Cost of Service By Member

Generate an itemized report of the cost of services for an enrolled member.

Prerequisites:

• This form is only available when the Require Member Enrollment registry setting is set to 'Y'.

1. ---

   Go to: Avatar MSO > Membership Management Reports > Cost of Service By Member.
2. In the Individual Or All Members field:
   • Select All to generate a report for all members.
   • Select Individual to generate a report for a single member.
     • Search for and select the specific person in the Member field.
3. In the Include Services On Or After field, enter the report start date.
4. In the Service From Date field, enter the first service date to include in the report.
5. In the Service Through Date field, enter the last service date to include in the report.
6. In the Show All Enrollments Or Only Active Enrollments field:
   • Select All to generate a report for all member enrollments.
   • Select Active to generate a report for all member enrollments that have not been terminated.
     • In the Active Enrollment Date field, enter the earliest enrollment date to include in the report.
7. Select Process.
   Result: The report details service cost, and the following information:
   • Proc Code - CPT or revenue code. (C - CPT, R - Revenue) followed by the code.
   • A/P/D- Approved/ Pending/ Denied - status of the service authorization.
   • Tot Fee Table Amt - cost of service.
   • Expected Disburse - service cost minus a member deductible, or co-pay.
   • Auth Number - service authorization number.
   • Amt Billed - charge amount entered in the claims processing form.
   • Provider Totals
     • Total Amount Paid - sum of expected disbursement for the member.
     • Total Amount Billed - sum of amount billed for the member.