Reporting

Claim.MD allows you to generate detailed reports for your processed claims, providing valuable insights into your billing performance. By reviewing these reports, you can analyze key data, identify issues with specific payers or procedures, and monitor the status of your claims. The reports are designed in a user-friendly format, making it easy to track and manage your billing and reimbursement activities.

With Claim.MD’s powerful reporting functionality, you can efficiently oversee your claims and optimize your billing operations.

Important

These reports specifically cover claims processed through Claim.MD. If a claim includes a payment reference in an Electronic Remittance Advice (ERA), the report provides details about that payment. However, Claim.MD reports do not handle balancing your overall accounts receivable (A/R). Instead, they focus solely on the payment information related to individual claims processed within Claim.MD.

Deep Dive into Reporting

For a more in-depth understanding of analyzing reports and utilizing data effectively, refer to these articles: php-template Copy code

Steps to Generate Reports

Click Reporting in the left-hand navigation menu.
To create a new report, click the button at the top of the screen.
The Generate Report window will appear. Here, you can use various filters to customize and generate reports based on Claim.MD data.
Once you've selected the desired criteria, click to create the report.

Report Dropdown Options

Report Types

Each report type in Claim.MD allows users to search for data based on specific criteria that vary depending on the selected report. All reports are interactive, enabling users to click on individual claims within a segment to access more details. Refer to the table below for descriptions of the different report types available in Claim.MD.

Report Type	Description
Billed Charges by Payer	This report provides a summary of the total amount billed to each payer for a specified time period. It includes the payer's name, total billed charges, and additional details for each claim submitted to that payer. Used for tracking billing performance and identifying issues such as payment delays, claim denials, or revenue cycle disruptions. Report options: Claim Group, Time Frame, Select By.
Billed Charges by Rendering Provider	This report summarizes the total amount billed for services provided by each rendering provider (e.g., physicians or other healthcare practitioners) within a specific time period. Useful for monitoring individual provider billing performance and identifying service trends. Report options: Claim Group, Time Frame, Select By.
Billed Charges by Billing Provider	This report displays the total amount billed by each billing provider within a specified timeframe. Helpful for tracking revenue by billing provider and analyzing claim trends. Report options: Claim Group, Time Frame, Select By.
Billed Charges by Billing Facility	This report summarizes the total amount billed for services provided by each facility, such as hospitals, clinics, or outpatient centers, over a specific time period. Key details included: Facility name Total billed charges Claim details for services rendered at the facility This report helps track the billing performance of individual facilities, identify trends in service utilization, and ensure accurate billing for rendered services. Report options: Claim Group, Time Frame, Select By
Billed Charges by Procedure	This report summarizes total billed charges categorized by procedure codes within a specified timeframe. Used for identifying trends in procedure billing, monitoring high-revenue procedures, and analyzing payer reimbursement patterns. Report options: Claim Group, Time Frame, Select By.
Transmits	This report provides details on claims transmitted within the last 30 days, categorized as either Transmitted (submitted once) or Re-Transmitted(submitted multiple times). Useful for tracking claim submission activity and identifying re-transmission trends. Report options: Claim Group, Time Frame.
Top Rejections	This report identifies the most common reasons for claim rejections within a specified time period. Includes details on rejection codes, the number of rejected claims per code, and specific claim details. Helps pinpoint recurring issues in billing processes and improve claim acceptance rates. Report options: Claim Group, Time Frame.
Claim Corrections	This report provides insights into claims that have been corrected and resubmitted after rejection or denial. Tracks correction reasons, correction frequency, and trends in resubmitted claims. Helps providers enhance billing accuracy and reduce claim denials. Report options: User, Claim Group, Time Frame.
Age of Billing	This report tracks the number of days between the date of service and the last claim submission. Used to identify submission delays and optimize claim processing times. Report options: Claim Group, Time Frame.
Payments / Adjustments	This report provides details on payments and adjustments applied by payers to submitted claims. Includes information on adjustment and denial codes. Useful for identifying claim adjustments and improving reimbursement accuracy. Report options: Claim Group, Time Frame.
Time Till Payment	This report measures the time it takes for claims to be processed and paid. Displays the number of days between claim submission and ERA receipt. Helps providers monitor payer processing times and address payment delays. Report options: Claim Group, Time Frame.
Patient Demographics	This report provides a visual representation (e.g., a map) of the geographical distribution of a provider's patients. Useful for analyzing patient location trends. Report options: Claim Group, Time Frame.
Claims Activity	This report tracks the status and activity of submitted medical claims. Provides insights into claim rejections, Transmit approvals, deletions, and archived. Helps providers monitor claim processing efficiency and improve revenue cycle management. Report options: Claim Group, Time Frame.
Avg. Payment Comparison by Procedure	This report compares the average amounts paid and billed for each procedure or service. It also provides a global comparison for the same procedures. Benefits of this report: Identify discrepancies in payments received vs. billed amounts. Assess financial performance relative to industry standards. Optimize billing practices and negotiate better reimbursement rates. Report options: Claim Group, Time Frame
Appeals Activity	This report provides insights into appeals submitted by healthcare providers to payers. Appeals are categorized by submission method: Faxed Mailed Electronic Downloaded By analyzing this report, providers can track appeal status, monitor trends, and identify the most effective appeal submission methods. Key insights: Track appeal success rates by submission method. Monitor the frequency and timing of appeals. Identify bottlenecks in the appeals process. Report options: User, Claim Group, Time Frame
Payer-Modified CPT/HCPC	This report lists procedure codes that were modified by the payer during claim adjudication. Clicking on a code will display a list of affected claims. Report options: Claim Group, Time Frame

Deleted vs. Archived Claims

Deleted claims are those that were uploaded but never transmitted. Claims in this category will not show successful resubmissions. Once a claim has been deleted, it cannot be removed from the report.

Archived claims refer to claims that have been both uploaded and transmitted.

Additional Report Filters

Claim Group

Customized drill-down filters allow grouping claims for more specific reporting. Examples include:

Paid vs. Unpaid Claims
Secondary Providers

For details on setting up claim groups, see the Claim Grouping article.

Time Frame

Defines the date range for reporting data.

Note: When selecting "Other" for date selection, the range must be one year or less.

When generating reports, a pie chart and a list view are displayed, both of which are interactive for deeper claim analysis.

Select By

Sorts report data based on:

Last Transmit Date
First Date of Service

Report View

When a report is generated, a chart or graph displays segmented data based on the selected report type.

For example, the Billed Charges by Payer report shows billed claims and their amounts by payer.
Clicking a pie chart segment reveals a list of all claims under that payer.
Users can then View/Edit Claims, add notes, or perform additional actions.

For more details, see the View/Edit Claims article.

Exporting Reports

To export report data as a CSV file, click the icon in the top-right corner of the screen. The file can then be opened in spreadsheet applications such as Excel.

Adding Criteria to Refine Claim Searches

Users can refine claim lists generated from reports for deeper data analysis.

How to Add Search Criteria:

Run a Report: Generate a report (e.g., "Billed Charges by Payer").
Select a Data Point: Click on a pie chart segment or a payer name in the report.
Access Additional Search Options: Click the gear icon in the upper-right corner.
Add Search Criteria: Use available filters to refine the report.
Example: In the image below, Procedure and Modifier criteria are selected.