Claims Report

The Claims report is found within the Reports module, and within the Safety grouping of reports available in Enterprise Health .

CLAIMS REPORT

Some workflows require to document and identify what TPA (Third Party Administrator) a case/incident should be sent to. This optional field can be configured for your system to be available in the case/incident encounter section to identify which TPA to send claim to. The TPA choices can be customized for your system also.

The Send Claim To field in the above encounter case/incident section interoperates with the Claims Report.

Some systems have a work comp interface for this automatic sending of case/incident data based on TPA selection, but this Claims Report gives a system the ability to report out the same data that a work comp interface would. The report can be downloaded as a CSV format to be able to send to the identified TPA(s) manually.

Claims Report Criteria

The Claims Report has the following logic criteria/logic built in order to run this report:

  • An observation named Send claim to TPA must be configured in the system
    • Result Type must be set to Custom Discrete Values
    • Value & Sort Order must be keyed in to allow your TPA selections for your system
    • Note: Don’t send the claim choice will automatically be a selection in the case/incident section if your system is configured to use Send claim to TPA. Do not manually configure a Don’t send the claim as a custom discrete value for the observation configuration, only your TPA company name selections need configured as values.

  • Your case/incident workflows must utilize the Case encounter section on specific encounter types deemed appropriate for your business
  • Your case/incident workflows use the Case Management encounter with Notes/Tracking encounter section
  • The case/incident does not need to be documented as OSHA Recordable to appear on this report (date determined recordable field)

Claims Report output

The Claims Report output displays in a datavis format with several columns of data pulled from the encounter case/incident and from the chart’s demographics and employment information.

The output of the report may cause you to scroll left and right to see all the columns that are rendering on the output.

Download Claims Report to a CSV format

The Claims Report is easily downloadable into a CSV format. Simply click the Generate CSV icon (looks like a corner fold paper icon), which will then turn into a Download CSV icon to click (looks like an in-box tray icon) to generate the report’s output into a CSV downloadable file. Store to your folder location of choice.


Enterprise Health Documentation

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