4.7 Diagnosis Analysis

Claims Review includes two reports that provide analysis based on the diagnostic information included in claims: Diagnosis Analysis and Lifestyle Analysis. Both reports are based on the International Classification of Diseases (ICD) diagnosis coding system and provide a set of categories made up of multiple ICD code ranges.

Code ranges for both diagnosis and lifestyle categories may be customized. Please see ICD9 Code Set section.

Claims-review-diagnosis-analysis

The graph displays how much the Plan Sponsor (green) and member (yellow) paid as well as the amount of savings obtained through network discounts (blue); the top of each bar represents the total original charge billed by providers. The numbers along the bottom of the graph can be matched back to the number (#) column in the table.

**Note that clicking on a specific diagnosis category drills down for further claims investigation. Please refer to the Drill Down section.

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