Set Range, FI, Region) plus Dupe Flag Indicator; Solicited Indicator; Exclude Base; PTC Date; Care Dates; Set Level User Defined Codes; Claim Level User Defined Codes; Responsible FI; Region; and Enrollment Codes.
Report Notes:
The data used by this report format is claim level data. The billed and net Government paid amounts are claim level dollar amounts.
Description of Institutional claims  Report (page 1 of 3) - This report lists institutional claims grouped by current set status. This report lists institutional claims within their respective sets.
Description of Institutional claims  Report (page 2 of 3) - This report lists institutional claims grouped by current set status. This report lists institutional claims within their respective sets.
Description of Institutional claims  Report (page 3 of 3) - This report lists institutional claims grouped by current set status. This report lists institutional claims within their respective sets.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => NON-INSTITUTIONAL => BY CLAIM
Printed Report Title:
Non-Institutional Claims
Report Description:
This report lists non-institutional claims grouped by current set status. This report lists non- institutional claims within their respective sets. The fields displayed on the report are: Owner FI; Region; Set Status Code; ICN; Claim Level User Defined Code; Solicited Indicator; Set Number; Dupe Flag Indicator; Processed to Completion Date; Responsible FI; Sponsor ID; Patient ID; Patient Name; Date of Birth; Amount Billed; Amount Allowed; and Government Paid Amount. The report identifies and prints all of the sets meeting the criteria selected on the report parameter screen. The report groups the claims in ascending set number order.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Claim Type (Claim Set Status, Adjustments, Set Owner Type, Match Type, Date Type, Set Range, FI, Region) plus Dupe Flag Indicator, Solicited Indicator, Exclude Base, Processed To Completion date, Care dates, Set Level User Defined Codes, Claim Level User Defined Codes, Responsible FI, Region, and Enrollment Codes.
Report Notes:
The data used by this report format is claim level data. The billed, paid and net Government paid amounts are claim level not line-item level dollar amounts.
Description of Non-Institutional Claims Report (page 1 of 3) - This report lists non-institutional claims grouped by current set status. This report lists non- institutional claims within their respective sets.
Description of Non-Institutional Claims Report (page 2 of 3) - This report lists non-institutional claims grouped by current set status. This report lists non- institutional claims within their respective sets.
Description of Non-Institutional Claims Report (page 3 of 3) - This report lists non-institutional claims grouped by current set status. This report lists non- institutional claims within their respective sets.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => NON-INSTITUTIONAL => BY LINE ITEM
Printed Report Title:
Non-Institutional Claims By Line Item
Report Description:
This report lists non-institutional claims grouped by current set status. This report displays line-item data. The fields displayed on the report are: Owner FI; Region; Set Status Code; ICN; Claim Level User Defined Code; Solicited Indicator; Set Number; Responsible FI; Sponsor ID; Patient ID; Patient Name; Provider Number; Provider Sub-ID; Line Item Number; CPT-4 Code; Care Begin Date; Care End Date; and Amount Paid CPT-4 Code. The report identifies and prints all of the sets meeting the criteria selected on the report parameter screen. The report groups the claims in ascending set number order.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Claim Type (Claim Set Status, Adjustments, Set Owner Type, Match Type, Date Type, Set Range, FI, Region) plus Dupe Flag Indicator, Solicited Indicator, Exclude Base, PTC Date; Care Dates; Set Level User Defined Codes; Claim Level User Defined Codes; Responsible FI; Region; and Enrollment Codes.
Report Notes:
The data used by this report format is line item level data. The paid amounts are line item level dollar amounts.
Description of Non-Institutional Claims By Line Items (1 of 2) - This report lists non-institutional claims grouped by current set status. This report displays line-item data.
Description of Non-Institutional Claims By Line Items (2 of 2) - This report lists non-institutional claims grouped by current set status. This report displays line-item data.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => RISK => RISK BASIC
Printed Report Title:
Risk Report By ICN
Report Description:
This report provides a listing of claims based on the Risk Indicator values selected by the user. The Risk Indicator identifies the claim as either financially underwritten or non-financially underwritten. The claims are grouped by claim number. The report can show both institutional and non- institutional claims. The fields displayed on the report are: Owner FI; Region; ICN; Claim Level User Defined Code; Solicited Indicator; Set Number; Duplicate Flag Value; Risk Indicator; Responsible FI; Sponsor ID; Patient ID; Patient Name; Provider Number; Provider Sub-ID; Amount Billed; Amount Paid; Government Paid Amount; Amount Identified For Recoupment; Amount Actually Recouped; Adjustment Amount.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Dupe Flag Indicator, Solicited Indicator, Exclude Base, PTC Dates, Care Dates, Set Level User Defined Codes, Claim Level User Defined Codes, Responsible FI, Region, Risk Indicator, and Enrollment Codes.
Report Notes:
The data used by this report format is claim level data. For non-institutional claims, the billed, paid and net Government paid amounts are claim level not line-item level dollar amounts.
Description of Risk Report by ICN (page 1 of 2) - This report provides a listing of claims based on the Risk Indicator values selected by the user. The identifies the claim as either financially underwritten or non-financially underwritten. The claims are grouped by claim number. The report can show both institutional and non- institutional claims.
Description of Risk Report by ICN (page 2 of 2) - This report provides a listing of claims based on the Risk Indicator values selected by the user. The identifies the claim as either financially underwritten or non-financially underwritten. The claims are grouped by claim number. The report can show both institutional and non- institutional claims.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => RISK => RISK BY SET
Printed Report Title:
Risk Report By Set Number
Report Description:
This report provides a listing of claims based on the Risk Indicator values selected by the user. The Risk Indicator identifies the claim as either financially underwritten or non-financially underwritten. The claims are grouped by set number. The report can show both institutional and non-institutional claims. The fields displayed on the report are: Owner FI; Region; Set Number; ICN; Claim Level User Defined Code; Solicited Indicator; Duplicate Flag Value; Risk Indicator; Responsible FI; Sponsor ID; Patient ID; Patient Name; Provider Number; Provider Sub-ID; Amount Billed; Amount Allowed; Government Paid Amount; Amount Identified For Recoupment; Amount Actually Recouped; Adjustment Amount.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Dupe Flag Indicator, Solicited Indicator, Exclude Base, PTC Dates, Care Dates, Set Level User Defined Codes, Claim Level User Defined Codes, Responsible FI, Region, Risk Indicator, and Enrollment Codes.
Report Notes:
The data used by this report format is claim level data. For non-institutional claims, the billed, paid and net Government paid amounts are claim level not line-item level dollar amounts.
Description of Risk Report by Set Number (page 1 of 2) - This report provides a listing of claims based on the Risk Indicator values selected by the user. The Risk Indicator identifies the claim as either financially underwritten or non-financially underwritten. The claims are grouped by set number.
Description of Risk Report by Set Number (page 2 of 2) - This report provides a listing of claims based on the Risk Indicator values selected by the user. The Risk Indicator identifies the claim as either financially underwritten or non-financially underwritten. The claims are grouped by set number.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => RISK => RISK SUMMARY
Printed Report Title:
Risk Summary Report
Report Description:
This report summarizes by Region the amounts billed, paid and Government paid amounts, as well as the amounts identified for recoupment, amounts actually recouped, and adjustment amounts. The fields displayed on the report are: Owner FI; Region; Amount Billed; Amount Allowed; Government Paid Amount; Amount Identified for Recoupment; Amount Actually Recouped; and Adjustment Amount.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Dupe Flag Indicator, Solicited Indicator, Exclude Base, PTC Dates, Care Dates, Set Level User Defined Codes, Claim Level User Defined Codes, Responsible FI, Region, Risk Indicator, and Enrollment Code.
Report Notes:
The data used by this report format is claim level data. For non-institutional claims, the billed, paid and net Government paid amounts are claim level not line-item level dollar amounts.
Description of Risk Summary Report - This report summarizes by Region the amounts billed, paid and Government paid amounts, as well as the amounts identified for recoupment, amounts actually recouped, and adjustment amounts.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => PROVIDER => CLAIM COUNTS
Printed Report Title:
Provider Claim Count Report
Grouped By Provider Number and Sub-ID
Report Description:
This report provides a total count by Provider Tax ID and Provider Sub-ID of all claims associated with selected providers. The fields displayed are: Provider Tax ID; Provider Sub-ID; and Total Number of Claims.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Last (update) Date, Set Range (Claim Set Status; Adjustments, Set Owner Type; Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Dupe Flag Indicator, PTC Dates, Responsible FI, Region, Provider Tax IDs, and Enrollment Code.
Report Notes:
The data used by this report format is claim level data.
Description of Provider Claim Count Report (Grouped by Provider Number and Sub ID) - This report provides a total count by Provider Tax ID and Provider Sub-ID of all claims associated with selected providers.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => PROVIDER => CLAIM DETAIL
Printed Report Title:
Provider Claim Detail Report
Grouped By Provider Number And Sub ID
Report Description:
This report provides a listing of claims grouped by Provider Tax ID and Sub-ID, associated with selected providers. The fields displayed are: Provider Tax ID; Provider Sub-ID; ICN; Time Stamp; Claim Level User Defined Code; Solicited Indicator; Set #; Duplicate Flag Indicator; Sponsor ID; Patient ID; Patient Name; Amount Govt Paid; PTC Date; Responsible FI; Total Number of Claims and Total Paid Amounts by Provider Sub-ID; and Total number of Claims and Total Paid Amounts by Provider Tax ID.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Last (update) Dates (Owner Type, Claim Set Status; Adjustments, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Dupe Flag Indicator, Solicited Indicator, PTC Dates, Responsible FI, Region, Set Level User Defined Codes, Claim Level User Defined Codes, and Provider Tax IDs, and Enrollment Codes.
Report Notes:
The data used by this report format is claim level data.
Description of Provide Claim Detail Report (Grouped by Provider and Sub ID) - This report provides a listing of claims grouped by Provider Tax ID and Sub-ID, associated with selected providers.
  
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => PROVIDER => CPT-4
Printed Report Title:
Provider CPT-4 Report
Grouped By Provider Tax ID and Sub ID
(CPT-4 Claim Level Match Types Only)
Report Description:
This report shows line items which appear on non-institutional claims which carry a CPT-4 match type (C) at the claim level (see REPORT NOTES below). Due to the way the Duplicate Claims System assigns match types to claims and sets, this report must be used very carefully. Users have the option in this report of selecting actual duplicate claims only. The user may think that the report is showing only actual duplicate line items identified by the CPT-4 match type criteria. In fact, the report is showing the line-items of actual (Y) non-institutional duplicate claims which have been assigned a match type of CPT-4 (see REPORT NOTES below). As a result, line items identified using the OTHER match type may appear on this report along with the line items identified under the CPT-4 criteria which caused the claim to be assigned the match type of CPT-4. This report will not show any line items identified under the EXACT or NEAR match criteria since line items identified using the EXACT and NEAR match would force the claim(s) to be assigned a higher level match type than CPT- 4. This report looks for only those actual duplicate non-institutional claims with a match type of CPT- 4 and then lists the line items on those claims.
This report can be used by Program Integrity staff to obtain a listing of the claims carrying a match type of CPT-4 and their associated line items. Using the Provider Claim Count Report, users can identify the provider numbers associated with high volumes of non-institutional claims involving line items whose last two digits of the procedure code have been changed. Then using the Provider CPT-4 Report and entering those provider numbers identified, the user can generate a listing of the non- institutional claims with line item details associated with those provider numbers.
The fields displayed on this report are: ICN; Time Stamp; Claim Level User Defined Code; Solicited Indicator; Set #; Duplicate Flag Indicator; Sponsor ID; Patient ID; Patient Name; Line Item Match Type; Line Item Number; CPT-4 Code; Amount Paid CPT-4; PTC Date; and Responsible FI. The report is grouped by Provider Number and Sub-ID and provides sub-totals for each provider Sub-ID and grand totals for each provider Tax-ID. The sub-totals and grand totals sum the number of line items and the total Paid dollars.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Match Type, Claim Type, Last Dates, Set Range (Set Owner Type, Claim Set Status, Adjustments, Date Type, FI, Region) plus Dupe Flag Indicator, Solicited Indicator, PTC Dates, Responsible FI, Region, Set Level User Defined Codes, Claim Level User Defined Codes, and Provider Tax ID.
Users may customize the report by selecting: All claims or actual duplicate claims only (to be counted as an actual duplicate claim, it must have a Y dupe flag and be in a Pending, Validate, or Closed set); status (All, Open, Pending, Closed, Validate); only sets that have adjustments associated with them; multi-FI sets, single FI sets, or both; set match type (All, Exact, Near, Date Overlap, CPT-4, Other); a single processed-to-completion date or a range of processed-to- completion dates; a single load date or a range of load dates; one or all FIs; one, several or all regions within selected FIs. Users may also select one, several or all Provider Tax ID numbers to be included in the report.
Report Notes:
Match types are applied at the line-item, claim, and set levels based on a hierarchy. The most stringent match type applicable is assigned at each level. The hierarchy for institutional claims is as follows: Exact, Near, Date Overlap and Other. For non-institutional claims, the hierarchy is as follows: Exact, Near, CPT-4, and Other. For both claim types, Exact Match criteria is the most stringent with Near Match next. Other Match is the least stringent. When the Duplicate Claims System identifies non-institutional potential duplicates, it is doing so at a line item level. When a line item is identified as a potential duplicate, the system labels the line item with the Match Type used to identify it as a potential duplicate. If a non-institutional claim contains line items identified as potential duplicates using more than one match type criteria (one line item identified under Exact Match criteria and another line item under CPT-4 criteria), the system uses the match type hierarchy and labels the claim with the most stringent match type appearing on the line items. If the set contains claims labeled with different match types (one claim labeled ‘Near’ and another labeled ‘CPT-4’), the system uses the match type hierarchy and labels the set with the most stringent match type appearing on the claims.
Description of Provider CPT-4 Report (Grouped by Provider Tax ID and Sub ID (CPT-4 Claim Level Match Types Only)) - This report shows line items which appear on non-institutional claims which carry a CPT-4 match type (C) at the claim level.
  
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => REASON CODE EXPLANATION => INDIVIDUAL CLAIMS
Printed Report Title:
Reason Code Explanation Report
Individual Claims
Report Description:
This report provides a listing of the explanations associated with reason codes on individual claims. The Duplicate Claims System requires that an explanation be entered when certain reason codes are used to describe why a claim is or is not a duplicate claim. This report prints the reason code explanation associated with a claim. Individual claim data is grouped within their respective sets. The fields displayed on this report are: Owner FI; Region; Set Number; Set Status; Current Load Date; ICN; Time Stamp; Responsible FI; PTC Date; Dupe Flag Indicator; Reason Code; and Reason Code Explanation.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Responsible FI, Region, Reason Codes, and Base Claims.
Report Notes:
The data used by this report format is claim level data.
Description of Reason Code Explanantion Report (Individual Claims) - This report provides a listing of the explanations associated with reason codes on individual claims.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => REASON CODE EXPLANATION => ENTIRE SET
Printed Report Title:
Reason Code Explanation Report
Entire Set
Report Description:
This report provides a listing of the explanations associated with reason codes by set number. The Duplicate Claims System requires that an explanation be entered when certain reason codes are used to describe why a claim is or is not a duplicate claim. This report prints the reason code explanations associated with the claims in a set. Individual claim data is grouped within their respective sets. The fields displayed on this report are: Owner FI; Region; Set Number; Set Status; Current Load Date; ICN; Time Stamp; Responsible FI; PTC Date; Dupe Flag Indicator; Reason Code; and Reason Code Explanation.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Responsible FI, Region, Reason Codes, and PTC Date.
Report Notes:
The data used by this report format is claim level data.
Description of Reason code Explanation Report (Entire Set) - This report provides a listing of the explanations associated with reason codes by set number.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => ADJUSTMENTS
Printed Report Title:
Claims With Associated Adjustments
Report Description:
This report provides a listing of claims, grouped in their respective sets, with any associated adjustment claims which have been submitted. Only sets which contain one or more claims that have associated adjustments will be listed. The fields displayed on the report are: Owner FI; Region; Set Number; ICN; Time Stamp; Dupe Flag Indicator; Reason Code; Responsible FI; Sponsor ID; Patient ID; Patient Name; Provider ID; Provider Sub-ID; Claim Level Paid; Line Item Number; Line Item Paid Amount; Adjustment Flag; Adjustment Line Item; and Adjustment Paid Amount.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Adjustments (Claim Set Status, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus PTC Dates, Responsible FI, Region, Claim Level User Defined Codes.
Report Notes:
The data used by this report format is claim and line item level data.
Description of Claims With Associated Adjustments Report - This report provides a listing of claims, grouped in their respective sets, with any associated adjustment claims which have been submitted. Only sets which contain one or more claims that have associated adjustments will be listed.
  
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIMS => WORK SHEETS => INSTITUTIONAL
Printed Report Title:
Institutional Claims Worksheet
Report Description:
This report resembles the paper duplicate claims reports provided to contractors in the past. This report lists institutional claim sets in Open status and provides space for entering by hand: 1) a Y or an N to indicate if the claim has been determined to be a duplicate or not; 2) a reason code for why the claim is or is not a duplicate; and 3) a recoupment or refund amount. This report provides the contractor with the ability to distribute the claim sets requiring research and duplicate determinations among several personnel. Once completed, these reports can be returned to the system operator for data entry. This report is limited to only institutional claims. The fields displayed on the report are: Owner FI; Region; ICN; Set Level User Defined Code; Solicited Indicator; Set Number; PTC Date; Responsible FI; Sponsor ID; Patient ID; Patient Name; Provider Nbr; Provider Sub-ID; Diagnosis; DRG; Amount Billed; Amount Allowed; Government Paid Amount; Dupe Flag?; Reason Code; ID Recoupment Amount. The report identifies and prints all of the sets meeting the criteria selected on the report parameter screen. The report groups the claims in ascending set number order.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Claim Set Status, Claims (Claim Set Status, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus PTC Dates; Adjustments; Care Dates; Solicited Flag; Responsible FI; and Region.
Report Notes:
The data used by this report format is claim level data.
Description of Institutional Claims Worksheet Report - This report resembles the paper duplicate claims reports provided to contractors in the past.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIMS => WORKSHEETS => NON-INSTITUTIONAL
Printed Report Title:
Non-Institutional Claims Worksheet
Report Description:
This report resembles the paper duplicate claims reports provided to contractors in the past. This report lists the sets of non-institutional line items in Open status and provides space for entering by hand: 1) a Y or an N to indicate if the claim has been determined to be a duplicate or not; 2) a reason code for why the claim is or is not a duplicate; and 3) a recoupment or refund amount. This report provides the contractor with the ability to distribute the claim sets requiring research and duplicate determinations among several personnel. Once completed, these reports can be returned to the system operator for data entry. This report is limited to only non-institutional claims. The fields displayed on the report are: Owner FI; Region; ICN; Claim Level User Defined Code; Solicited Indicator; Set Number; Responsible FI; Sponsor ID; Patient ID; Patient Name; Provider Number; Provider Sub-ID; Diagnosis; Line Item Number; CPT-4 Code; Line Item Amount Billed; Line Item Paid Amount; Dupe? (Y/N); Reason Code; and Identified Recoupment or Refund Amount. The report identifies and prints all of the sets meeting the criteria selected on the report parameter screen. The report groups the claims in ascending set number order.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Status, Claim Type (Adjustments, Set Owner Type, Match Type, Date Type, Set Range, FI, Region) plus PTC Dates, Care Dates, Responsible FI, and Region.
Report Notes:
The data used by this report format is line item level data.
Description of Non-Institutional Claims Worksheet Report - This report resembles the paper duplicate claims reports provided to contractors in the past.
Report Category:
Claim Report
Report Menu Hierarchy And Format Name:
REPORT => CLAIM REPORTS => CLAIM LEVEL USER CODES
Printed Report Title:
Claim Level User Defined Field Definitions
Report Description:
This report displays the Owner FI; Contract Number; the Claim Level User Defined Codes; their definitions, and whether they are active or inactive.
Report Parameter Options:
Users may not customize this report.
Report Notes:
The data used by this report format is claim level data.
Description of Claim Level User Defined Field Definitions  Report - This report displays the Owner FI; Contract Number; the Claim Level User Defined Codes; their definitions, and whether they are active or inactive.
Report Category:
Summary/Management
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => INST BY DUPLICATE TYPE
Printed Report Title:
Institutional Summary Report
Potentials/Actuals/Non-Duplicates
By Contractor
(grouped by Region)
Report Description:
This summary/management report shows the total number of institutional potential duplicates, actual duplicates, non-duplicates, and those not yet worked by the contractor for the initial or current load date selected or load date range specified by the user. The report lists the number of claims and the amount paid by match type. The report also shows the number of actual duplicates, non-duplicates, and potential duplicate claims as a percentage of the total number of potential duplicates loaded. For this report, potential duplicates are the universe of all non-base claims. Actual duplicates are those claims with a Y dupe flag in Pending, Validate, or Closed status. Non-duplicates are those non-base claims with an N dupe flag in Pending, Validate, or Closed status. Potential duplicates not worked are non-base claims in Open status irrespective of any dupe flag value. The dollar totals on the report are for non-base claims only.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Claim Set Status; Claim Types; Match Types; Last Dates; Set Range (Adjustments, Set Owner Type, Date Type, FI, Region) plus Responsible FI, and Region, and Risk Indicator.
Report Notes:
The data used by this report format is claim level data.
It should be noted that the total number of claims and percentages shown on this report may differ from that shown on the “Actual vs. Potential” graph report. Any discrepancy will be due to the fact that this report will count a claim more than once if it appears in two or more sets owned by the same region but which have different match types. The graph, alternatively, will not count a claim more than once if it appears in two or more sets owned by the same region.
Description of Institutional Summary Report (Potentials/Actuals/Non-Duplicates by FI/Contractor) -  This summary/management report shows the total number of institutional potential duplicates, actual duplicates,  non-duplicates, and those not yet worked by the contractor for the initial or current load date selected or load date range specified by the user.
Report Category:
Summary/Management
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => NONINST BY DUPLICATE TYPE
Printed Report Title:
Non-Institutional Summary Report
Potentials/Actuals/Non-Duplicate by FI/Contractor
Report Description:
This summary/management report shows the total number of non-institutional potential duplicates, actual duplicates, non-duplicates, and those not yet worked by the contractor for the initial or current load dates selected or load date range specified by the user. The report lists the number of claims and the allowed amounts paid by match type. The report also shows the number of actual duplicates, non-duplicates, and potential duplicate claims as a percentage of the total number of potential duplicates loaded.
This report does not count unique claims but rather all non-base claims appearing in sets with a particular match type, i.e., the total number of non-base claims appearing in CPT-4, Exact, Near, and Other match type sets. Since a non-institutional claim may appear in more than one set, the counts of the claims appearing on this report may be inflated. The dollars shown on this report, however, will not be inflated since a line-item will never appear in more than one set. As a result, the dollars appearing on this report are the paid amounts for the line items appearing in the sets in which their host claim appears. While the host claim may be counted more than once, the dollar amounts associated with the line items will not be counted more than once.
For this report, potential duplicates are the universe of all non-base claims. Actual duplicates are those claims with a Y dupe flag in Pending, Validate, or Closed status. Non-duplicates are those non-base claims with an N dupe flag in Pending, Validate, or Closed status. Potential duplicates not worked are non-base claims in Open status irrespective of any dupe flag value. The dollar totals on the report are for non-base claims only.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Claim Set Status, Claim Types, Match Types, Last Dates, Set Range (Adjustments, Set Owner Type, Date Type, Region) plus Responsible FI, Region, and Risk Indicator.
Report Notes:
The data used by this report format is claim level and line-item data.
It should be noted that the total number of claims and percentages shown on this report may differ from that shown on the “Actual vs. Potential” graph report. Any discrepancy will be due to the fact that this report will count a claim more than once if it appears in two or more sets owned by the same region but which have different match types. The graph, alternatively, will not count a claim more than once if it appears in two or more sets owned by the same region.
Description of Non-Institutional Summary Report (Potentials/Actuals/Non-Duplicates by FI/Contractor) - This summary/management report shows the total number of non-institutional potential duplicates, actual duplicates, non-duplicates, and those not yet worked by the contractor for the initial or current load dates selected or load date range specified by the user.
Report Category:
Summary/Management Report
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => SET AGING REPORT
Printed Report Title:
Set Aging Report
Report Description:
This report provides the total number of sets in Open, Pending, Validate, and Closed status grouped by region and either initial or current load date (depending on which is selected) as of the date the report is run. The report also shows the percentage each total represents of the total number of sets counted. The fields displayed on the report are: Owner FI; Region; Initial or Current Load Date; Number and Percentage of Open Sets; Number and Percentage of Pending Sets; Number and Percentage of Validate Sets; Number and Percentage of Closed Sets; and the Total Number of Sets. The report provides sub-totals for each contract region and grand totals for each contractor.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Status, Last Dates, Set Range (Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, FI, Region).
Report Notes:
The data used by this report format is set level data.
Description of Set Aging Report - This report provides the total number of sets in Open, Pending, Validate, and Closed status grouped by region and either initial or current load date (depending on which is selected) as of the date the report is run.
Report Category:
Summary/Management Report
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => CLAIM AGING REPORT
Printed Report Title:
Claim Aging Report
Report Description:
This report provides the total number of non-base claims in Open status (Not Worked), the total number of actual duplicate claims (Y dupe flag in Pending, Validate, and Closed status) and the total number of non-duplicate claims N dupe flag in Pending, Validate, and Closed status) as of the date the report is run. The report also provides the total paid amounts of the non-base claims in Open status (Not Worked), the total amounts identified for recoupment and actually recouped of the actual duplicate claims, and the total paid amounts of the non-duplicate claims. The report shows claim counts but for non-institutional claims the paid amount totals are the sum of the line-item paid amounts in the system. The report is grouped by Initial or Current Load Date (depending on which is selected) and region and provides sub-totals by region and grand totals by contractor.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Status; Last Dates; Set Range (Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, FI, Region) plus Responsible FI and Region.
Report Notes:
The data used by this report format is claim level data.
Description of Claim Aging Report - This report provides the total number of non-base claims in Open status (Not Worked), the total number of actual duplicate claims (Y dupe flag in Pending, Validate, and Closed status) and the total number of non-duplicate claims N dupe flag in Pending, Validate, and Closed status) as of the date the report is run.
Report Category:
Summary/Management Report
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => ARCHIVED SET REPORT
Printed Report Title:
Archived Set Report
Report Description:
This report provides the total number of sets in the History Database in Validate and Closed status grouped by region and Initial Load Date as of the date the report is run. While the report contains columns for Open status and Pending status, these will always be 0% since sets in Open and Pending status are never archived to the History Database. The report also shows the percentage each total represents of the total number of sets counted. The fields displayed on the report are: Owner FI; Region; Initial Load Date; Number and Percentage of Open Sets; Number and Percentage of Pending Sets; Number and Percentage of Validate Sets; Number and Percentage of Closed Sets; and the Total Number of Sets. The report provides sub-totals for each contract region and grand totals for each contractor.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Status, Last Dates, Current Load Dates, Set Range (Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, FI, Region).
Report Notes:
The data used by this report format is set level data.
Description of Set Aging Report - This report provides the total number of sets in the History Database in Validate and Closed status grouped by region and Initial Load Date as of the date the report is run.
Report Category:
Summary/Management Report
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => REASON CODE REPORT
Printed Report Title:
Reason Code Report
Report Description:
This report provides a list of actual duplicate and non-duplicate reason codes and the total number claims to which each code was assigned. The report counts actual duplicate claims (Y dupe flag) and non-duplicate claims (N dupe flag) in Pending, Validate, and Closed sets.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Claim Set Status (Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Dupe Indicator, Solicited Indicator, Exclude Base, PTC Dates, Set Level User Defined Code, Claim Level User Defined Code, Responsible FI, Region, and Risk Indicator.
Report Notes:
The data used by this report format is claim level data.
Description of Reason Code Report - This report provides a list of actual duplicate and non-duplicate reason codes and the total number claims to which each code was assigned.
Report Category:
Summary/Management Report
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => REASON CODE BY INIT LOAD DATE
Printed Report Title:
Reason Code Report by Initial Load Date
Report Description:
This report provides a list of actual duplicate and non-duplicate reason codes and the total number claims to which each code was assigned. The report counts actual duplicate claims (Y dupe flag) and non-duplicate claims (N dupe flag) in Pending, Validate, and Closed sets. The report is grouped by Initial Load Date.
Report Parameter Options:
This report provides a list of actual duplicate and non-duplicate reason codes and the total number claims to which each code was assigned. The report counts actual duplicate claims (Y dupe flag) and non-duplicate claims (N dupe flag) in Pending, Validate, and Closed sets. The report is grouped by Initial Load Date.
Report Notes:
Users may customize the report by selecting: All “Standard” parameters minus Claim Set Status (Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Dupe Flag Indicator, Solicited Indicator, Exclude Base, PTC Dates, Set and Claim Level User Defined Codes, Responsible FI, Region, and Risk Indicator.
Description of Reason Code Report By Initial Load Date - This report provides a list of actual duplicate and non-duplicate reason codes and the total number claims to which each code was assigned.
Report Category:
Summary/Management Report
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => MODIFY FI
Printed Report Title:
Changed Owner FI Sets
Report Description:
This report identifies multi-contractor sets which have had their ownership changed through the use of the “Modify FI” function on the system menu bar. It does not show multi-contractor sets which have had their ownership changed by the mass change process. The fields displayed on the report are: Set Number; Contractor; Changed Date; and User. The report shows each instance ownership of a multi-contractor set was changed; the name of the new owner contractor, the date ownership was changed, and the application User ID of the user who made the change. The first record listed for each set on the report shows the User as ‘INITLOAD.’ This means that the set was initially loaded by the system.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Set Owner Type and Last Date (Claim Set Status Adjustments, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus PTC Dates.
Report Notes:
The data used by this report format is set level data.
Single-line entries with “INITLOAD” as the user may appear on this report. These single-line entries will appear for sets where a user has begun the process of changing (modifying) ownership of the multi-contractor set, enters the reason for making the change, presses the UPDATE CHANGES button, but decides to “rollback” the changes, i.e., does not complete changing the set’s ownership. Such sets will be listed on this report as a single-line entry with “INITLOAD” as the user.
Description of Changed Owner FI Sets Report - This report identifies multi-contractor sets which have had their ownership changed through the use of the “Modify FI” function on the system menu bar. It does not show multi-contractor sets which have had their ownership changed by the mass change process.
Report Category:
Summary/Management Report
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => SET STATUS COUNT HISTORY
Printed Report Title:
Set Status Count History
Report Description:
This report provides a count and percentage of sets within each status as of a date or range of dates grouped by contract.
Report Parameter Options:
Users may customize the report by selecting: Owner FI, Region, and As of Dates.
Report Notes:
The data used by this report format is set level data.
Description of Set Status Count History Report - This report provides a count and percentage of sets within each status as of a date or range of dates grouped by contract.
Report Category:
Summary/Management Report
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => PERFORMANCE STANDARD
Printed Report Title:
Performance Standard
Report Description:
This report will be used to measure contractor compliance with the performance standard. The performance standard requires that no more than 10% of the sets remaining in Open status at the end of a month shall have load dates over 30 days old. The report shows the Reporting Month; Beginning Inventory; Receipts; Monthly Inventory; the total number of sets “Moved” during the reporting month; the total number of sets Moved within 30 days of set load dates; Ending Inventory; the total number of sets in Ending Inventory Over 30 Days old; the Percent Moved Within 30 Days; and the Percent Remaining Over 30 Days. The data is grouped by contract.
Field Descriptions
Field Name
Definition
Reporting Month:
The month and year for which the statistics are applicable.
Beginning Inventory:
The total number of sets in Open status at the beginning of the reporting month.
Receipts:
The total number of new sets loaded or the number of sets which changed to Open status during the reporting month.
Monthly Inventory:
The sum of the Beginning Inventory and Receipts.
Moved:
The total number of sets moved for Open status to Pending, Validate, or Closed status during the reporting month.
Moved Within 30 Days:
Of those sets moved during the reporting month, the number moved within 30 days of their load date.
Ending Inventory:
The Monthly Inventory minus the number Moved. The result is the total number of remaining sets in Open status.
Ending Inventory Over 30 Days:
The total number of claim sets remaining in Open status with load dates over 30 days old.
% Moved In 30 Days:
Of those sets moved, the percentage moved within 30 days of their load date.
% Remaining Over 30 Days:
The percentage of claim sets remaining in Open status with load dates over 30 days old.
Report Parameter Options:
Users may customize the report by selecting: a single reporting month or a range of reporting months; one or all FIs; one, several or all regions within selected FIs.
Report Notes:
The data used by this report format is set level data.
Description of Performance Standard Report - This report will be used to measure contractor compliance with the performance standard.
Report Category:
Summary/Management Report
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => DOLLAR TOTALS
Printed Report Title:
Dollar Totals
Report Description:
This report summarizes the total dollars identified for recoupment and actually recouped, as well as the total paid amount of the applicable adjustments by Regional contract. The report reflects the total dollars on the system at the time the report is run. The fields displayed on the report are: Owner FI; Region; Total Amount Identified For Recoupment; Total Amount Actually Recouped; and the Total Paid Amount of the Associated Adjustments. The totals reflect only those sets in Pending, Validate, or Closed status.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Claim Set Status (Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, Set Range, FI, Region) plus Set Range, Set and Claim Level User Defined Codes, Responsible FI, Region, and Enrollment Codes.
Report Notes:
The data used by this report format is set level data.
Description of Dollar Totals Report - This report summarizes the total dollars identified for recoupment and actually recouped, as well as the total paid amount of the applicable adjustments by Regional contract. The report reflects the total dollars on the system at the time the report is run.
Report Category:
Summary/Management Report
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => LOAD DATE REPORT
Printed Report Title:
Initial Load Date Report
Report Description:
This report provides a listing of set initial load dates grouped by contract.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Set Range (Claim Set Status, Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, FI, Region) plus Enrollment Codes.
Report Notes:
The data used by this report format is set level data.
Description of Initial Load Date Report - This report provides a listing of set initial load dates grouped by contract.
Report Category:
Summary/Management Report
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => USER ACTIVITY DETAIL
Printed Report Title:
User Activity Detail Report
Report Description:
This report provides a listing of transaction dates and times and associated User IDs grouped by set number. The report shows changes in Set Status; FI; User ID; Amount Identified For Recoupment; Amount Actually Recouped; and the Adjustment Amount.
Report Parameter Options:
Users may customize the report by selecting: Set Range, Transaction Dates, and User IDs.
Report Notes:
The data used by this report format is set level data.
Description of User Activity Detail Report - This report provides a listing of transaction dates and times and associated User IDs grouped by set number.
Report Category:
Summary/Management Report
Report Menu Hierarchy And Format Name:
REPORT => SUMMARY/MANAGEMENT REPORTS => USER ACTIVITY SUMMARY
Printed Report Title:
User Activity Summary Report
Report Description:
This report provides a summary of the transactions performed by individual user ID. The report provides the total number of updates performed by a USER ID, the total number of sets updated by that USER ID, and the net change in status in the following categories: sets moved from Open to Pending and Pending to Open; Open to Validate and Validate to Open; Open to Closed and Closed to Open; Pending to Closed and Closed to Pending; Pending to Validate and Validate to Pending; and Validate to Closed and Closed to Validate. This report can provide management with a summary view of user activity by individual USER ID.
Report Parameter Options:
Users may customize the report by selecting: Set Range, Transaction Dates, and User IDs.
Report Notes:
The data used by this report format is set level data.
Description of User Activity Summary Report - This report provides a summary of the transactions performed by individual user ID.
Report Category:
Graphs
Report Menu Hierarchy And Format Name:
REPORT => GRAPHS => ACTUAL VS. POTENTIAL
Printed Report Title:
Total Actual Duplicates as a Percentage of Total Potential Duplicates
Report Description:
This report provides the user with a graph which shows the total number of distinct actual duplicate claims (Y dupe flags in Pending, Validate, or Closed status) as a percentage of the total number of distinct potential duplicates in the system (all non-base claims). The data displayed is grouped by region.
Report Parameter Options:
Users may customize the report by selecting: All “Standard” parameters minus Claim Set Status and Set Range (Adjustments, Set Owner Type, Claim Type, Match Type, Date Type, FI, Region).
Report Notes:
The data used by this report format is set level data.
If a claim appears in more than one set and the sets are owned by different regions, the claim will be counted once for each region.
Description of Total Actual Duplicates as a Percentage of Total Potential Duplicates Report - This report provides the user with a graph which shows the total number of distinct actual duplicate claims (Y dupe flags in Pending, Validate, or Closed status) as a percentage of the total number of distinct potential duplicates in the system (all non-base claims). The data displayed is grouped by region.
Report Category:
Graphs
Report Menu Hierarchy And Format Name:
REPORT => GRAPHS => USER ACTIVITY SUMMARY
Printed Report Title:
User Activity Summary Report
Report Description:
This report provides the user with a graphical representation of the data in the User Activity Detail Report. The graph provides a summary of the transactions performed by individual user ID. The report provides the total number of updates performed by a USER ID, the total number of sets updated by that USER ID, and the net change in status in the following categories: sets moved from Open to Pending and Pending to Open; Open to Validate and Validate to Open; Open to Closed and Closed to Open; Pending to Closed and Closed to Pending; Pending to Validate and Validate to Pending; and Validate to Closed and Closed to Validate. This report can provide management with a summary view of user activity by individual USER ID.
Report Parameter Options:
Users may customize the report by selecting: Set Range, Transaction Dates, and User IDs.
Report Notes:
The data used by this report format is set level data.
This report is best viewed on screen or printed to a color printer.
Description of User Activity Summary Report - This report provides the user with a graphical representation of the data in the User Activity Detail Report.
  
- END -
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery