Accounting Reports
Cash Flow Summary: Report outlines the amounts the health center has either received or paid during a given time period, and shows the net Cash Generated/Used. Report provides a drill down by pharmacy, and further by claim type and patient type. PAP metrics are also included if the Health Center participates in the PAP Simplified program.
Accounting Report: Developed to simplify the bookkeeping around our 340B program. This report provides an accurate reflection of Accounts Receivable, Accounts Payable and Replenishment activities as well as a full Profit and Loss statement for any given period. The report contains the summary of the Financial Activity of the entity’s program during a period and can be run for any date range or by cycle dates. The Accounting Report is different from other activity reports as it shows only the Financial Activity effecting the entity’s General Ledger. Other Virtual Inventory reports summarize various claim activity.
Plan Benefit Analysis Reports
Claims Detail Report: The Claims Detail Report is designed to allow a user to pull specific claims for a health center in order to review. User can determine what the pricing of the claim was, compare the price to Network/U&C/340B, review savings and profit amounts, and determine if claim was later reversed. Summary lines provide total claims counts, amount spent, and profit/subsidy.
Claim Benefit – Subsidy by Sliding Scale: Report is designed to give an FQHC insight into the profitability of their plan design, based on the co-pay rules for each individual Sliding Scale/Division. Report shows the average number of claims and profit per patient in each group, as well as the total number of claims, patients, amount collected and amount spent.
Claim Benefit – Subsidy by Tier: Report is similar to the Sliding Scale report, except that it provides the data broken down by Formulary tier. An expansion allows the user to see the drugs that are being dispensed.
Report is designed to give an FQHC insight into the profitability of their plan design, based on the co-pay rules for each separate formulary tier. Report shows the average number of claims and profit per patient in each group, as well as the total number of claims, patients, amount collected and amount spent.
Report will display net claims, Cash only (No third party or Payor partner claims are included).
Performance Reports
Utilization Actionable Items: This report is designed to show items that an FQHC can use to drive their 340B Capture rate. Report outlines the number of claims received vs the number of claims that were eligible for 340B. The report then provides a breakdown for the reasons why a claim was not eligible for 340B. Specific details are provided for: Non 340B Pharmacies, Non 340B Prescribers and Non 340B NDC11s.
Rejection Claims Detail: The Rejected Claims Detail Report is designed to allow a user to review claims that were rejected at the point of sale. User can determine what the reason for rejection was, and if possible correct the underlying issue
Rejections Claims Summary: The Rejected Claims Summary Report is designed to allow a user to view a summary count of rejected claims by the rejection reason. The user can determine if any patterns exist. Report provides a total of rejected claims for each selected pharmacy, and then a breakdown count by reason.
Claims Detail by Provider: The Claims Detail by Provider report is designed to allow a user to review all claims processed for a specific list of prescribers.
Running a Report
1. Select the Reports tab from the main menu.
2. Select Report Category from drop down.
3. Select applicable report under category.
4. Select report criteria.
5. Click Go to open the report.
6. Click the <View> link.
7. Report generates in a new window.
Note: Once the report generates, there is an option to export the report into one of several different formats for further review.