6.2 Disclosure Listing

The Disclosure Listing includes each participant that matches one or more of the following criteria:

Members that have received medical services within the covered experience period, the cost of which exceeds a user configured disclosure level amount (default: $50,000).
Members that have been diagnosed with or treated for any of the codes included in the standardized list of ICD-9 codes for disclosure notification.
Members that have incurred Case Management related claims.
Members that have incurred Disability related claims.

The participants are sorted from highest to lowest paid dollar, select Sort by Last Name to change the view.

NOTE: The Disclosure Listing is based on the SPBA and SIIA endorsed standardized Disclosure Form and diagnosis "hit list".

The information displayed on the disclosure is two tiered. The top level records in large type display information about the participant:

DIV (Division) - Denotes the division of the company the member is employed / covered under.
Member - The participant's name. When private health information is blinded, the participant's internal system identifier is displayed.
Relation - Employee, Spouse, or Dependent/Other.
Terminated- The date the member's coverage was terminated, if applicable. If no termination date is displayed, the member is active.
Age - The member's age as of the last day of the reporting period.
Diagnosis Code - The ICD-9 code attached to the largest charge in the trigger category. Selecting the ICD code opens an ICD code browser showing the hierarchy of related diagnoses.
Plan Paid - The total gross amount paid by the plan. On top level participant lines, this item indicates the total amount paid toward the member. On individual disclosure level, diagnosis, or special hit lines, this item indicates the total amount paid toward the specific item.
Outstanding - The total billed amount in claims that are known/pending but have not yet been paid. On top level participant lines, this item indicates the outstanding amount for the member. On individual disclosure level, diagnosis, or special hit lines, this item indicates the outstanding amount for the specific item.
Adverse Claims - The total billed amount in claims that were recently denied with adverse explanations. These claims have a high probability of being resubmitted with minor corrections. On top level participant lines, this item indicates the adverse amount for the member. On individual disclosure level, diagnosis, or special hit lines, this item indicates the adverse amount for the specific item.
Most Recently Incurred - The date of service recorded on the most recently incurred claim. On top level participant lines, this item indicates the most recent date of service for the member. On individual disclosure level, diagnosis, or special hit lines, this item indicates the most recent date of service for the specific item.