Predeterminations Received Report

Owned by Dylan Nigh
Mar 17, 2023
2 min read

The Predetermination Received Report displays details for all predeterminations that have been received.

Filter Options

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  • Providers: Filters the report by the patient provider associated to the predetermination.

  • Offices: Filters the report by the office provider associated to the predetermination.

  • Insurances: Filters the report by the Insurance associated to the predetermination.

  • Procedures: Filters the report by the procedure(s) associated to the predetermination.

  • Plans: Filters the report by the Insurance Plan associated to the predetermination.

  • Predetermination Received Start/End Date: Filters the report by the date range in which the predetermination was received.

  • Plan Type: Filters the report by Plan Type.

  • Procedures Include Modifiers: Filters the report to include procedures that contain modifiers.

Results Columns

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Unexpanded

The report displays results in the below columns:

  • Insurance Company: The first column displays the name of each insurance company.

  • Charges: The Charges column totals the number of predetermination charges for the designated insurance company.

  • Avg. Days Open: This column calculates the average days a predetermination remains open.

  • Applied Payments: The next column displays the total applied payments for the specified insurance company.

  • % of Paid: Finally, the % of Paid column shows what percentage of all predeterminations have been paid from the insurance company.

First Expansion

To view additional details for a specific insurance company, twist down by clicking the triangle to the right of the Insurance Company. You may also choose to use the Expand All checkbox to view details for all companies. Each record will display additional information in the following columns:

  • Plan Name: This column displays the Insurance Company Plan name.

  • Charges: The Charges column totals the number of predetermination charges for the specific insurance plan.

  • Avg. Days Open: This column calculates the average days a predetermination remains open.

  • Applied Payments: The next column displays the total applied payments for the designated insurance plan.

  • % of Paid: The % of Paid column shows what percentage of all predeterminations have been paid by the specified insurance plan.

Second Expansion

Finally, you can expand once more to see another level of details displayed in these columns:

  • Patient Last, First: The first column displays the patients name (last name, first name).

  • Code: The next column provides the procedure code.

  • Description: This column lists a description of the designated procedure.

  • Days Open: The Days Open column displays the number of days the predetermination has been open.

  • Fee: This column lists the fee associated to the procedure.

  • Paid: The Paid column shows the dollar amount paid on the predetermination.

  • Allowed: The next column displays the allowed amount for the code, as entered in References > Insurance Companies > Plans > Allowed. If no allowed amount is entered, it will read 0.00.

  • % Paid: Lastly, the % Paid column displays the percent paid on the specified procedure.