Stop Loss Report Screen





 

Report Name

Function

Required Parameters

Optional Parameters
Individual Stop Loss Report This report generates a list of individuals for the given date range to see if any individuals claims exceeded a given threshold.
  • Group or Location or Unit or SSN
  • Paid Date Range and/or Incurred Date Range
    		•
  • Threshold
    		•
    Aggregate Stop Loss Report This report generates the stop loss aggegrate report for the given time period, which will assist the TPA in observing extreme costs due to excessively large claims.
  • Group ID
  • Paid Date Range and/or Incurred Date Range
  • Coverage Factor 1 to 6
  • Loss Fund Date Range
    		•  None
    Provider Utilization Report This report generates a list of all providers claims were paid to, in a given period. Providers are grouped by network.
  • Group or Location or Unit or SSN
  • Paid Date Range and/or Incurred Date Range
    		•
  • Threshold
    		•


     

    Parameter Name

    Definition

    Used in Reports
    Group ID Group ID is the highest level of the four level eligiblity hierarchy. All Reports
    Location ID Location ID is the second highest level of the four level eligiblity hierarchy.
  • Individual Stop Loss Report
  • Provider Utilization Report
    		•
    Unit ID
    		 Unit ID is the third highest level of the four level eligiblity hierarchy.
  • Individual Stop Loss Report
  • Provider Utilization Report
    		•
    SSN SSN is used to reference an individual employee. The Employee is the lowest level of the four level eligiblity hierarchy.
  • Individual Stop Loss Report
  • Provider Utilization Report
    		•
    Threshold Threshold is used to see if any claims exceed the specified threshold amount in the Individual Stop Loss Report.
  • Individual Stop Loss Report
  • Provider Utilization Report
    		•
    Paid Begin Date Paid Begin Date is the begin date of the Paid Date Range which is used when compiling stop loss reports using the dates claims were paid. All Reports
    Paid End Date Paid End Date is the end date of the Paid Date Range which is used when compiling stop loss reports using the dates claims were paid. All Reports
    Incurred Begin Date The begin date of the date range which is used when compiling stop loss reports, using the date a claim was incurred. All Reports
    Incurred End Date The end date of the date range which is used when compiling stop loss reports, using the date a claim was incurred. All Reports
    Loss Fund Begin Date The end date that the Loss Fund is calculated for in the Aggregate Stop Loss Report.
  • Aggregate Stop Loss Report
    • Loss Fund End Date The end date that the Loss Fund is calculated for in the Aggregate Stop Loss Report.
  • Aggregate Stop Loss Report
    • Coverage Factor 1 The Coverage Factor is used to determine the total loss fund by single factors in the Aggregate Stop Loss Report.
  • Aggregate Stop Loss Report
    • Coverage Factor 2 to 6 The Coverage Factor is used to determine the total loss fund by family unit factors in the Aggregate Stop Loss Report.
  • Aggregate Stop Loss Report


    •   The Done button closes the Stop Loss Report Screen, returning you to the Primary Report Screen.