Reporting

Updated on 22 Aug 2024
9 Minutes to read

Print
Dark
Light
PDF

Article summary

Did you find this summary helpful?

Thank you for your feedback

With Claim.MD, you can generate detailed reports for your processed claims, giving you access to essential data and insights. By reviewing these reports, you can analyze your billing performance, identify any issues with specific payers or procedures, and monitor the status of your claims. The reports are presented in a user-friendly format, making it easy for you to track your billing and reimbursement activities.

Claim.MD's reporting functionality offers you a powerful tool to manage your claims and enhance your billing performance effectively.

Important

These reports are specifically about claims processed through Claim.MD. If you receive a payment reference with an Electronic Remittance Advice (ERA) for a claim handled by Claim.MD, it provides details about that particular payment. Importantly, Claim.MD reports don't deal with balancing your overall accounts receivable (A/R). Instead, they focus on the specific payment information related to individual claims processed through Claim.MD.

Deep Dive into Reporting

For a more comprehensive look at analyzing reports and making use of data see these articles:

Steps to generate reports

Click on Reporting on the left-hand navigation menu.
To create a new report, simply click on the top of the screen.
A Generate Report window will appear. From here, reports can use various filter options to generate reports on Claim.MD data.
Once the criteria is selected, click the button to generate the report.

Report type

Each report type in Claim.MD offers users the ability to search for data based on specific criteria that may vary depending on the report. Additionally, all reports are interactive, allowing users to click on individual claims within a segment to view more details. Please refer to the table below for a description of the different report types available in Claim.MD.
.rf

Report Type	Description
Billed Charges by payer	This report provides a summary of the total amount billed to each payer for a specific time period. It includes information on the payer name, total billed charges, and any relevant details for each claim submitted to that payer by clicking into a selected payer. This report can be used to track billing performance and identify any issues with specific payers such as delays in payment, denials of claims, or other issues that may be hindering the revenue cycle. Report options: Claim Group, Time Frame, Select By
Billed Charges by Rendering Provider	This report provides a summary of the total amount billed for services provided by each facility (such as a hospital, clinic, or outpatient center) for a specific time period. It includes information on the facility name, the total billed charges, and any relevant details for each claim submitted for services provided by that facility. This report can be useful for tracking the billing performance of individual facilities, identifying any patterns or trends in the services provided, and ensuring accurate billing for the services rendered at each facility. Report options: Claim Group, Time Frame, Select By
Billed Charges by Billing Provider	This report provides a summary of the total amount billed for services provided by each rendering provider (such as a physician or other healthcare practitioner) for a specific time period. It includes information on the rendering provider's name, the total billed charges, and any relevant details for each claim submitted by that provider. This report can be useful for tracking the billing performance of individual providers, identifying any patterns or trends in the services provided, and ensuring accurate billing for the services rendered. Report options: Claim Group, Time Frame, Select By
Billed Charges by Billing Facility	This report provides a summary of the total amount billed for services provided by each facility (such as a hospital, clinic, or outpatient center) for a specific time period. It includes information on the facility name, the total billed charges, and any relevant details for each claim submitted for services provided by that facility. This report can be useful for tracking the billing performance of individual facilities, identifying any patterns or trends in the services provided, and ensuring accurate billing for the services rendered at each facility. Report options: Claim Group, Time Frame, Select By
Billed Charges by Procedure	This report provides a summary of the total amount billed for each medical procedure performed for a specific time period. It includes information on the procedure code, the total billed charges, and any relevant details for each claim submitted for that procedure. This report can be useful for tracking the volume of specific medical procedures performed, monitoring changes in billing trends over time, and ensuring accurate billing for each procedure performed. Report options: Claim Group, Time Frame, Select By
Transmits	This report provides information on the last 30 days worth of claims that were transmitted. Transmissions have two categories: Transmitted and Re-Transmitted. Transmitted means the claim was submitted once. Re-Transmittedmeans it was transmitted more than once Report options: Claim Group, Time Frame
Top Rejections	This report provides information on the most common reasons for claim rejections for a specific time period. It includes details on the rejection reason code, the number of claims rejected for that reason, and any relevant details for each rejected claim. This report can be useful for identifying patterns or trends in claim rejections, pinpointing any recurring issues in the billing process, and taking steps to address those issues and improve billing performance. Report options: Claim Group, Time Frame
Claim Corrections	This report provides information on the claims that have been corrected and resubmitted after being rejected or denied by payers during the processing of medical claims. It includes details on the reason for the correction, the number of corrected claims, and any relevant details for each corrected claim. This report can be useful for monitoring the accuracy and timeliness of resubmissions and identifying any patterns or trends in the types of claims that require corrections. By tracking this report, healthcare providers can improve their billing performance by reducing the number of rejected or denied claims and ensuring accurate and timely reimbursement. Report options: User, Claim Group, Time Frame
Age of Billing	This is reporting on the number of days between date of service and the last submission of a claim. By analyzing this report, healthcare providers can identify any patterns or trends in delays of submission and improve the timeliness and accuracy of claim submissions. Report options: Claim Group, Time Frame
Payments / Adjustments	This report provides detailed information on payments and adjustments (by adjustment code) made by insurance companies or other payers for medical claims submitted by healthcare providers. It includes details on the adjustment and denial codes. This report can be useful for identifying claims with specific adjustment codes or denials. Report options: Claim Group, Time Frame
Time Till Payment	This report provides the length of time it takes for medical claims to be processed and paid by insurance companies or other payers in terms of days. It provides information on the number of days elapsed between the date of submission and the date of payer's ERA received. This report can be useful for healthcare providers to identify any delays or issues in the payment process and take steps to improve the timeliness and accuracy of claim submissions. By analyzing this report, providers can track the time it takes for each payer to process and pay claims, identify patterns and trends in payment activity, and improve their billing practices over time. Report options: Claim Group, Time Frame
Patient Demographics	This provides a visual view (map) of where provider’s patients are coming from. Report options: Claim Group, Time Frame
Claims Activity	This provides information on the status and activity of medical claims submitted. It provides details on the number of claims that were rejected, transmitted and approved, deleted, or rejected by the insurance company or other payer. This report can be useful for identifying any issues or discrepancies in the claims submission process and tracking the progress of claims through the payment cycle. By analyzing this report, healthcare providers can improve their billing practices, reduce the number of rejected or deleted claims, and ultimately improve their financial performance. *Deleted is defined as uploaded claims that were never transmitted. Claims that have been deleted will not show successful resubmissions in the same category. These claims will be moved out of this particular category. Once a claim has been deleted, it cannot be removed from the report. *Archived claims are those claims uploaded AND transmitted. Report options: Claim Group, Time Frame
Avg. Payment Comparison by Procedure	This provides information the average amount paid and billed for each procedure or service, as well as the global average paid and billed for the same procedures or services. By analyzing this report, healthcare providers can identify any discrepancies in payments received and billed for different procedures and assess their financial performance relative to industry standards. This report can help healthcare providers optimize their billing practices, negotiate better reimbursement rates with insurance companies or other payers, and make data-driven decisions to improve their financial performance. Report options: Claim Group, Time Frame
Appeals Activity	This provides information on the appeals submitted by healthcare providers to insurance companies or other payers. This report groups appeals by the method they were submitted, such as faxed, mailed, electronic, or downloaded, and display the quantity and date of each appeal. By analyzing this report, healthcare providers can track the status and outcome of their appeals and identify any trends or patterns in the appeal process. For instance, they can determine which appeal submission methods are most effective, monitor the frequency and timing of appeals, and identify any bottlenecks in the appeals process. By using this information, healthcare providers can make informed decisions to optimize their appeals process, improve their reimbursement rates, and reduce their financial risk. Report options: User, Claim Group, Time Frame

Claim Group

These are customized drilldown filters that can more specifically group information in reporting such as Paid / Unpaid claims or Secondary Providers. (See Claim Grouping article to see how to create customized claim groups).

Time Frame

This is the time frame parameters for searching the reporting data.

Please note that when using Other in the date selection, the date range entered must be one year or less. Click generate to receive a report which will produce both a pie chart and a list. Both can be clicked on to obtain further, claim based information.

Select By

This sorts the information according to either the last transmit date or the first date of service date.

Report View

When a report is generated, generally a chart or graph is displayed that is broken into different segment groupings depending on the report selected. In the chart above, the data represents Billed Charges by Payer, so each segment represents the number of billed claims and their amounts split out by payer. To drill into the specific data for each segment, click on one of the pie slices. It will display a list all the claims under that particular payer. From here, click on an individual record to View/Edit the claim, add notes, or perform any other number of actions (see View/Edit Claims).

Exporting Report

The information on the report can be exported to a CSV file, by clicking the icon on the top right of the screen. This should download the file into a local folder as a CSV file which can later be opened in a spreadsheet application like Excel.

Adding Criteria to Search for Specific Claims

Refining claim lists derived from a report is simple, enabling you to effortlessly enhance and expand your data analysis. Here’s how you can use this functionality step by step:

Run a Report: Start by generating a report, such as "Billed Charges by Payer."
Select a Data Point: Click on a specific pie slice or a payer listed in the report to focus on that data segment.
Access Additional Search Options: Navigate to the gear icon in the upper right corner of the screen.
Add Search Criteria: Use the available options to add new search criteria, allowing you to further customize and narrow down the report based on your additional research needs. In this example, Procedure and Modifier criteria have been selected.