The Insurance Transaction Analysis Report displays charges (claims) and payments posted for a selected date range. Charges and payments are grouped by insurance carrier.
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Why: |
To view the claims and payment issued for a selected date range for an insurance carrier, and to view the total value of claims posted for all insurance carriers |
When: |
As needed |
To generate the report
In DXOne Reporting, select Analysis, and then double-click Insurance Transaction Analysis.
The Insurance Transaction Analysis dialog box appears.
Set up the following options:
Date Range - To filter the report by date, do one of the following:
To include transactions that have dates (based on the Date Type) within a range that you specify, select the Specific Range option. With this option selected, do one of the following:
Enter a date range (in a m/d/yyyy format) in the From and To boxes.
To select a date, do the following for From and To:
Click the corresponding calendar icon to view a month calendar.
Navigate to the correct month, using the left and right arrows.
Note: To quickly change the year and month, click the month-year at the top of the calendar, navigate to the correct year, using the left and right arrows, and then click the correct month.
Click the correct day.
To include transactions that have dates (based on the Date Type) within a range that is relative to the report date, select the Relative Date Range option. With this option selected, select one of the following relative date ranges from the list:
Current Day Current MTD Current Fiscal YTD Current Calendar YTD |
Previous Day Previous Week Previous Month Previous 3 Months Previous 6 Months Previous Fiscal Year Previous Calendar Year |
Next Day Next Week Next Month Next 3 Months Next 6 Months Next Fiscal Year Next Calendar Year |
Date Type - Select one of the following options:
Entry Date - To include a transaction based on the date that it was created (entered into the database).
Procedure Date - To include a transaction based on the date that was specified for it.
Note: Most of the time, a transaction will have the same entry and procedure date. They will differ only if you backdate the transaction.
Filter Date By - To further filter the report by date, from the list, select one of the following options:
Charge Date - To include a transaction based on the service date of the corresponding claim.
Claim Date Sent - To include a transaction based on the date that the corresponding claim was sent.
Claim Date Received - To include a transaction based on the date that the corresponding claim was paid.
Clinic - To filter the report by the clinics that are associated with transactions, do one of the following:
To include all clinics that you are allowed to generate the report for, select the All checkbox.
To include specific clinics, do the following:
Click the search button 
.
The Select Clinics dialog box appears.
Note: Only the clinics that you are allowed to generate the report for are available.
If the list is long, to search for a clinic by ID and/or title, do the following:
Click Search.
The options for searching appear in the upper list.
Enter the first character or more of a clinic's ID and/or title in the ID and Practice Title boxes, respectively.
Click Show Results to view a list of matching clinics.
Note: To return to viewing the list of all the clinics, click Search, click Clear Search to clear the search criteria that you entered, and then click Show Results.
In the upper list, select one or more clinics.
Note: To select multiple clinics, click a clinic, and then, while pressing the Ctrl key, click the other desired clinics. To select a range of adjacent clinics, click the first clinic of the desired range of clinics, and then, while pressing the Shift key, click the last clinic of the desired range of clinics.
Click Add.
Repeat steps b-d as needed to add other clinics.
Note: To not include a clinic that you added, select that clinic in the lower list, and then click Remove.
Click OK.
Provider - To filter the report by the providers that are associated with transactions, do one of the following:
To include all providers that you are allowed to generate the report for, select the All checkbox.
To include specific providers, do the following:
Click the search button .
The Select Providers/Staff dialog box appears.
Note: Only the providers and staff that you are allowed to generate the report for are available.
If the list is long, to search for a provider by ID, first name, last name, and/or title, do the following:
Click Search.
The options for searching appear in the upper list.
Enter the first character or more of a provider's ID, first name, last name, and/or title in the ID, First Name, Last Name, and Title boxes, respectively.
Click Show Results to view a list of matching providers and staff members.
Note: To return to viewing the list of all the providers and staff members, click Search, click Clear Search to clear the search criteria that you entered, and then click Show Results.
In the upper list, select one or more providers.
Note: To select multiple providers, click a provider, and then, while pressing the Ctrl key, click the other desired providers. To select a range of adjacent providers, click the first provider of the desired range of providers, and then, while pressing the Shift key, click the last provider of the desired range of providers.
Click Add.
Repeat steps b-d as needed to add other providers.
Note: To not include a provider that you added, select that provider in the lower list, and then click Remove.
Click OK.
Filter Provider By - To further filter the report by provider, from the list, select one of the following options:
Charge Provider - To include a transaction based on the provider of the procedures on the corresponding claim.
Billing Provider - To include a transaction based on the corresponding claim's billing provider.
Claim Rendering Provider - To include a transaction based on the corresponding claim's rendering provider.
Pay To Provider - To include a transaction based on the corresponding claim's pay-to provider.
Insurance Carrier - To filter the report by the insurance carriers that are associated with claims, do one of the following:
To include all insurance carriers, select the All checkbox for both From and To.
To include a specific range of insurance carriers, select the starting insurance carrier (alphabetically by name) of the range for From and the ending insurance carrier of the range for To.
To include a specific insurance carrier, select the same insurance carrier for both From and To.
To include an open-ended range of insurance carriers, select an insurance carrier for either From or To, and then select the All check box for the other option.
To select a specific insurance carrier for From or To, do the following:
Click the corresponding search button
.
The Select Insurance Carriers dialog box appears.
Do one of the following:
To get a list of all insurance carriers, do not enter any search criteria.
To search for insurance carriers by name, group plan name, group plan number, local number, payor ID, and/or address, enter the first character or more of an insurance carrier name, group plan name, group plan number, local number, payor ID, and/or address in the Carrier Name, Group Plan, Group#, Local#, Payor ID, and Address boxes, respectively.
Note: To clear any text that you have entered, click Clear Search.
Click Show Results to view a list of insurance carriers.
Note: To clear the list so you can search again, click Search.
In the list, select an insurance carrier.
Click OK.
Insurance Type - To filter the report by the type of insurance that carriers provide, select one of the following options:
Dental - To include insurance carriers that are associated with dental insurance plans.
Medical - To include insurance carriers that are associated with medical insurance plans.
Billing Type - To filter the report by the billing types that are associated with patients on claims, do one of the following:
To include all billing types, select the All checkbox.
To include specific billing types, do the following:
Click the search button .
The Select Billing Type dialog box appears.
If the list is long, to search for a billing type by ID and/or description, do the following:
Click Search.
The options for searching appear in the upper list.
Enter the first character or more of a billing type's ID and/or description in the ID and Description boxes, respectively.
Click Show Results to view a list of matching billing types.
Note: To return to viewing the list of all the billing types, click Search, click Clear Search to clear the search criteria that you entered, and then click Show Results.
In the upper list, select one or more billing types.
Note: To select multiple billing types, click a billing type, and then, while pressing the Ctrl key, click the other desired billing types. To select a range of adjacent billing types, click the first billing type of the desired range of billing types, and then, while pressing the Shift key, click the last billing type of the desired range of billing types.
Click Add.
Repeat steps b-d as needed to add other billing types.
Note: To not include a billing type that you added, select that billing type in the lower list, and then click Remove.
Click OK.
Financial Class - To filter the report by the class types that are assigned to plans that are provided by insurance carriers, do one of the following:
To include all class types, select the All checkbox.
To include specific class types, do the following:
Click the search button .
The Select Financial Class dialog box appears.
If the list is long, to search for a class type by ID and/or description, do the following:
Click Search.
The options for searching appear in the upper list.
Enter the first character or more of a class type's ID and/or description in the ID and Description boxes, respectively.
Click Show Results to view a list of matching class types.
Note: To return to viewing the list of all the class types, click Search, click Clear Search to clear the search criteria that you entered, and then click Show Results.
In the upper list, select one or more class types.
Note: To select multiple class types, click a class type, and then, while pressing the Ctrl key, click the other desired class types. To select a range of adjacent class types, click the first class type of the desired range of class types, and then, while pressing the Shift key, click the last class type of the desired range of class types.
Click Add.
Repeat steps b-d as needed to add other class types.
Note: To not include a class type that you added, select that class type in the lower list, and then click Remove.
Click OK.
Patient Tag - Do one of the following:
To not filter the report by a patient tag, clear the Run By Patient Tag checkbox.
To filter the report by the tags that are assigned to patients, select the Run By Patient Tag checkbox. With this checkbox selected, the options to filter the report by tag are available. Do one of the following:
To include transactions for patients with any patient tag, select the All checkbox.
To include transactions for patients with specific tags, do the following:
Click the search button .
The Patient Tag Selection dialog box appears.
If the list is long, to search for a patient tag, do the following:
Click Search.
The options for searching appear in the upper list.
Enter the first character or more of a patient tag name in the Tag Name box.
Click Show Results to view a list of matching patient tags.
Note: To return to viewing the list of all the patient tags, click Search, click Clear Search to clear the search criteria that you entered, and then click Show Results.
In the upper list, select one or more patient tags.
Note: To select multiple patient tags, click a patient tag, and then, while pressing the Ctrl key, click the other desired patient tags. To select a range of adjacent patient tags, click the first patient tag of the desired range of patient tags, and then, while pressing the Shift key, click the last patient tag of the desired range of patient tags.
Click Add.
Repeat steps b-d as needed to add other patient tags.
Note: To not include a patient tag that you added, select that patient tag in the lower list, and then click Remove.
Click OK.
Options - Select or clear the following checkboxes as needed:
Include Grand Totals - With this checkbox selected, the report displays the following totals for all carriers on the report: the total number of claims sent and received, total insured charges, total payments, and total adjustments made. With this checkbox clear, the report does not display the grand totals.
Include Sub Totals by Carrier - With this checkbox selected, the report displays the following subtotals for each carrier: the total claims sent, totals claims received, totals insurance payments, total patient payments, and total adjustments made. With this checkbox clear, the report does not display the subtotals.
Include Charges - With this check box selected, the report displays charges for procedures on claims. With this checkbox clear, the report does not display charges.
Include Charge Adjustments - With this checkbox selected, the report displays charge adjustments that are associated with claims. With this checkbox clear, the report does not display charge adjustments.
Include Ins Payments - With this checkbox selected, the report displays insurance payments that are associated with claims. With this checkbox clear, the report does not display insurance payments.
Include Patient Payments - With this checkbox selected, the report displays patient payments that are applied to procedures on claims. With this checkbox clear, the report does not display patient payments.
Include Credit Adjustments - With this checkbox selected, the report displays credit adjustments that are associated with claims. With this checkbox clear, the report does not display credit adjustments.
Include Secondary Claims - With this checkbox selected, the report includes claims that were sent to insurance carriers that provide secondary insurance plans. With this check box clear, the report does not include secondary claims.
Include Tertiary Claims - With this checkbox selected, the report includes claims that were sent to insurance carriers that provide tertiary insurance plans. With this checkbox clear, the report does not include tertiary claims.
Include Quaternary Claims - With this checkbox selected, the report includes claims that were sent to insurance carriers that provide quaternary insurance plans. With this checkbox clear, the report does not include quaternary claims.
Display Allocate Date for Pmts - With this checkbox selected, the report displays dates for payments that were applied to procedures on claims. With this checkbox clear, the report does not display applied dates.
New Page for Each Plan - With this checkbox selected, each insurance plan starts on a new page. With this checkbox clear, an insurance plan can start anywhere on a page.
Click Save as Default to save the current settings for the next time you run the report.
Click Clear Defaults to revert the dialog box options to the original defaults.
Click Schedule to schedule a report job.
Click OK to preview the report.
Important information this report provides
Claim Details:
Sent - The date that the claim was posted.
Note: If a report is filtered by procedure date, the sent date can fall outside the date range of the report.
Received - The date that a payment was received for the claim.
Notes:
If a patient has multiple claims posted during the date range of the report, each claim appears separately.
If you select Include Secondary Claims, Include Tertiary Claims, and/or Include Quaternary Claims when setting options for this report, secondary, tertiary, and/or quaternary claims appear on the report. For secondary, tertiary, and quaternary claims, claim charges are not itemized.
Charges - If you select Include Charges when setting options for this report, the procedures that were billed on a claim appear on the report.
Insurance Payments - If you select Include Claim Charges and Include Ins Payments when setting options for this report, payments that were made by the insurance carrier are itemized on the report.
Adjustments - If you select Include Charge Adjustments and/or Include Credit Adjustments when setting options for this report, adjustments appear on the report.
Patient Payments - If you select Include Patient Payments when setting options for this report, patient payments appear on the report.
Totals - If you select Include Sub Totals by Carrier and/or Include Grand Totals when setting options for this report, totals for each carrier appear on the report, and/or totals for all carriers appear at the end of the report. The following totals appear, according to the information you chose to include when setting options for this report:
Total Claims Sent & Received - The number of claims that were sent and received.
Insured Charges - The number and dollar amount of charges that were billed to insurance.
Total Insurance & Patient Payments - The number and dollar amount of insurance payments and patient payments.
Total Credit & Charge Adjustments - The number and dollar amount of credit and charge adjustments.
