High Utilizers Report
Report Columns
Column | Description |
|---|---|
member_id | Cardholder ID of the member |
last_name | Patient Last Name |
first_name | Patient First Name |
dob | Patient Date of Birth |
lob | Line of business (EGWP, MAPD, DSNP) |
total_rx_cost | Total cost of pharmacy claims in the past 365 days |
total_medical_cost | Total cost of medical claims in the past 365 days |
total_spend | Total spend of claims in the past 365 days |
chronic_count | Count of ICD-10 codes that identify presence of a chronic condition found in medical claims in entire patient history Chronic conditions: HTN, DM, Hyperlipidemia, CKD, Asthma, COPD, HIV |
behavioral_counts | Count of ICD-10 codes that identify presence of a behavioral health diagnosis found in medical claims in entire patient history |
distinct_drugs | Count of distinct drugs filled in the past 365 days |
CCM_Code | 1 - Member has a CCM (Chronic Care Management) code ('99490', '99439') in the past 365 days on medical claims 0 - No CCM code |
Latest_PCP_Name | Provider name of provider who has a taxonomy of Primary Care found in the latest OFFICE medical claim |
NPI | NPI of the provider |
Fax | Fax of the provider |
Phone | Phone of the provider |
dx_codes_list | List of unique ICD-10 codes found in member's medical claims in the past 365 days |