4.8 Lifestyle 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.

The Lifestyle Analysis report is similar to the Diagnosis Analysis report, but uses a set of categories based on lifestyle specific diagnosis indicators.

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

Claims review lifestyle 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.

The lifestyle categories include only a small portion of possible diagnoses. Non lifestyle related charges fall into an Other category. In normal cases, a large percentage of charges should fall into the Other category.

**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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