4.15 Facility And Physician Analysis
The facility and Physician Analysis reports show the top fifteen most utilized providers in each category for both network and non-network activity. The list includes the provider's name, the total amount paid by the plan sponsor, and the percentage of total plan dollars.
The Facility and Physician analysis provides a summary of charges for both network and non-network providers utilized by the member population.
** Note that clicking on a provider name drills down for further claim investigation. Please refer to the Drill Down section.
- # Claims: Total number of claims for each represented network and savings outlet used to monitor volume activity.
- Total Charge: Original total amount billed by provider before any network or other claim payment consideration. More.
- Plan Paid: Total amount paid by Plan Sponsor.
- % Paid: The percentage of original billed charges paid by the plan sponsor. More.
- % Usage: The percentage of total dollars paid by the Plan sponsor. This is a measure of how much of total plan payment went to a specific item and is a useful indicator of how plan dollars are distributed between network and non network. More.
Headers (Facility/Physician Name, # Claims, Total Charge, Plan Paid, % Paid, % Usage) can be manipulated by clicking on the desired report header to create additional reporting outcomes.
These reports are often useful in discovering providers that are not currently in a network for potential contracting opportunities.