What is a Claims by Payor Report?

Claims by payor reports are considered operational reports and are used by CFOs, accountants and claims managers to analyze claims statistics and related charges and reimbursements. Some of the main functionality in this type of report is that it shows claims-related information by employee and insurance provider (payor). The metrics include charges, reimbursements, # of claims, # of claims paid, and % of claims paid. All figures roll up to totals by payor. You find an example of this type of report below.

Purpose of Claims by Payor Reports

Healthcare providers use Claims by Payor Reports to provide managers with a clear understanding of how many claims are paid and how much of their charges are reimbursed. When used as part of good business practices in a Financial Planning & Analysis (FP&A) department, a healthcare organization can improve its revenues and claims processes as well as reduce the chances that financial results suffer as a result of poor insight to claims metrics.

Claims by Payor Report Example

Here is an example of a Claims by Payor Report with charges, reimbursements and claims metrics.

Claims by Payor Report Example for a Healthcare Provider

Claims by Payor Report Example for a Healthcare Provider

You can find hundreds of additional examples here

Who Uses This Type of Report?

The typical users of this type of report are: CFOs, revenue officers, collections managers, analysts, accountants, claims managers.

Other Reports Often Used in Conjunction with Claims by Payor Reports

Progressive Financial Planning & Analysis (FP&A) departments sometimes use several different Claims by Payor Reports, along with claims dashboards, detailed claims reports and other management and control tools.

Where Does the Data for Analysis Originate From?

The Actual (historical transactions) data for competitors typically comes from specialized claims systems or enterprise resource planning (ERP) systems like: Microsoft Dynamics 365 (D365) Finance, Microsoft Dynamics 365 Business Central (D365 BC), Microsoft Dynamics AX, Microsoft Dynamics NAV, Microsoft Dynamics GP, Microsoft Dynamics SL, Sage Intacct, Sage 100, Sage 300, Sage 500, Sage X3, SAP Business One, SAP ByDesign, Acumatica, Netsuite and others.

In analyses where budgets or forecasts are used, the planning data most often originates from in-house Excel spreadsheet models or from professional corporate performance management (CPM/EPM) solutions.

What Tools are Typically used for Reporting, Planning and Dashboards?

Examples of business software used with the data and ERPs mentioned above are:

  • Native ERP report writers and query tools
  • Spreadsheets (for example Microsoft Excel)
  • Corporate Performance Management (CPM) tools (for example Solver)
  • Dashboards (for example Microsoft Power BI and Tableau)

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