View Claim Volume by Payor Code

The Claim Volume by Payor page displays the claim volume for a selected date range, patient type and sort option(s). This page helps you to determine whether a contract listed as a high priority (for implementation) is consistent with a high claim volume and/or billed charges. If there is a discrepancy, FinThrive and the client can determine whether:

  • The priority for implementing a certain contract should be adjusted.
  • There is some reason why FinThrive is not receiving the correct (or expected) number of claims for the payor.
  1. To access the Claim Volume by Payor Code page, select Go To > Implementation > Payor Code Definitions > Claim Volume by Payor Code.
  2. Specify criteria.
    • A larger date range results in more data, but you might be interested in a specific date range, if you believe it will yield a representative sample.
    • If it takes more than thirty seconds to yield results, the system times out and a message asks you to select a smaller date range and try again.
  3. Click Display Claim Volume. The claim volume results appear.

    Note: In % Of Total Claims Repriced, the percentage is not expected to be 100%. It is typically less than 10%, because it is the percentage of total claims repriced, not the percentage of claims repriced for the Plan ID.

  4. Click a link in the Payor Code column to display the Payor Mapping page.

    The Stage column is blank if the contract is in production.

  5. Optionally, click the Product Term Name link to access the Contract Profile and then drill down to contract definitions. For more information, refer to View a Contract Profile.

    This action might be helpful if the total billed charges are lower or higher than expected for the payor.

The following table describes the fields on the Claim Volume by Payor Code page.

Field

Description

# of Claims

Number of claims for the payor. Click this field to display the Exception Worklist for the account

% of Payor Code Repriced

Percentage of claims for the payor that repriced (not the percentage of total claims repriced). If the percentage is zero and there is no check mark in the Processed column, FinThrive is not processing reprices for that Plan ID

% of Total Claims Repriced

Percentage of total claims repriced; if less than 100%, some claims have pass-through service types or exceptions that prevent repricing

Date Range

Range of dates searched

End Date

Last date in the date range of the date type selected

Billed Charges

Total charges for the account

No.

Sequential reference number of the issue

Payor Code

Payor code associated with the product

Processed

Processed indicator; a check mark means the claim was processed

Start Date

First date in the date range of the date type selected
  • View Payor Mapping Analysis shows mapping of the payor code to the product and effective dates table (and determines if there are any missing links). For more information, refer to Analyze Payor Mapping.