dr.ntr vaidya seva trust - a p

DR.NTR VAIDYA SEVA TRUST

MIS MANUAL WITH

INDICATORS COMPENDIUM AND REPORT TABLES

VOLUME II

©2012 Dr.NTR Vaidya Seva Trust Road Number 46 Jubilee Hills Hyderabad 500033 Telephone: 040-23148000 Website: www.ntrvaidyaseva.ap.gov.in ail: [email protected]

All rights reserved This book is produced by the staff of Dr.NTR Vaidya Seva Trust.

Rights and permissions Copy and reproduction of all or part of the material in this book without prior permission is allowed subject to the material being reproduced accurately and not being used in a derogatory or misleading context. Where the material is being published or issued to others, the source shall be prominently acknowledged.

ABBREVIATIONS

Sl.No Abbreviation Full Form

1 ~CA Cost of the Claims Approved

2 ~TD Cost of the Therapies Done

3 ~TDs Cost of the Therapies discharged

4 ~TP Cost of the Therapies Preauthorised

5 ACC Average Claim Case Waiting Time

6 ACN Average Categories per NWH

7 ACS Average Claim Size

8 AFR Adverse Feedback Rate

9 AI Autonomous Institutions

10 NVMCCO Dr.NTR Vaidya Seva Medical Camp Coordinator

11 AP Average Price

12 APC Average Preauth Case Waiting Time

13 APS Average Preauth Size

14 AS Dr.NTR Vaidya Seva

15 ATPCC Average therapies per covered card-year for a given therapy

16 ATPCP Average therapies per covered person-year for a given therapy

17 ATPUC Average therapies per utilised card-year for a given therapy

18 ATPUP Average therapies per utilised person-year for a given therapy

19 AVG. CAT Average Number of Categories

20 BC Backward Caste

21 BCR Bare Claim Ratio

22 BE Budget Estimate

23 BOR Dr.NTR Vaidya Seva Bed Occupancy Rate

24 BPAU Buffer case Preauthorisation

25 BPCD Bare Premium Claim Difference

26 CA Claims Approved

27 CAO Claims Authorization Officer

28 C-CC Chairman - Cochlear Committee

29 CDR Claim Deduction Ratio

30 CFR Case Fatality Rate

31 CH Claim Head

32 ClE Therapy Claims Eligible

33 CLMF Claims Afresh

34 CLMP Claims Pending

35 CLR Claim Rate

36 CMCO CM Camp Office

37 CMRF Chief Minister Relief Fund

38 CPD Claims Panel Doctor

39 CPP Claim Pendency Percentage

40 CR Claim Ratio

41 CRe Claims Rejected

42 Cr Crores

43 CTD Claims Trust Doctor

44 CUR Card Utilization Rate

45 CX / CEX Claims Executive

46 CY Cumulative Year

47

d Q[n] Q is the quarter of a year. The statistic is calculated from quarterly period amounts (Q[n] - Q[n-1]).

48 DFO Deputy Financial Officer

49 EAO Empanelment Authorization Officer

50 EEX Empanelment Executive

51 EH Empanelment head

52 EPD Empanelment Processing Doctor

53 EPO Empanelment Processing Officer

54 EPO (CMA) Empanelment Processing Officer

55 EW Empanelment Weight

56 EX Executive

57 EXPDR Expenditure

58 F Female

59 F/U Follow-up

60 FC Frequency Count

61 FY Financial Year

62 GH Government Hospital

63 Govt Government

64 GR Grievance Rate

65 HCAP HC Patient Referral Capture Rate

66 HCC Health Camps Conducted

67 HCON HC Patient Referral Conversion Rate

68 HCPR Patients Referred (through Health Camps)

69 HCPS Patients Screened (In Health Camp)

70 HD Hospital District

71 HD TP Hospital District Therapies Preauthorised

72 INS Insurance

73 IP Hospital In Patients

74 ITEX IT Executive

75 LCLM Live Claims

76 LP Therapy Claim Lapsed

77 LPAU Live Preauthorisation

78 LPAUC Live Preauthorisation Cancellation

79 M Male

80 MC-CC Member Convener - Cochlear Committee

81 MC-EDC Member Convener - Empanelment Disciplinary Committee

82 MIN Minority

83 NAM Network Vaidyamitra

84 NWH Network Hospital

85 OP Hospital Out Patients

86 PAO Preauth Authorization Officer

87 PAUC Preauthorisation Cancellation

88 PAUP Preauthorisation Pending

89 PCD Premium Claim Difference

90 PCLM Past Claims

91 PCR Preauth Cost Rate

92 PD Patient District

93 PD TP Patient District Therapies Preauthorised

94 PDR Preauth Disposal Rate

95 PEX-C Preauth Executive Cochlear

96 PFF Period Falling in the Financial Year

97 PID Preauth Insurance Doctor

98 PP Policy Period

99 PPAU Past Preauthorisation

100 PPAUC Past Preauthorisation Cancellation

101 PPD Preauth Panel Doctor

102 PPP Preauth Pendency Percentage

103 PTD Preauth Trust Doctor

104 PUR Person Utilization Rate

105 Pvt Private

106 R Rural

107 MEDCO Dr.NTR Vaidya Seva Medical Coordinator

108 REL Amount Released

109 SC Scheduled Caste

110 ST Scheduled Tribe

111 T Total

112

TAP/RAP/AA P/AP

Types of Cards

113 TCB Therapies Claim Pending at Bank

114 TCBC Therapies Claim Pending at Bank Cost

115 TCO Therapies Claim Outstanding

116 TCOC Therapies Claim Outstanding Cost

117 TD Therapies Done

118 TDs Therapies discharged

119 TP Therapies Preauthorised

120 U Urban

121 WAC Weighted Average Cases (WAC) per month for a NWH

122 WSD Weighted Standard Deviation (WSD)

123 Wt Weight

TABLE OF CONTENTS

VOLUME – I

1. Introduction ............................................................................. 1

2. Overview of MIS in AHCT .......................................................... 3

3. Overview of the scheme ........................................................... 7

4. Administration department .................................................... 10

5. Operations department ........................................................... 20

6. Empanelment, Disciplinary action and

Medical audit department ....................................................... 41

7. Field operations department .................................................... 50

8. Grievance department .............................................................. 54

9. Cochlear implant program ........................................................ 56

VOLUME -2

10. Indicators Organization Structure ............................................. 61

11. Data Types and Notations used ................................................ 69

12. Definition Dictionary ................................................................. 70

13. List of Indicators ......................................................................... 73

14. Indicator Bank ...........................................................................95

15. Appendix .................................................................................. 565

VOLUME-3

16. Report Tables .................................................................................. 569

1. Scheme Performance ............................................................... 570

1A. scheme utilization

1B. scheme experience

2. District Performance .............................................................. 585

2A.district wise tables

2B. government hospital performance

2C. utilisation rates

2E. migration pattern

2F.Grievances

2G.District specific tables

3. Category Performance .............................................................. 601

3A. Category wise tables

3B. Government hospital performance

3C. Utilisation rates

3D. Category specific tables

4. Therapy Performance ............................................................... 612

4A.Therapy wise tables

4B.Theray specific tables

5. Government Hospitals progress ................................................. 616

5A. Government hospital performance

5B. NWH wise tables

5C.NWH specific tables

6. Finance ...................................................................................... 626

6A.Finance and budget

6B Forecasts

7. Dash boards ............................................................................... 635

8 Field operations .......................................................................... 656

9. Periodic reports ......................................................................... 658

61

11. INDICATORS ORGANIZATION STRUCTURE

Sl.no Major Group

Minor Group

Sub Catego ry

Major Group Description

Minor Group Description

Sub Category Description

1 ADM SCO PCO Administration Scheme Population Coverage

2 ADM SCO BCO Administration Scheme Benefit Coverage

3 ADM SCO FCO Administration Scheme Financial Coverage

4 ADM SUT CUT Administration Scheme Utilization

Cards Utilization

5 ADM SUT PUT Administration Scheme Utilization

Persons Utilization

6 ADM SUT TUT Administration Scheme Utilization

Therapy Utilization Operations Wise Summary

7 ADM SUT UTR Administration Scheme Utilization

Utilization Rates

8 ADM SUT CLR Administration Scheme Utilization

Claim Rates

9 ADM SUT WGT Administration Scheme Utilization

Weights

10 ADM SEP CRT Administration Scheme Experience

Claim Ratios

11 ADM SEP CCO Administration Scheme Experience

Claims Commitment

12 ADM SEP FFO Administration Scheme Experience

Fund Forecast

14 FOP NWH *** Field Operations

Network Hospital NA

15 FOP HCA *** Field Operations

Health Camps NA

16 FOP FUC *** Field Operations

Follow-up Cases NA

17 FOP GHP *** Field Operations

Government Hospital Performance

NA

18 GRE GRE *** Grievances Grievances NA

19 EDM EMP *** Empanelment, Disciplinary Action And Medical Audit

Empanelment NA

62

Sl.no Major Group

Minor Group

Sub Catego ry




20 EDM MAU *** Empanelment, Disciplinary Action And Medical Audit

Medical Audit NA

21 OPR PAU SUB Operations Preauthorisation Submitted

22 OPR PAU UPD Operations Preauthorisation Updated

23 OPR PAU FWD Operations Preauthorisation Forwarded

24 OPR PAU RAP Operations Preauthorisation Recommended for Approval

25 OPR PAU PEN Operations Preauthorisation Pending

26 OPR PAU RRJ Operations Preauthorisation Recommended for Rejection

27 OPR PAU APP Operations Preauthorisation Approved

28 OPR PAU REJ Operations Preauthorisation Rejected

29 OPR PAU TDP Operations Preauthorisation Total Disposed

30 OPR PAU AUC Operations Preauthorisation Auto Cancellation

31 OPR TRT UPD Operations Treatment Updated

32 OPR DSC UPD Operations Discharge Updated

33 OPR DEA UPD Operations Death Updated

34 OPR PAU WTC Operations Preauthorisation Waiting cases count

35 OPR PAU TWT Operations Preauthorisation Total Waiting

36 OPR TRT WTC Operations Treatment Waiting cases count

37 OPR DSC WTC Operations Discharge Waiting cases count

38 OPR PAU AWT Operations Preauthorisation Average Waiting Time

39 OPR TRT AWT Operations Treatment Average Waiting Time

40 OPR OBD AWT Operations On bed Average Waiting Time

41 OPR PAU HPA Operations Preauthorisation Hourly Preauth Arrival

42 OPR PAU ART Operations Preauthorisation Preauth Arrival Rate

43 OPR PAU HAP Operations Preauthorisation Hourly Preauth Approval

44 OPR PAU APR Operations Preauthorisation Preauth Approval Rate

45 OPR PAU DTO Operations Preauthorisation Daily Turnover

63

Sl.no Major Group

Minor Group

Sub Catego ry




46 OPR PAU TOR Operations Preauthorisation Turn Over

47 OPR PAU CPT Operations Preauthorisation Case Processing Time

48 OPR PAU PPP Operations Preauthorisation Preauth Pendency Percentage

49 OPR PAU TIN Operations Preauthorisation Telephonic Intimations

50 OPR PAU BUF Operations Preauthorisation Buffer

51 OPR PAU ENH Operations Preauthorisation Enhancement

52 OPR PAU CCH Operations Preauthorisation Cochlear Cases

53 OPR CLM ELG Operations Claims Eligible

54 OPR CLM SUB Operations Claims Submitted

55 OPR CLM UPD Operations Claims Updated

56 OPR CLM WTC Operations Claims Waiting cases count

57 OPR CLM FWD Operations Claims Forwarded

58 OPR CLM RAP Operations Claims Recommended for Approval

59 OPR CLM RRJ Operations Claims Recommended for Rejection

60 OPR CLM PEN Operations Claims Pending

61 OPR CLM APP Operations Claims Approved

62 OPR CLM REJ Operations Claims Rejected

63 OPR CLM TDP Operations Claims Total Disposed

64 OPR CLM HAR Operations Claims Hourly Claims Arrival

65 OPR CLM CAR Operations Claims Claims Arrival Rate

66 OPR CLM HCD Operations Claims Hourly Claims Disposal

67 OPR CLM CDR Operations Claims Claims Disposal Rate

68 OPR CLM TWN Operations Claims Total Waiting

69 OPR CLM AWT Operations Claims Average Waiting Time

70 OPR CLM TOR Operations Claims Turn Over Rate

71 OPR CLM DTO Operations Claims Daily Turnover

72 OPR CLM CPP Operations Claims Claim Pendency Percentage

73 EMP EAP INT Empanelment Empanelment Application

Initiated

64

Sl.no Major Group

Minor Group

Sub Catego ry




74 EMP EAP UPD Empanelment Empanelment Application

Updated

75 EMP ERE FWD Empanelment Empanelment Registration

Forwarded

76 EMP ERE APP Empanelment Empanelment Registration

Approved

77 EMP ERE PEN Empanelment Empanelment Registration

Pending

78 EMP ERE REJ Empanelment Empanelment Registration

Rejected

79 EMP EIP INT Empanelment Empanelment Inspection

Initiated

80 EMP EIP UPD Empanelment Empanelment Inspection

Updated

81 EMP EAU RAP Empanelment Empanelment Authorization

Recommended for Approval

82 EMP EAU RRE Empanelment Empanelment Authorization

Recommended for Rejection

83 EMP EAU REJ Empanelment Empanelment Authorization

Rejected

84 EMP EAU PEN Empanelment Empanelment Authorization

Pending

85 EMP EAU APP Empanelment Empanelment Authorization

Approved

86 EMP EAS INT Empanelment Empanelment Additional Specialities

Initiated

87 EMP EAS UPD Empanelment Empanelment Additional Specialities

Updated

88 EMP EAS RAP Empanelment Empanelment Additional Specialities


89 EMP EAS RRE Empanelment Empanelment Additional Specialities


90 EMP EAS PEN Empanelment Empanelment Additional Specialities

Pending

91 EMP EAS IAP Empanelment Empanelment Additional Specialities

Inspection Approved

65

Sl.no Major Group

Minor Group

Sub Catego ry




92 EMP EAS IRE Empanelment Empanelment Additional Specialities

Inspection Rejected

93 EMP EAS IUP Empanelment Empanelment Additional Specialities

Inspection Updated

94 EMP EAS APP Empanelment Empanelment Additional Specialities

Approved

95 EMP ECR INT Empanelment Empanelment Change Request of MEDCO

Initiated

96 EMP ECR UPD Empanelment Empanelment Change Request of MEDCO

Updated

97 EMP ECR RAP Empanelment Empanelment Change Request of MEDCO


98 EMP ECR PEN Empanelment Empanelment Change Request of MEDCO

Pending

99 EMP ECR REJ Empanelment Empanelment Change Request of MEDCO

Rejected

100 EMP ECR APP Empanelment Empanelment Change Request of MEDCO

Approved

101 EMP ECA INT Empanelment Empanelment Change Request of NVMCCO

Initiated

102 EMP ECA UPD Empanelment Empanelment Change Request of NVMCCO

Updated

103 EMP ECA RAP Empanelment Empanelment Change Request of NVMCCO


104 EMP ECA PEN Empanelment Empanelment Change Request of NVMCCO

Pending

105 EMP ECA REJ Empanelment Empanelment Change Request of NVMCCO

Rejected

66

Sl.no Major Group

Minor Group

Sub Catego ry




106 EMP ECA APP Empanelment Empanelment Change Request of NVMCCO

Approved

107 EMP EAA INT Empanelment Empanelment Change Request of Additional NVMCCO

Initiated

108 EMP EAA UPD Empanelment Empanelment Change Request of Additional NVMCCO

Updated

109 EMP EAA RAP Empanelment Empanelment Change Request of Additional NVMCCO


110 EMP EAA PEN Empanelment Empanelment Change Request of Additional NVMCCO

Pending

111 EMP EAA REJ Empanelment Empanelment Change Request of Additional NVMCCO

Rejected

112 EMP EAA APP Empanelment Empanelment Change Request of Additional NVMCCO

Approved

113 EMP EAR INT Empanelment Empanelment Change Request of Additional MEDCO

Initiated

114 EMP EAR UPD Empanelment Empanelment Change Request of Additional MEDCO

Updated

115 EMP EAR RAP Empanelment Empanelment Change Request of Additional MEDCO


116 EMP EAR PEN Empanelment Empanelment Change Request of Additional MEDCO

Pending

67

Sl.no Major Group

Minor Group

Sub Catego ry




117 EMP EAR REJ Empanelment Empanelment Change Request of Additional MEDCO

Rejected

118 EMP EAR APP Empanelment Empanelment Change Request of Additional MEDCO

Approved

119 EMP EBA INT Empanelment Empanelment Change of Bank Account Number

Initiated

120 EMP EBA UPD Empanelment Empanelment Change of Bank Account Number

Updated

121 EMP EBA RAP Empanelment Empanelment Change of Bank Account Number


122 EMP EBA REJ Empanelment Empanelment Change of Bank Account Number

Rejected

123 EMP EBA PEN Empanelment Empanelment Change of Bank Account Number

Pending

124 EMP EBA APP Empanelment Empanelment Change of Bank Account Number

Approved

125 EMP EXD INT Empanelment Expertise Details Initiated

126 EMP EXD UPD Empanelment Expertise Details Updated

127 EMP EXD RAP Empanelment Expertise Details Recommended for Approval

128 EMP EXD REJ Empanelment Expertise Details Rejected

129 EMP EXD PEN Empanelment Expertise Details Pending

130 EMP EXD APP Empanelment Expertise Details Approved

131 OPR FOL SUB Operations Follow-up Cases Submitted

132 OPR FOL UPD Operations Follow-up Cases Updated

133 OPR FOL FWD Operations Follow-up Cases Forwarded

134 OPR FOL RAP Operations Follow-up Cases Recommended for Approval

135 OPR FOL RRJ Operations Follow-up Cases Recommended for Rejection

136 OPR FOL PEN Operations Follow-up Cases Pending

137 OPR FOL APP Operations Follow-up Cases Approved

68

Sl.no Major Group

Minor Group

Sub Catego ry




138 OPR FOL REJ Operations Follow-up Cases Rejected

139 OPR FCH SUB Operations Follow-up Cochlear Cases

Submitted

140 OPR FCH UPD Operations Follow-up Cochlear Cases

Updated

141 OPR FCH FWD Operations Follow-up Cochlear Cases

Forwarded

142 OPR FCH RAP Operations Follow-up Cochlear Cases


143 OPR FCH RRJ Operations Follow-up Cochlear Cases


144 OPR FCH PEN Operations Follow-up Cochlear Cases

Pending

145 OPR FCH APP Operations Follow-up Cochlear Cases

Approved

146 FOP NAM ATN Operations Network Vaidyamitra

Attendance

147 FOP NAM PCL Operations Network Vaidyamitra

Preauth Cleared

148 FOP NAM REG Operations Network Vaidyamitra

Registered

149 FOP NAM CON Operations Network Vaidyamitra

Conversions

150 FOP NAM FOL Operations Network Vaidyamitra

Follow-up

151 FOP NAM REF Operations Network Vaidyamitra

Referred Cases

152 FOP NAM BUP Operations Network Vaidyamitra

On-bed Updation

153 FOP PAM ATN Operations PHC Vaidyamitra

Attendance

154 FOP PAM REG Operations PHC Vaidyamitra

Registered

155 FOP PAM REF Operations PHC Vaidyamitra

Referred

156 FOP PAM CON Operations PHC Vaidyamitra

Conversions

157 FOP PAM FVS Operations PHC Vaidyamitra

Follow-up eligible case Visits

158 FOP PAM FOL Operations PHC Vaidyamitra

Follow-up

159 FOP PAM IEC Operations PHC Vaidyamitra

IEC

69

12. DATA TYPES AND NOTATIONS USED

Data Types for Indicators used

A Absolute Numbers

Re Real Numbers

P Percentage

R Rate

G Average

N Proportion

Rt Ratio

Notations used in the document

D Day W Week

M Month

Q Quarter

H Half Yearly

Y Yearly

Cum Cumulative

NA Not Any

Notations used for frequency of monitoring an indicator

Y Yes

N No

70

13. DEFINITION DICTIONARY

Id Definition name

Description

1

n' user card

A utilized card which is used by only n users of the family either one or more times, for one or more uses each time it is used. n <= number of members in the family card

2

Times of use of a card

Times of use of a card indicates the number of different times the card is used by a user, each time the card being used for one or more therapies. For ex: A hemodialysis patient would be using a card many times in a year

3

Uses of a card

Uses of a card indicates the number of therapies for which preauthorisation is given at one time for a user. For ex: an accident case may have three therapies preauthorised at the same time, in which case it is said the card is used once for three uses

4

Cards utilized or used for a given therapy

The frequency count of cards for which preauthorisation is given at least one time for at least one use of the therapy, during one or more specified periods (usually policy periods). A card for which preauthorisation is given more than once needs to be counted as a single card utilized.

5 Package Price Price per single performance of a therapy on a patient

6 Bed Unit (BU) 50 Beds (A NWH with 50 beds empanelled for one or more specialities)

7 From date The date from which the policy period started, in dd-mm-yyyy format.

8 To date The date on which the policy period ended, in dd-mm-yyyy format.

9

Policy Period (PP)

The time period between the start and end of an insurance contract during which a beneficiary unit will be eligible for a fixed financial cover.

10

Period Falling in FY (PFF)

The number of days which fall in the particular FY out of the total number of days in the PP. (= Latest date of PP falling in FY - Earliest date of PP falling in the same FY)

11

Major PP / Minor PP

Two policy periods fall in any financial year for the insurance scheme. The PP having the major share in the 365 days of FY is called major PP and the PP having the minor share in 365 days of FY is called minor PP.

71

12

Card Year

Card Year concept is a standardized measure of measuring the cards covered and their duration with exactness over a period of time. Even if the number of cards covered changes during the time period they will be considered using this measure. For example: 50 cards were covered in the first 6 months and later in the next 6 months 100 cards were covered (i.e. 50 cards were added during the middle of a year) and this is expressed as (25 cardyears+50 card years = 75 card years). 'x card years' represents that an equivalent to x number of cards were covered for one year during that period. We calculate card years at two levels. (1)For all the cards covered during a period and (2) the utilized cards during a period. There are a set of indicators which we want to calculate among the utilized cards. While calculating card years for utilized cards (only the utilized cards are taken into account and the duration for which they were covered). For example: we have a set of 700 cards covered for 1 year (i.e. 700 card years) and only 300 cards among these 700 cards were utilized. So while calculating indicators for utilized cards the denominator would be 300 card years. Interpretation of these indicators would be: Among the utilized cards, the average number of times a particular therapy has been performed per card year. These set of indicators are used to capture the change in the utility pattern of a particular therapy and so on (at card level).

13

Person Year

Person Year concept is a standardized measure of measuring the number of persons that were covered and their duration with exactness over a period of time. Even if the number of persons covered changes during the time period they will be considered using this measure. For example: 50 persons were covered in the first 6 months and later in the next 6 months 100 persons were covered (i.e. 50 persons were added during the middle of a year) and this is expressed as (25 personyears+50 person years = 75 person years). 'x person years' represents that an equivalent to x number of persons were covered for one year. We calculate person years at two levels. (1)For all the persons covered during a period and (2) for utilized persons covered during a period. There are a set of indicators which we want to calculate among the utilized persons. While calculating person years for utilized persons (only the utilized persons are taken into account and the duration for which they were covered). For example: we have covered 900 persons for 1 year (i.e. 900 person years) and only 300 persons among these 900 persons have utilized the services. So while calculating indicators for utilized persons the denominator would be 300 person years. Interpretation of these indicators would be: Among the utilized persons, the average number of times a particular therapy has been performed per person year. These set of indicators are used to capture the change in the utility pattern of a particular therapy and so on (at person level).

72

14 Procedure Basket

Procedure basket is a collection of specified procedures that are available in our scheme at a particular point of time.

15

Weights

We use two types of weights: Bare Weights and Weights. They are always calculated cumulatively (i.e. using data from the beginning of the scheme till the current date).

16

Defined Set of Therapies

A defined set of therapies is a specific set of therapies say (t1, t2, t3, t4) which are selected from the procedure basket. A defined set of therapies can also be all the therapies available in the procedure basket in some circumstances.

73

14. LIST OF INDICATORS

Gsl n

Indicator Name Indicator Code

Indicator Acronym Pg No.

1

Number of Cards Covered ADM-SCO- PCO-001

CCO

95

2

Number of Persons covered ADM-SCO- PCO-002

PCO

96

3

Number of Therapies available ADM-SCO- BCO-001

THR_AV

97

4

Number of Therapies applicable ADM-SCO- BCO-002

THR_APP

98

5 Number of Medical Specialities Available

ADM-SCO- BCO-003

MCAT_AV

100

6 Number of Surgical Specialities Available

ADM-SCO- BCO-004

SCAT_AV

101

7

Premium Paid ADM-SCO- FCO-001

PR_PA

102

8

Bare Premium ADM-SCO- FCO-002

BR_PR

103

9

Proportionate Premium

ADM-SCO- FCO-003

PRO_PR

104

10

Premium paid per card

ADM-SCO- FCO-004

PR_PA_PCRD

105

11

Cards Utilized

ADM-SUT- CUT-001

CRD_UTI

107

12

Covered Card-years ADM-SUT- CUT-002

CCY

108

13

Utilised card-years ADM-SUT- CUT-003

UCY

110

14

Persons Utilized ADM-SUT- PUT-001

P_UTI

111

15

Covered Person-years ADM-SUT- PUT-002

CPY

113

16

Utilised person-years

ADM-SUT- PUT-003

UPY

114

17

Therapies done (TD=TrR_U) ADM-SUT- TUT-001

TD

116

18

Therapies discharged

ADM-SUT- TUT-002

TDIS

117

19

Therapies Claim raised ADM-SUT- TUT-003

CL_RS

118

20

Therapy Claim Approved ADM-SUT- TUT-004

CLA

120

21

Therapy Claim Rejected

ADM-SUT- TUT-005

CLR

121

74

Gsl n



22

Therapy Claim kept Pending ADM-SUT- TUT-006

CLPN

122

23

Therapy Claim Lapsed ADM-SUT- TUT-007

CL_LP

123

24

Therapies Claim paid

ADM-SUT- TUT-008

CLB_A

125

25

Claims amount paid for therapies preauthed during a specified period

ADM-SUT- TUT-009

CL_PCST_TP

126

26

Claim amount paid for therapies during a specified period

ADM-SUT- TUT-010

CL_PCST_D

127

27

Card Utilization Rate ADM-SUT- UTR-001

CUR

128

28

Person Utilization Rate ADM-SUT- UTR-002

PUR

130

29

Average number of times a Therapy was performed per 100 card-years among the covered cards

ADM-SUT- UTR-003

ATPCC

131

30

Average number of times a Therapy was performed per 100 card-years among the utilized cards

ADM-SUT- UTR-004

ATPUC

132

31

Average number of times a Therapy was performed per 100 person-years among covered persons

ADM-SUT- UTR-005

ATPCP

134

32

Average number of times a Therapy was performed per 100 person-years among utilized persons

ADM-SUT- UTR-006

ATPUP

135

33

Average number of cards utilized per 100 card years among the covered cards

ADM-SUT- UTR-007

ACPCC

136

34

Average number of Persons who Utilized a service per 100 card years among the covered cards

ADM-SUT- UTR-008

APPCC

138

35

Average number of Persons who Utilized a service per 100 card years among utilized cards

ADM-SUT- UTR-009

APPUC

139

36

Average number of times a card is used per 100 card years among the covered cards

ADM-SUT- UTR-010

ATIPCC

140

37 Average number of times a utilized card is used per 100 card years

ADM-SUT- UTR-011

ATIPUC

141

75

Gsl n



among the utilized cards

38 Average number of therapies used per one time usage of a card

ADM-SUT- UTR-012

AUPUC

143

39

Claim Rate for a [dimension] ADM-SUT- CLR-001

CLR

144

40

Claim Deduction Ratio ADM-SUT- CLR-002

CDR

145

41

Weight ADM-SUT- WGT-001

WT_DIM

146

42

Bare Weight ADM-SUT- WGT-002

BW_DIM

147

43

Claim Ratio ADM-SEP- CRT-001

CR

149

44

Bare Claim Ratio ADM-SEP- CRT-002

BCR

150

45

Premium Claim Difference ADM-SEP- CRT-003

PCD

151

46

Average Preauth Size ADM-SEP- CRT-004

APS

152

47

Average Claim Size ADM-SEP- CRT-005

ACS

154

48 Interest Earned by Insurer on Unspent Premium for a phase

ADM-SEP- CRT-006

INT_INS

155

49

Therapies Claim Outstanding for a specified period

ADM-SEP- CCO-001

TCO

156

50 Therapies Claim Outstanding Cost for a specified period

ADM-SEP- CCO-002

TCOC

157

51

Therapies Claim Pending at Bank for a specified period

ADM-SEP- CCO-003

TCB

158

52 Therapies Claim Pending at Bank Cost for a specified period

ADM-SEP- CCO-004

TCBC

160

53

Health Camp Claim Outstanding ADM-SEP- CCO-005

HC_CL_O

161

54 Health Camp Claim Outstanding Cost

ADM-SEP- CCO-006

HC_CLOC

162

55

Health Camp Claim pending ADM-SEP- CCO-007

HC_CLPN

163

56

Health Camp Claim Pending Cost ADM-SEP- CCO-008

HC_CLPNC

165

57

The R² value ADM-SEP- FFO-001

M_PA

166

58

The curve that is fitted ADM-SEP- FFO-002

M_CU

167

59

Error Plot

ADM-SEP- FFO-003

M_ERRPLT

168

76

Gsl n



60

Forecast data date ADM-SEP- FFO-004

M_FCST_DT

169

61 Weight of Specified Procedure Basket

ADM-SEP- FFO-005

FCST_RF_WT

170

62

Weight of month's Procedure Basket

ADM-SEP- FFO-006

FCST_MN_WT

172

63 Therapy Claim Paid-Total for a month

ADM-SEP- FFO-007

FCST_TH_CLM

173

64 Relative claim Paid for the month for RAS

ADM-SEP- FFO-008

FCST_RL_CLM

174

65

Relative Total Claim ADM-SEP- FFO-009

FCST_RL_TCLM

175

66

Cumulative relative Claim (Cr)

ADM-SEP- FFO-010

FCST_CL_RCLM

177

67

Hospital Beds

FOP-NWH- ***-001

HB

178

68

Reserved Beds in a NWH FOP-NWH- ***-002

RB

179

69

Occupied Beds in a NWH

FOP-NWH- ***-003

OB

180

70 Occupied Bed-days in a NWH, during a specified period

FOP-NWH- ***-004

OBD

181

71

Hospital OP in a NWH FOP-NWH- ***-005

OP

182

72

Hospital IP in a NWH FOP-NWH- ***-006

IP

183

73

Dr.NTR Vaidya Seva Bed Occupancy Rate, during a specified period

FOP-NWH- ***-007

BOR

184

74 Therapy-month for a given therapy, during a specified period

FOP-NWH- ***-008

THR_MTH

186

75

Bed Occupancy updation time FOP-NWH- ***-009

OB

187

76

Health Camps Conducted FOP-HCA- ***-001

HCC

188

77

Patients Screened FOP-HCA- ***-002

HCPS

189

78

Patients Referred FOP-HCA- ***-003

HCPR

190

79

Health Camp Rate

FOP-HCA- ***-004

HCR

192

80

Patients Screening Rate

FOP-HCA- ***-005

HCSR

193

81

HC patient referral capture rate

FOP-HCA- ***-006

HCAP

194

77

Gsl n



82

HC patient referral conversion rate FOP-HCA- ***-007

HCON

195

83

Follow-up eligible cases FOP-FUC-***- 001

FU_ECS

196

84

Follow-up availed cases

FOP-FUC-***- 002

FU_ACS

197

85

Follow-up claim submitted cases FOP-FUC-***- 003

FU_CSCS

199

86

Follow-up claim approved cases FOP-FUC-***- 004

FU_CACS

200

87 Percentage of therapies done in Government hospitals

FOP-GHP- ***-001

PCT_TDN_GH

201

88

Percentage of the cost for therapies done in Government hospitals

FOP-GHP- ***-002

PCT_CSTTDN_GH

202

89 Government Hospital Preauths through Health Camp Route

FOP-GHP- ***-003

HC_RT_GH

203

90 Private Hospital Preauths through Health Camp Route

FOP-GHP- ***-004

HC_RT_PH

205

91

Grievance Arrivals during a specified period

GRE-GRE- ***-001

GR_ARRV

206

92 Relative Frequency of Grievances during a specified period

GRE-GRE- ***-002

RFG

207

93

Grievance Rate during a specified period

GRE-GRE- ***-003

GR

208

94 Feedback letter Return Rate during a specified period

GRE-GRE- ***-004

FB_RR

210

95

Adverse Feedback Rate during a specified period

GRE-GRE- ***-005

AFR

211

96

Relative Bed Units for a NWH EDM-EMP- HUT-001

RBU

212

97

Empanelment Weight for a NWH EDM-EMP- HUT-002

EW

213

98

Weighted Average Cases per month for a NWH, for a specified period

EDM-EMP- HUT-003

WAC

215

99

Weighted Standard Deviation for a NWH

EDM-EMP- HUT-004

WSD

216

100 Average Categories per NWH during a specified period

EDM-EMP- HUT-005

ACN

218

101 Therapies preauthed per Category in a given NWH

EDM-EMP- HUT-006

THR_PA_CA

219

102

Percentage of therapies done by Government Doctors in Private hospitals during a specified period

EDM-EMP- HUT-007

PCT_THR_GVTDOC

220

78

Gsl n



103

Revolving Fund from the Preauthorisation's done during a specific period of time

EDM-EMP- HUT-008

RF

221

104

Case Fatality Rate EDM-MAU- ***-001

CFR

223

105

Therapies preauth submitted by MEDCO

OPR-PAU- SUB-001

PAU_S_R PAUC_S_R

224

106

Therapies Preauth Submitted by MEDCO and Live

OPR-PAU- SUB-002

LPAU_S_R LPAUC_S_R

225

107

Therapies Preauth Submitted by MEDCO in Past

OPR-PAU- SUB-003

PPAU_S_R PPAUC_S_R

227

108 Therapies Preauth Updated by MEDCO

OPR-PAU- UPD-001

PAU_U_R

PAUC_U_R

228

109 Therapies Preauth Updated by MEDCO and Live

OPR-PAU- UPD-002

LPAU_U_R LPAUC_U_R

229

110

Therapies Preauth Updated by MEDCO in Past

OPR-PAU- UPD-003

PPAU_U_R PPAUC_U_R

230

111

Therapies Preauth Updated by MEDCO and sent to Preauth operator

OPR-PAU- UPD-004

PAU_U_R_PPD PAU_U_R_PTD PAU_U_R_PAO

231

112

Therapies Preauth cancellation Updated by MEDCO and sent to Preauth operator

OPR-PAU- UPD-005

PAUC_U_R_PPD PAUC_U_R_PTD PAUC_U_R_PAO

233

113 Therapies Preauth Forwarded by NAM

OPR-PAU- FWD-001

PAU_F_N

234

114 Therapies Preauth Forwarded by NAM and Live

OPR-PAU- FWD-002

LPAU_F_N

235

115 Therapies Preauth Forwarded by NAM in Past

OPR-PAU- FWD-003

PPAU_F_N

236

116

Therapies Preauth Disposed by Preauth operator with Recommendation for Approval

OPR-PAU- RAP-001

PAU_RA_PPD PAU_RA_PID PAU_RA_PTD

237

117

Therapies Preauth Disposed by Preauth operator with Recommendation for Approval and Live

OPR-PAU- RAP-002

LPAU_RA_PPD LPAU_RA_PID LPAU_RA_PTD

239

118

Therapies Preauth Disposed by Preauth operator with Recommendation for Approval in the Past

OPR-PAU- RAP-003

PPAU_RA_PPD PPAU_RA_PID PPAU_RA_PTD

240

119

Therapies Preauth Disposed by Preauth operator with Recommendation for Approval without pendency

OPR-PAU- RAP-004

PAU_RA~NP_PPD PAU_RA~NP_PID PAU_RA~NP_PTD

241

79

Gsl n



120

Therapies Preauth Disposed by Preauth operator with Recommendation for Approval after pendency

OPR-PAU- RAP-005

PAU_RA~P_PPD PAU_RA~P_PID PAU_RA~P_PTD

243

121

Therapies Preauth Cancellation request Disposed by Preauth operator with Recommendation for Approval

OPR-PAU- RAP-006

PAUC_RA_PPD PAUC_RA_PID PAUC_RA_PTD

244

122

Therapies Preauth Cancellation request Disposed by Preauth operator with Recommendation for Approval (RA)and Live

OPR-PAU- RAP-007

LPAUC_RA_PPD LPAUC_RA_PID LPAUC_RA_PTD

245

123

Therapies Preauth Cancellation request Disposed by with Preauth operator with Recommendation for Approval (RA) in the Past

OPR-PAU- RAP-008

PPAUC_RA_PPD PPAUC_RA_PID PPAUC_RA_PTD

247

124

Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection(RR)

OPR-PAU- RRJ-001

PAU_RR_PPD PAU_RR_PID PAU_RR_PTD

248

125

Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection and live

OPR-PAU- RRJ-002

LPAU_RR_PPD

LPAU_RR_PID

LPAU_RR_PTD

249

126

Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection in the Past

OPR-PAU- RRJ-003

PPAU_RR_PPD

PPAU_RR_PID

PPAU_RR_PTD

251

127

Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection without pendency

OPR-PAU- RRJ-004

PAU_RR~NP_PPD PAU_RR~NP_PID PAU_RR~NP_PTD

252

128

Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection after pendency

OPR-PAU- RRJ-005

PAU_RR~P_PPD PAU_RR~P_PID PAU_RR~P_PTD

253

129 Therapies Preauth Disposed by Preauth operator with Pendency

OPR-PAU- PEN-001

PAU_P_PPD PAU_P_PID PAU_P_PTD

254

130

Therapies Preauth Disposed by Preauth operator with Pendency and Live

OPR-PAU- PEN-002

LPAU_P_PPD LPAU_P_PID LPAU_P_PTD

256

131

Therapies Preauth Disposed by Preauth operator with Pendency in the Past

OPR-PAU- PEN-003

PPAU_P_PPD PPAU_P_PID PPAU_P_PTD

257

80

Gsl n



132

Total number of therapies preauthorisation kept pending during specified period

OPR-PAU- PEN-004

PAU_P_T

258

133

Therapies Preauth cancellation request disposed by Preauth operator with Pendency

OPR-PAU- PEN-005

PAUC_P_PPD PAUC_P_PID PAUC_P_PTD

259

134

Therapies Preauth cancellation request Disposed by Preauth operator with Pendency and Live

OPR-PAU- PEN-006

LPAUC_P_PPD LPAUC_P_PID LPAUC_P_PTD

261

135

Therapies Preauth cancellation request disposed by Preauth operator with Pendency in the Past

OPR-PAU- PEN-007

PPAUC_P_PPD PPAUC_P_PID PPAUC_P_PTD

262

136 Therapies Preauth Disposed by Preauth operator with Approval

OPR-PAU- APP-001

PAU_A_PTD PAU_A_PAO

263

137

Total number of therapies preauthorisation approved during specified period

OPR-PAU- APP-002

PAU_A_T

264

138

Therapies Preauth Disposed by Preauth operator with Approval without pendency

OPR-PAU- APP-003

PAU_A~NP_PTD PAU_A~NP_PAO

266

139

Therapies Preauth Disposed by Preauth operator with Approval after pendency

OPR-PAU- APP-004

PAU_A~P_PTD PAU_A~P_PAO

267

140

Therapies Preauth cancellation request Disposed by Preauth operator with Approval

OPR-PAU- APP-005

PAUC_A_PTD PAUC_A_PAO

268

141

Total number of Therapies Preauth cancellation request disposed by Approval

OPR-PAU- APP-006

PAUC_A_T

269

142 Therapies Preauth Disposed by Preauth operator with Rejection

OPR-PAU- REJ-001

PAU_R_PTD PAU_R_PAO

270

143

Therapies Preauth Disposed by Preauth operator with Rejection without pendency

OPR-PAU- REJ-002

PAU_R~NP_PTD PAU_R~NP_PAO

272

144

Therapies Preauth Disposed by Preauth operator with Rejection after pendency

OPR-PAU- REJ-003

PAU_R~P_PTD PAU_R~P_PAO

273

145

Total number of therapies preauthorisation rejected during specified period

OPR-PAU- REJ-004

PAU_R_T

274

146

Total Therapies Preauth Disposed by PPD

OPR-PAU- TDP-001

PAU_D_PPD

275

147

Total Therapies Preauth Disposed by PTD

OPR-PAU- TDP-002

PAU_D_PTD

276

81

Gsl n



148 Total Therapies Preauth Disposed by PAO

OPR-PAU- TDP-003

PAU_D_PAO

277

149 Therapies Preauth disposed by auto cancellation

OPR-PAU- AUC-001

PAU_D_AUC

279

150

Therapies treatment Updated by MEDCO

OPR-TRT- UPD-001

TRT_U_R_SUR TRT_U_R_MTR

280

151 Therapies treatment Updated by MEDCO and Live

OPR-TRT- UPD-002

LTRT_U_R_SUR LTRT_U_R_MTR

281

152 Therapies treatment Updated by MEDCO in Past

OPR-TRT- UPD-003

PTRT_U_R_SUR PTRT_U_R_MTR

282

153 Total Therapies Treatment Updated by MEDCO

OPR-TRT- UPD-004

TRT_U_R_T

283

154

Total Therapies Treatment Updated by MEDCO and Live

OPR-TRT- UPD-005

LTRT_U_R_T

284

155

Total Therapies Treatment Updated by MEDCO in Past

OPR-TRT- UPD-006

PTRT_U_R_T

286

156 Therapies Discharge Updated by MEDCO

OPR-DSC- UPD-001

DSC_U_R

287

157

Therapies Death Updated by MEDCO/Executive

OPR-DEA- UPD-001

DEA_U_R DEA_U_X

288

158

Therapies Preauth Waiting for <12 hrs at preauth operator

OPR-PAU- WTC-001

PAU_W<12hrs-NAM PAU_W<12hrs-MEDCO PAU_W<12hrs-PPD PAU_W<12hrs-PTD PAU_W<12hrs-PAO

289

159

Therapies Preauth Waiting for >12 hrs at various levels

OPR-PAU- WTC-002

PAU_W>12hrs_NAM PAU_W>12hrs_MEDCO PAU_W>12hrs_PPD PAU_W>12hrs_PTD PAU_W>12hrs_PAO

290

160 Therapies Preauth Waiting at Preauth operator afresh

OPR-PAU- WTC-003

PAUF_W_PPD PAUF_W_PTD PAUF_W_PAO

292

161

Therapies Preauth Waiting at Preauth operator after updation of pendency

OPR-PAU- WTC-004

PAUP_W_PPD PAUP_W_PTD PAUP_W_PAO

293

162 Total Therapies Preauth Waiting at NAM

OPR-PAU- TWT-001

PAU_W_N

294

163 Therapies Preauth Waiting at MEDCO

OPR-PAU- TWT-002

PAU_W_R

295

164 Total Therapies Preauth Waiting at Preauth operator

OPR-PAU- TWT-003

PAU_W_PPD

296

165 Total Therapies Preauth Waiting at Preauth operator

OPR-PAU- TWT-004

PAU_W_PTD

297

166

Total Therapies Preauth Waiting at Preauth operator

OPR-PAU- TWT-005

PAU_W_PAO

299

82

Gsl n



167

Therapies Preauth Waiting at Trust OPR-PAU- TWT-006

PAU_W_TRU

300

168

Therapies Preauth Waiting at NWH OPR-PAU- TWT-007

PAU_W_NWH

301

169

Total Therapies Preauth Waiting

OPR-PAU- TWT-008

PAU_W_T

302

170 Therapies preauthed waiting for Treatment for >15 days

OPR-TRT- WTC-001

TRT_W>15days_R_SUR TRT_W>15days_R_MTR

303

171 Therapies preauthed waiting for Treatment for <15 days

OPR-TRT- WTC-002

TRT_W<15days_R SUR TRT_W<15days_R_MTR

304

172 Total Therapies waiting for Treatment for >15 days

OPR-TRT- WTC-003

TRT_W>15days_R_T

305

173

Total Therapies waiting for <15 days Treatment

OPR-TRT- WTC-004

TRT_W<15days_R_T

307

174

Total Therapies preauthed waiting for Treatment

OPR-TRT- WTC-005

TRT_W_R_T

308

175 Therapies waiting for discharge after Treatment for <15 days

OPR-DSC- WTC-001

DSC_W<15days_R_SUR DSC_W<15days_R_MTR

309

176

Therapies waiting for discharge after treatment for >15 days

OPR-DSC- WTC-002

DSC_W>15days_R_SUR DSC_W>15days_R_MTR

310

177 Total Therapies waiting for discharge after treatment

OPR-DSC- WTC-003

DSC_W_R_T

311

178

Average Case Waiting time for a therapy preauth case at NAM during a specified period

OPR-PAU- AWT-001

PAU_AWT N

312

179

Average case waiting time for a therapy preauth case at MEDCO during a specified period

OPR-PAU- AWT-002

PAU_AWT_R

314

180

Average case waiting time for a therapy preauth case at Preauth operator for a case during a specified period

OPR-PAU- AWT-003

PAU_AWT_PPD PAU_AWT_PTD PAU_AWT_PAO

315

181

Average case waiting time for a fresh therapy preauth case at Preauth operator during a specified period

OPR-PAU- AWT-004

PAUF_AWT_PPD PAUF_AWT_PTD PAUF_AWT_PAO

316

182

Average case waiting time at Preauth operator for a pending preauth updated case during a specified period

OPR-PAU- AWT-005

PAUP_AWT_PPD PAUP_AWT_PTD PAUP_AWT_PAO

317

183

Average waiting time at Trust for a preauth case during a specified period

OPR-PAU- AWT-006

PAU_AWT_TRU

319

184 Average waiting time at NWH for a preauth case during a specified

OPR-PAU- AWT-007

PAU_AWT_NWH

320

83

Gsl n



period

185 Average total waiting time for a preauth case

OPR-PAU- AWT-008

PAU_AWT_T

321

186

Average waiting time for treatment updation for a preauth approved case

OPR-TRT- AWT-001

TRT_AWT_SUR TRT_AWT_MTR

322

187

Average discharge updation waiting time for a preauth approved case during a specified period

OPR-DSC- AWT-001

DSC_AWT_SUR DSC_AWT_MTR

323

188

On-bed time for a case

OPR-OBD- AWT-001

OBD_AWT_SUR OBD_AWT_MTR

325

189

Hourly Preauth Arrival for each of the 24 hours in a day

OPR-PAU- HPA-001

PAU_HA

326

190

Preauth Arrival Rate OPR-PAU- ART-001

PAU_ART

327

191

Hourly Preauth approval for each of the 24 hours in a day

OPR-PAU- HAP-001

PAU_HAP

328

192

Preauth Approval rate OPR-PAU- APR-001

PAU_APR

329

193 Daily Turnover of preauth cases by Preauth operator

OPR-PAU- DTO-001

PAU_DTO_PPD PAU_DTO_PTD PAU_DTO_PAO

330

194 Preauth Turnover Rate for Preauth operator

OPR-PAU- TOR-001

PAU_TOR_PPD PAU_TOR_PTD PAU_TOR_PAO

332

195

Average Case Processing Time of Preauth Operator, during a specified period

OPR-PAU- CPT-001

PAU_ACPT

333

196

Preauth Pendency Percentage for Preauth Operator during a specified period

OPR-PAU- PPP-001

PAU_PPP_PPD PAU_PPP_PTD PAU_PPP_PAO

334

197 Telephonic Intimations PEX Approved

OPR-PAU- TIN-001

PAU_TIN_A_X

335

198

Preauthorisations-Regular-With buffer PTD Recommended Approval

OPR-PAU- BUF-001

BPAU_RA_PTD

336

199

Preauthorisations-Regular-With buffer PTD Recommended Rejection

OPR-PAU- BUF-002

BPAU_RR_PTD

338

200

Preauthorisations-Regular-With buffer PTD Pending

OPR-PAU- BUF-003

BPAU_P_PTD BPAU_P_PAO

339

201

Preauthorisations-Regular-With buffer PAO Approved

OPR-PAU- BUF-004

BPAU_A_PAO

340

202

Preauthorisations-Regular-With

OPR-PAU-

BPAU_R_PAO 341

84

Gsl n



buffer PAO Rejected BUF-005

203 Pre-authorisations - Enhancement MEDCO Initiated

OPR-PAU- ENH-001

PAU_ENH_I_R

342

204 Pre-authorisations - Enhancement MEDCO Updated

OPR-PAU- ENH-002

PAU_ENH_U_R

343

205 Pre-authorisations Enhancement updation waiting MEDCO

OPR-PAU- ENH-003

PAU_ENH_U_W_R

344

206

Pre-authorisations - Enhancement Preauth Operator Recommended Approval

OPR-PAU- ENH-004

PAU_ENH_RA_PTD PAU_ENH_RA_MC-ETC

345

207 Pre-authorisations - Enhancement Preauth Operator Rejected

OPR-PAU- ENH-005

PAU_ENH_R_PTD PAU_ENH_R_MC-ETC PAU_ENH_R_PAO

347

208 Pre-authorisations - Enhancement Preauth Operator Pending

OPR-PAU- ENH-006

PAU_ENH_P_PTD PAU_ENH_P_MC-ETC PAU_ENH_P_PAO

348

209 Pre-authorisations - Enhancement PAO Approved

OPR-PAU- ENH-007

PAU_ENH_A_PAO

349

210 Pre-authorisations Enhancement cases waiting at Preauth Operator

OPR-PAU- ENH-008

PAU_ENH_W_PTD PAU_ENH_W_MC-ETC PAU_ENH_W_PAO

350

211 Pre-Authorisations-Cochlear Cases Initiated by MEDCO

OPR-PAU- CCH-001

PAU_CCH_I_R

351

212 Pre-Authorisations-Cochlear Cases Updated by MEDCO

OPR-PAU- CCH-002

PAU_CCH_U_R

353

213 Pre-authorisations Cochlear cases updation waiting at MEDCO

OPR-PAU- CCH-003

PAU_CCH_W_R

354

214

Pre-Authorisations-Cochlear Cases forwarded by Preauth Operator

OPR-PAU- CCH-004

PAU_CCH_F_N PAU_CCH_F_X

355

215

Pre-authorisations Cochlear cases waiting at Preauth Operator

OPR-PAU- CCH-005

PAU_CCH_W_N PAU_CCH_W_X

356

216

Pre-Authorisations-Cochlear Cases Recommended Approval by Preauth Operator

OPR-PAU- CCH-006

PAU_CCH_RA_MC-CC PAU_CCH_RA_C-CC

357

217

Pre-Authorisations-Cochlear Cases Recommended Rejection by Preauth Operator

OPR-PAU- CCH-007

PAU_CCH_RR_MC-CC PAU_CCH_RR_C-CC

358

218 Pre-Authorisations-Cochlear Cases Pending with Preauth Operator

OPR-PAU- CCH-008

PAU_CCH_P_MC-CC PAU_CCH_P_C-CC PAU_CCH_P_PAO

360

219 Pre-authorisations Cochlear cases waiting with Preauth Operator

OPR-PAU- CCH-009

PAU_CCH_W_MC-CC PAU_CCH_W_C-CC PAU_CCH_W_PAO

361

220 Pre-Authorisations-Cochlear Cases C-CC Rejected by Preauth Operator

OPR-PAU- CCH-010

PAU_CCH_R_C-CC PAU_CCH_R_PAO

362

85

Gsl n



221 Pre-Authorisations-Cochlear Cases PAO Approved

OPR-PAU- CCH-011

PAU_CCH_A_C-CC PAU_CCH_A_PAO

363

222 Pre-auth Cochlear Cancel Requests MEDCO Initiated

OPR-PAU- CCH-012

PAUC _CCH_I_R

365

223

Pre-auth Cochlear cases Cancel Requests MEDCO Updated

OPR-PAU- CCH-013

PAUC_CCH_U_R

366

224 Pre-auth Cochlear cases Cancel Requests waiting with MEDCO

OPR-PAU- CCH-014

PAUC_CCH_W_R

367

225

Pre-Authorisations-Cochlear Cases Cancel Requests Recommended Approval by preauth operator

OPR-PAU- CCH-015

PAUC_CCH_RA_MC-CC PAUC_CCH_RA_C-CC

368

226

Pre-Authorisations-Cochlear Cases Cancel Requests Recommended Rejection by preauth operator

OPR-PAU- CCH-016

PAUC_CCH_RR_MC-CC PAUC_CCH_RR_C-CC

369

227

Pre-Authorisations-Cochlear Cases Cancel Requests Pending by preauth operator

OPR-PAU- CCH-017

PAUC_CCH_P_MC-CC PAUC_CCH_P_C-CC

370

228

Pre-auth Cochlear cases Cancel Requests waiting with preauth operator

OPR-PAU- CCH-018

PAUC_CCH_W_MC-CC PAUC_CCH_W_C-CC

372

229

Pre-Authorisations-Cochlear Cases Cancel Requests Rejected by preauth operator

OPR-PAU- CCH-019

PAUC_CCH_R_C-CC

373

230

Therapy Claims Eligible

OPR-CLM- ELG-001

CLM_ELG

374

231

Therapy Claims submitted OPR-CLM- SUB-001

CLM_S_R

375

232

Therapy Claims submitted and Live

OPR-CLM- SUB-002

LCLM_S_R

376

233

Therapy Claims submitted in Past OPR-CLM- SUB-003

PCLM_S_R

377

234 Therapy Claims Updated by MEDCO

OPR-CLM- UPD-001

CLM_U_R

378

235 Therapy Claims Updated by MEDCO and Live

OPR-CLM- UPD-002

LCLM_U_R

379

236 Therapy Claims Updated by MEDCO in Past

OPR-CLM- UPD-003

PCLM_U_R

381

237

Therapy Claims Updated by MEDCO and sent to Claims operator

OPR-CLM- WTC-001

CLM_W_CPD CLM_W_CTD CLM_W_CH CLM_W_CAO

382

238

Therapy Claims Forwarded by CEX OPR-CLM- FWD-001

CLM_F_X

383

239

Therapy Claims Forwarded by CEX and Live

OPR-CLM- FWD-002

LCLM_F_X

384

86

Gsl n



240 Therapy Claims Forwarded by CEX in Past

OPR-CLM- FWD-003

PCLM_F_X

385

241

Therapy Claims Disposed by Claims operator with Recommended for Approval

OPR-CLM- RAP-001

CLM_RA_CPD CLM_RA_CTD CLM_RA_CH

386

242

Therapy Claims Disposed by Claims operator with Recommended for Approval and Live

OPR-CLM- RAP-002

LCLM_RA_CPD LCLM_RA_CTD LCLM_RA_CH

388

243

Therapy Claims Disposed by Claims operator with Recommended for Approval in the Past

OPR-CLM- RAP-003

PCLM_RA_CPD PCLM_RA_CTD PCLM_RA_CH

389

244

Therapy Claims Disposed by Claims operator with Recommended for Approval without pendency

OPR-CLM- RAP-004

CLM_RA~NP_CTD CLM_RA~NP_CH

390

245

Therapy Claims Disposed by Claims operator with Recommended for Approval after pendency

OPR-CLM- RAP-005

CLM_RA~P_CTD CLM_RA~P_CH

391

246 Therapy Claims Disposed by Claims operator with RR

OPR-CLM- RRJ-001

CLM_RR_CPD CLM_RR_CTD CLM_RR_CH

393

247

Therapy Claims Disposed by Claims operator with Recommendation for Rejection and Live

OPR-CLM- RRJ-002

LCLM_RR_CPD LCLM_RR_CTD LCLM_RR_CH

394

248

Therapy Claims Disposed by Claims operator with Recommendation for Rejection in the Past

OPR-CLM- RRJ-003

PCLM_RR_CPD PCLM_RR_CTD PCLM_RR_CH

395

249

Therapy Claims Disposed by Claims operator with Recommendation for Rejection without pendency

OPR-CLM- RRJ-004

CLM_RR~NP_CTD CLM_RR~NP_CH

396

250

Therapy Claims Disposed by Claims operator with Recommendation for Rejection after pendency

OPR-CLM- RRJ-005

CLM_RR~P_CTD CLM_RR~P_CH

398

251

Therapy Claims Disposed by Claims operator with Pendency

OPR-CLM- PEN-001

CLM_P_CPD CLM_P_CTD CLM_P_CH CLM_P_CAO

399

252

Therapy Claims Disposed by Claims operator with Pendency and Live

OPR-CLM- PEN-002

LCLM_P_CPD LCLM_P_CTD LCLM_P_CH LCLM_P_CAO

400

253

Therapy Claims Disposed by Claims operator with Pendency in the Past

OPR-CLM- PEN-003

PCLM_P_CPD PCLM_P_CTD PCLM_P_CH PCLM_P_CAO

401

254

Therapy Claims Disposed by Claims operator with Approval

OPR-CLM- APP-001

CLM_A_CH CLM_A_CAO

403

87

Gsl n



255

Therapy Claims Disposed by Claims operator with Approval without pendency

OPR-CLM- APP-002

CLM_A~NP_CH CLM_A~NP_CAO

404

256

Therapy Claims Disposed by Claims operator with Approval after pendency

OPR-CLM- APP-003

CLM_A~P_CH CLM_A~P_CAO

405

257

Therapy Claims Disposed by Claims operator with Rejection

OPR-CLM- REJ-001

CLM_R_CH CLM_R_CAO

406

258

Therapy Claims Disposed by Claims operator with Rejection without pendency

OPR-CLM- REJ-002

CLM_R~NP_CH CLM_R~NP_CAO

407

259

Therapy Claims Disposed by Claims operator with Rejection after pendency

OPR-CLM- REJ-003

CLM_R~P_CH CLM_R~P_CAO

408

260

Total Therapy claims Disposed by CPD

OPR-CLM- TDP-001

CLM_D_CPD

409

261 Total Therapy claims Disposed by CTD

OPR-CLM- TDP-002

CLM_D_CTD

410

262 Total Therapy claims Disposed by CH

OPR-CLM- TDP-003

CLM_D_CH

412

263 Therapy claims Disposed by CH (for insurance)

OPR-CLM- TDP-004

CLM_D_ICH

413

264

Therapy claims Disposed by CAO

OPR-CLM- TDP-005

CLM_D_CAO

414

265 Therapy Claims Disposed by A/C with Approval

OPR-CLM- TDP-006

CLM_A_AC

415

266

Therapy Claims Paid by Bank

OPR-CLM- TDP-007

CLM_A_B

416

267 Average Hourly Claims Arrival for each of the 24 hours in a day

OPR-CLM- HAR-001

CLM_HA

417

268

Claims Arrival Rate

OPR-CLM- CAR-001

CLM_ART

418

269 Average Hourly Claims Disposal for each of the 24 hours in a day

OPR-CLM- HCD-001

CLM_HD

419

270

Claims Disposal Rate OPR-CLM- CDR-001

CLM_DR

420

271

Therapy Claims Waiting at MEDCO OPR-CLM- WTC-001

CLM_W>7days_R CLM_W<7days_R

421

272

Therapy Claims Waiting at CEX OPR-CLM- WTC-002

CLM_W>7days_CX CLM_W<7days_CX

423

273

Therapy Claims Waiting at Claims operator afresh

OPR-CLM- WTC-003

CLMF_W_CPD CLMF_W_CTD CLMF_W_CH CLMF_W_CAO

424

88

Gsl n



274

Therapy Claims Waiting at Claims operator after updation of pendency

OPR-CLM- WTC-004

CLMP_W_CPD CLMP_W_CTD CLMP_W_CH CLMP_W_CAO

425

275

Therapy Claims Waiting at CPD for <7 days

OPR-CLM- WTC-005

CLM_W<7_CPD CLM_W<7_CTD CLM_W<7_CH CLM_W<7_CAO

426

276

Therapy Claims Waiting at Claims operator for >7 days

OPR-CLM- WTC-006

CLM_W>7_CPD CLM_W>7_CTD CLM_W>7_CH CLM_W>7_CAO

428

277

Therapy Claims Waiting at A/C OPR-CLM- WTC-007

CLM_W<7days_AC CLM_W>7days_AC

429

278

Therapy Claims Waiting at Bank OPR-CLM- WTC-008

CLM_W<7days_B CLM_W>7days_B

430

279 Total Therapy Claims Waiting at MEDCO

OPR-CLM- TWN-001

CLM_W_R_T

431

280 Total Therapy Claims Waiting at CEX

OPR-CLM- TWN-002

CLM_W_CX_T

432

281 Total Therapy Claims Waiting at CPD

OPR-CLM- TWN-003

CLM_W_CPD_T

433

282 Total Therapy Claims Waiting at CTD

OPR-CLM- TWN-004

CLM_W_CTD_T

434

283

Total Therapy Claims Waiting at CH

OPR-CLM- TWN-005

CLM_W_CH_T

436

284 Total Therapy Claims Waiting at CAO

OPR-CLM- TWN-006

CLM_W_CAO_T

437

285

Total Therapy Claims Waiting at A/C

OPR-CLM- TWN-007

CLM_W_AC

438

286 Total Therapy Claims Waiting at Bank

OPR-CLM- TWN-008

CLM_W_B

439

287

Total Therapy Claims Waiting for approval at Trust

OPR-CLM- TWN-009

CLM_W_TRU

440

288

Total Therapy Claims Waiting for approval at NWH

OPR-CLM- TWN-010

CLM_W_NWH

441

289

Total Therapy Claims Waiting for Approval

OPR-CLM- TWN-011

CLM_W_T

442

290

Average CWT for disposal of fresh claim cases at MEDCO during a specified period

OPR-CLM- AWT-001

CLMF_AWT_R

443

291

Average CWT for updation of pending claim cases at MEDCO during a specified period

OPR-CLM- AWT-002

CLMP_AWT_R

444

292 Average CWT at CEX for a fresh Claim case during a specified

OPR-CLM- AWT-003

CLM_AWT_CX

446

89

Gsl n



period

293

Average CWT at Claims operator for a fresh Claim case during a specified period

OPR-CLM- AWT-004

CLMF_AWT_CPD CLMF_AWT_CTD CLMF_AWT_CH CLMF_AWT_CAO

447

294

Average CWT at claims operator for a pending updated Claim case during a specified period

OPR-CLM- AWT-005

CLMP_AWT_CPD CLMP_AWT_CTD CLMP_AWT_CH CLMP_AWT_CAO

448

295

Average CWT at claims operator for a Claim case during a specified period

OPR-CLM- AWT-006

CLM_AWT_CPD CLM_AWT_CTD CLM_AWT_CH CLM_AWT_CAO

449

296

Average CWT at A/C for a Claim case during a specified period

OPR-CLM- AWT-007

CLM_AWT_AC

451

297 Average CWT at Bank for a Claim case during a specified period

OPR-CLM- AWT-008

CLM_AWT_B

452

298 Average CWT at Trust for a Claim case

OPR-CLM- AWT-009

CLM_AWT_TRU

453

299

Average CWT at NWH for a Claim case

OPR-CLM- AWT-010

CLM_AWT_NWH

454

300 Average CWT for approval of a claim case

OPR-CLM- AWT-011

CLM_AWT_TO

455

301

Average CWT for payment of a claim case during a specified period

OPR-CLM- AWT-012

CLM_AWT_P

456

302

Turnover Rate for claims, of claims operator for a specified period

OPR-CLM- TOR-001

CLM_TOR_CX CLM_TOR_CPD CLM_TOR_CTD CLM_TOR_CH CLM_TOR_CAO

457

303 TOR for a role during a specified period

OPR-CLM- TOR-002

CLM_TOR_RO

459

304

Daily Turnover of claims operator

OPR-CLM- DTO-001

CLM_DTO_CX CLM_DTO_CPD CLM_DTO_CTD CLM_DTO_CH CLM_DTO_CAO

460

305

Claim Pendency Percentage for claims operator during a specified period

OPR-CLM- CPP-001

CLM_CPP_CPD CLM_CPP_CTD CLM_CPP_CH CLM_CPP_CAO

461

306 Empanelment Application Hospital User Initiated

EMP-EAP- INT-001

EAP_I_R

463

307 Empanelment Application Hospital User Updated

EMP-EAP- UPD-001

EAP_U_R

464

90

Gsl n



308

Empanelment Application Registration Forwarded by empanelment operator

EMP-ERE- FWD-001

EAP_RE_F_EEX EAP_RE_F_EPO EAP_RE_F_EPD

465

309 Empanelment Application- Registration approved by EH

EMP-ERE- APP-002

EAP_RE_A_EH

466

310

Empanelment Application- Registration kept pending by EH

EMP-ERE- PEN-003

EAP_RE_P_EH

467

311

Empanelment Application- Registration rejected by EH

EMP-ERE-REJ- 004

EAP_RE_R_EH

468

312

Empanelment -Inspection EPO Initiated

EMP-EIP-INT- 001

EMP_IP_I_EPO

469

313 Empanelment -Inspection MC-EDC Updated

EMP-EIP- UPD-002

EMP_IP_U_MC-EDC

470

314

Empanelment Authorisation Recommended Approval by empanelment operator

EMP-EAU- RAP-001

EMP_AU_RA_MC-EDC EMP_AU_RA_EAO

471

315

Empanelment Authorisation Recommended Rejection by empanelment operator

EMP-EAU- RRE-002

EMP_AU_RR_MC-EDC EMP_AU_RR_EAO

472

316

Empanelment Authorisation Rejected by empanelment operator

EMP-EAU- REJ-003

EMP_AU_R_MC-EDC EMP_AU_R_EAO EMP_AU_R_EH

474

317 Empanelment Authorisation Pending by empanelment operator

EMP-EAU- PEN-004

EMP_AU_P_MC-EDC EMP_AU_P_EAO EMP_AU_P_EH

475

318 Empanelment Authorisation- EH Approved

EMP-EAU- APP-005

EMP_AU_A_EH

476

319 Additional Specialities Empanelment MEDCO Initiated

EMP-EAS-INT- 001

EAS_I_R

477

320 Additional Specialities Empanelment MEDCO Updated

EMP-EAS- UPD-001

EAS_U_R

478

321

Additional Specialities Empanelment Recommended Approval Empanelment Operator

EMP-EAS- RAP-001

EAS_RA_EEX EAS_RA_EPO

479

322

Additional Specialities Empanelment Recommended Rejection Empanelment Operator

EMP-EAS- RRE-001

EAS_RR_EEX EAS_RR_EPO

480

323

Additional Specialities Empanelment Pending Empanelment Operator

EMP-EAS- PEN-001

EAS_P_EEX EAS_P_EPO EAS_P_MC-EDC

482

324

Additional Specialities Empanelment inspection Approved Empanelment Operator

EMP-EAS-IAP- 001

EAS_IP_A_MC-EDC EAS_IP_A_EPO

483

325 Additional Specialities Empanelment Inspection MC-EDC

EMP-EAS-IRE- 001

EAS_IP_R_MC-EDC EAS_IP_R_EH

484

91

Gsl n



Rejected

326

Additional Specialities Empanelment-Inspection MC-EDC Updated

EMP-EAS- IUP-001

EAS_IP_U_MC-EDC

485

327 Additional Specialities Empanelment EH Approved

EMP-EAS- APP-001

EAS_A_EH

486

328 Change Requests of MEDCO Initiated by MEDCO

EMP-ECR- INT-001

ECR_I_R

487

329 Change Requests of MEDCO Updated by MEDCO

EMP-ECR- UPD-001

ECR_U_R

488

330

Change Requests of MEDCO- Recommended Approval by Empanelment Operator

EMP-ECR- RAP-001

ECR_RA_ITEX ECR_RA_EEX ECR_RA_MD-EDC

489

331

Change Requests of MEDCO Pending by Empanelment Operator

EMP-ECR- PEN-001

ECR_P_ITEX ECR_P_EEX ECR_P_MD-EDC ECR_P_EH

491

332

Change Requests of MEDCO Rejected by Empanelment Operator

EMP-ECR-REJ- 001

ECR_R_EEX ECR_R_MD-EDC ECR_R_EH

492

333 Change Requests of MEDCO Approved

EMP-ECR- APP-001

ECR_A_EH

493

334 Change Requests of NVMCCO Initiated by MEDCO

EMP-ECA- INT-001

ECA_I_R

494

335

Change Requests of NVMCCO Updated by MEDCO

EMP-ECA- UPD-001

ECA_U_R

495

336

Change Requests of NVMCCO Recommended Approval by Empanelment Operator

EMP-ECA- RAP-001

ECA_RA_ITEX ECA_RA_EEX ECA_RA_MD-EDC

496

337

Change Requests of NVMCCO Pending by Empanelment Operator

EMP-ECA- PEN-001

ECA_P_ITEX ECA_P_EEX ECA_P_MD-EDC ECA_P_EH

498

338

Change Requests of NVMCCO Rejected by Empanelment Operator

EMP-ECA- REJ-001

ECA_R_EEX ECA_R_MD-EDC ECA_R_EH

499

339

Change Requests of NVMCCO Approved by Empanelment Operator

EMP-ECA- APP-001

ECA_A_EH

500

340

Change Requests of Additional NVMCCO Initiated by MEDCO

EMP-EAA- INT-001

EAA_I_R

501

341 Change Requests of Additional NVMCCO Updated by MEDCO

EMP-EAA- UPD-001

EAA_U_R

502

342

Change Requests of Additional NVMCCO Recommended Approval by Empanelment Operator

EMP-EAA- RAP-001

EAA_RA_ITEX EAA_RA_EEX EAA_RA_MD-EDC

504

92

Gsl n



343

Change Requests of Additional NVMCCO Pending by Empanelment Operator

EMP-EAA- PEN-001

EAA_P_ITEX EAA_P_EEX EAA_P_MD-EDC EAA_P_EH

505

344

Change Requests of Additional NVMCCO Rejected by Empanelment Operator

EMP-EAA- REJ-001

EAA_R_EEX EAA_R_MD-EDC EAA_R_EH

506

345 Change Requests of Additional NVMCCO Approved by EH

EMP-EAA- APP-001

EAA_A_EH

508

346

Change Requests of Additional MEDCO Initiated by MEDCO

EMP-EAR- INT-001

EAR_I_R

509

347 Change Requests of Additional MEDCO Updated by MEDCO

EMP-EAR- UPD-001

EAR_U_R

510

348

Change Requests of Additional MEDCO Recommended Approval by Empanelment Operator

EMP-EAR- RAP-001

EAR_RA_ITEX EAR_RA_EEX EAR_RA_MD-EDC

511

349

Change Requests of Additional MEDCO Pending by Empanelment Operator

EMP-EAR- PEN-001

EAR_P_ITEX EAR_P_EEX EAR_P_MD-EDC EAR_P_EH

512

350

Change Requests of Additional MEDCO Rejected by Empanelment Operator

EMP-EAR- REJ-001

EAR_R_EEX EAR_R_MD-EDC EAR_R_EH

513

351

Change Requests of Additional MEDCO Approved by Empanelment Operator

EMP-EAR- APP-001

EAR_A

515

352 Change of Bank Account Number Initiated by MEDCO

EMP-EBA- INT-001

EBA_I_R

516

353

Change of Bank Account Number Updated by MEDCO

EMP-EBA- UPD-001

EBA_U_R

517

354

Change of Bank Account Number Recommended Approval by Empanelment Operator

EMP-EBA- RAP-001

EBA_RA_EEX EBA_RA_DFO

518

355

Change of Bank Account Number Rejected by Empanelment Operator

EMP-EBA- REJ-001

EBA_R_EEX EBA_R_DFO EBA_R_CH

519

356

Change of Bank Account Number Pending by Empanelment Operator

EMP-EBA- PEN-001

EBA_P_EEX EBA_P_DFO EBA_P_CH

520

357 Change of Bank Account Number Approved by CH

EMP-EBA- APP-001

EBA_A_CH

522

358 Expertise Details Initiated by MEDCO

EMP-EXD- INT-001

EXD_I_R

523

359 Expertise Details Updated by MEDCO

EMP-EXD- UPD-001

EXD_U_R

524

93

Gsl n



360

Expertise Details Recommended Approval by Empanelment Operator

EMP-EXD- RAP-001

EXD_RA_EEX EXD_RA_EPD EXD_RA_MD-EDC

525

361

Expertise Details Rejected Empanelment Operator

EMP-EXD- REJ-001

EXD_R_EEX EXD_R_EPD EXD_R_MD-EDC EXD_R_EH

526

362

Expertise Details Pending Empanelment Operator

EMP-EXD- PEN-001

EXD_P_EEX EXD_P_EPD EXD_P_MD-EDC EXD_P_EH

527

363

Expertise Details Approved EH

EMP-EXD- APP-001

EXD_A_EH 529

364 Therapies Follow-up cases submitted by MEDCO

OPR-FOL- SUB-001

FOL_S_R 530

365 Therapies Follow-up cases updated by MEDCO

OPR-FOL- UPD-001

FOL_U_R 531

366 Therapies Follow-up cases forwarded by CEX

OPR-FOL- FWD-001

FOL_U_R 532

367

Therapies Follow-up cases Recommended Approval

OPR-FOL- RAP-001

FOL_RA_CTD 533

368 Therapies Follow-up cases Recommended Rejection

OPR-FOL-RRJ- 001

FOL_RR_CTD 534

369

Therapies Follow-up cases kept pending

OPR-FOL- PEN-001

FOL_P_CTD FOL_P_CAO

535

370

Therapies Follow-up cases approved

OPR-FOL- APP-001

FOL_A_CTD FOL_A_CAO FOL_A_AC

537

371

Therapies Follow-up cases rejected OPR-FOL-REJ- 001

FOL_R_CTD FOL_R_CAO

538

372 Cochlear Therapies Follow-up cases submitted by MEDCO

OPR-FCH- SUB-001

FCH_S_R 539

373 Cochlear Therapies Follow-up cases updated by MEDCO

OPR-FCH- UPD-001

FCH_U_R 540

374

Cochlear Therapies Follow-up cases forwarded by CEX

OPR-FCH- FWD-001

FCH_F_CEX 541

375 Cochlear Therapies Follow-up cases Recommended Approval

OPR-FCH- RAP-001

FCH_RA_MC-CC FCH_RA_C-CC

542

376

Cochlear Therapies Follow-up cases Recommended Rejection

OPR-FCH-RRJ- 001

FCH_RR_MC-CC FCH_RR_C-CC

544

377 Cochlear Therapies Follow-up cases kept pending

OPR-FCH- PEN-001

FCH_P_MC-CC FCH_P_C-CC

545

378 Cochlear Therapies Follow-up cases approved

OPR-FCH- APP-001

FCH_A_CAO FCH_A_AC

546

379 Attendance of NAM FOP-NAM-

ATN-001

ATN_N 547

94

Gsl n



380 Regular preauth cases cleared by NAM

FOP-NAM- PCL-001

PAU_F_N 549

381 Patient registrations done by NAM FOP-NAM-

REG-001

REG_N 550

382

OP/IP Conversions done by NAM FOP-NAM- CON-001

CON_N 551

383 Follow-up cases cleared by NAM FOP-NAM-

FOL-001

FOL_F_N 552

384 133 reserved procedure Cases referred by NAM

FOP-NAM- REF-001

REF_N 553

385 On bed updation by NAM FOP-NAM-

BUP-001

BUP_N 555

386

Attendance of PAM FOP-PAM- ATN-001

ATN_PAM 556

387

Patient registrations done by PAM FOP-PAM- REG-001

REG_PAM 557

388 Referral Capture count by PAM FOP-PAM-

REF-001

REF_PAM 558

389

Referral Conversion Count by PAM FOP-PAM- CON-001

CON_PAM 560

390 Dr.NTR Vaidya Seva discharged patients visited by PAM

FOP-PAM- FVS-001

FVS_PAM 561

391 Dr.NTR Vaidya Seva patients mobilised for follow-up treatment by PAM

FOP-PAM- FOL-001

FOL_PAM 562

392 IEC Conducted by PAM FOP-PAM-

IEC-001

IEC_PAM 563

95

15. INDICATOR BANK

1. ADM-SCO-PCO-001

# KPI Properties Description

1 Gsln: 1

2 Major Group: ADM

3 Minor Group: SCO

4 Sub Category: PCO

5 Indicator Code: ADM-SCO-PCO-001

6 Indicator Name: Number of Cards Covered

7 Indicator Acronym:

CCO

8 Indicator Description:

The number of cards which were covered as per the agreement with Insurer during that policy period (or) the number of cards eligible under a Scheme during a specified period

9 Dimensions: Policy Period and Phase, District

10 Role & Action: NA

11 Formula: Count of the cards covered

12 Data required: Number of cards covered during a specified period

13 Frequency of

Monitoring:

D W M Q H Y Cum Other

N N N N N N N Policy Period

14 Data source: Bid dcouments of RAS

15 Indicator Monitors:

Input

16 Indicator use: Summary measure to see how many cards are being covered during a particular period

96

17 Unit of measure for the Indicator:

Number of cards

18 Type: A

19 Remarks: Note: Categorised as program administration indicator, that is the reason the indicators are coded by adm-***- ***-*** format (in reports referred as 'Cards')

********************************************************************

2. ADM-SCO-PCO-002


1 Gsln: 2

2 Major Group: ADM

3 Minor Group: SCO

4 Sub Category: PCO

5 Indicator Code: ADM-SCO-PCO-002

6 Indicator Name: Number of Persons covered


PCO


The number of people in the cards that were covered as per the agreement with the insurer during the policy period (or) the number of persons eligible under a scheme during a specified period



11 Formula: Count of the people covered

12 Data required: The population covered is obtained from civil supplies and other relevant data sources (such as Journalist Cards etc.)

97

13 Frequency of

Monitoring:



14 Data source: Bid documents of RAS


Input

16 Indicator use: Summary measure to see how many people are being covered during a particular period


Number of persons

18 Type: A

19 Remarks: (in reports referred as 'Population')

********************************************************************

3. ADM-SCO-BCO-001


1 Gsln: 3

2 Major Group: ADM

3 Minor Group: SCO

4 Sub Category: BCO

5 Indicator Code: ADM-SCO-BCO-001

6 Indicator Name: Number of Therapies available


THR_AV


The number of therapies available as a whole for the Trust

9 Dimensions: Policy Period and Phase


98

11 Formula: Count of the number of therapies

12 Data required: Number of therapies or procedures available during a specified period (generally policy period)

13 Frequency of

Monitoring:



14 Data source: RAS Database


Input

16 Indicator use: Summary measure to see how many therapies are covered during a particular period


Number of therapies

18 Type: A

19 Remarks: (in reports referred as 'Therapies Available')

********************************************************************

4. ADM-SCO-BCO-002


1 Gsln: 4

2 Major Group: ADM

3 Minor Group: SCO

4 Sub Category: BCO


6 Indicator Name: Number of Therapies applicable


THR_APP

99


The number of therapies applicable in a particular scheme for a specified period. This number differs for insurance scheme, for trust mode, CMCO, Journalist scheme etc



11 Formula: Count of the number of therapies

12 Data required: Number of therapies or procedures available under different schemes during a specified period (generally policy period)

13 Frequency of

Monitoring:





Input

16 Indicator use: Summary measure to see how many therapies are covered under different schemes present in our business model during a particular period


Number of therapies

18 Type: A

19 Remarks: (in reports referred as 'Therapies applicable')

********************************************************************

100

5. ADM-SCO-BCO-003


1 Gsln: 5

2 Major Group: ADM

3 Minor Group: SCO

4 Sub Category: BCO


6 Indicator Name: Number of Medical Specialities Available


MCAT_AV


The number of medical specialities which are available



11 Formula: Count of the number of medical specialities

12 Data required: Number of medical specialities available during a specified period (generally policy period)

13 Frequency of

Monitoring:





Input

16 Indicator use: Summary measure to see how many medical specialities are covered during a particular period


Number of medical specialities

18 Type: A

101

19 Remarks: NA

*****************************************************************

6.ADM-SCO-BCO-004


1 Gsln: 6

2 Major Group: ADM

3 Minor Group: SCO

4 Sub Category: BCO


6 Indicator Name: Number of Surgical Specialities Avaialable


SCAT_AV


The number of surgical specialities which are available



11 Formula: Count of the number of surgical specialities

12 Data required: Number of surgical specialities available during a specified period (generally policy period)

13 Frequency of

Monitoring:





Input

16 Indicator use: Summary measure to see how many surgical specialities are covered during a particular period

102


Number of surgical specialities

18 Type: A

19 Remarks: NA

********************************************************************

7.ADM-SCO-FCO-001


1 Gsln: 7

2 Major Group: ADM

3 Minor Group: SCO

4 Sub Category: FCO

5 Indicator Code: ADM-SCO-FCO-001

6 Indicator Name: Premium Paid


PR_PA


Total Amount prepaid to the insurer during the policy period including taxes, including payments for any additional cards



11 Formula: Sum of the amounts paid to the insurer including service tax

12 Data required: Amount paid to the insurer including service tax

13 Frequency of

Monitoring:




103


Input

16 Indicator use: Summary measure to monitor the amount paid to the insurer


Rupees

18 Type: A

19 Remarks: NA

********************************************************************

8.ADM-SCO-FCO-002


1 Gsln: 8

2 Major Group: ADM

3 Minor Group: SCO

4 Sub Category: FCO


6 Indicator Name: Bare Premium


BR_PR


Premium paid without including taxes



11 Formula: Amount paid to the insurer including service tax - Amount covered under service tax

12 Data required: Amount paid to the insurer including service tax and Amount covered under service tax

104

13 Frequency of

Monitoring:





Input

16 Indicator use: Summary measure to monitor the amount paid to the insurer devoid of service taxes. Service taxes could be changed by the government and if it happens we want to exclude the service taxes amount and monitor the premium amount paid to the insurer


Rupees

18 Type: A

19 Remarks: NA

********************************************************************

9.ADM-SCO-FCO-003


1 Gsln: 9

2 Major Group: ADM

3 Minor Group: SCO

4 Sub Category: FCO


6 Indicator Name: Proportionate Premium


PRO_PR


The amount of money paid to the insurers as per the policy periods (i.e. Major Policy period and Minor Policy period)

105

9 Dimensions: Financial Year


11 Formula: The premium paid for the Policy Period x (Period Falling in the Financial year / total number of days in the Policy Period)

12 Data required: Premium paid for the Policy Period, Policy Period duration details

13 Frequency of

Monitoring:


N N N N N Y Y N



Input

16 Indicator use: It is useful for caculating the premium amount paid to the insurer as per financial years. (Premium amount paid to the insurer = Proportionate premium paid to the insurer for the Major and Minor policy periods falling in that year).


Rupees

18 Type: Re

19 Remarks: NA

******************************************************************** 10.ADM-SCO-FCO-004


1 Gsln: 10

2 Major Group: ADM

3 Minor Group: SCO

4 Sub Category: FCO

106

5 Indicator Code:

ADM-SCO-FCO-004

6 Indicator Name:

Premium paid per card


PR_PA_PCRD


Actuals



11 Formula: Premium Amount / Number of cards covered (during the specified period)

12 Data required: Premium amount paid to the insurer and number of cards covered

13 Frequency of

Monitoring:


N N N N N N Y Policy Period



Input

16 Indicator use: Summary measure to monitor the amount paid for a card and also the change in premium per card over a course of time


Rupees per card

18 Type: R

19 Remarks: NA

********************************************************************

107

11.ADM-SUT-CUT-001


1 Gsln: 11

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: CUT

5 Indicator Code: ADM-SUT-CUT-001

6 Indicator Name: Cards Utilized


CRD_UTI


The frequency count of cards for which a preauthorisation is given atleast one time for atleast one use of any therapy during one or more specified periods (usually policy periods). A card for which preauthorisation is given more than once needs to be counted as a single card utilised.



11 Formula: Count of cards as per the indicator description

12 Data required: Cards Utilization Profile (i.e. how many cards have been utilized and for what purposes)

13 Frequency of

Monitoring:


N N Y Y Y Y Y Policy Period



Outcome

16 Indicator use: Summary measure to see the cards utilized as a whole and also in dimensions of categories etc.

108


Number of cards (In Thousands)

18 Type: A

19 Remarks: Note1: While breaking down the utilization of cards per category: a card for which preauthorisation is given more than once, for the category, needs to be counted as a single card utilised for that category. Note2: This number can be taken for the whole scheme, for insurance mode, and for trust modes separately.

********************************************************************

12.ADM-SUT-CUT-002


1 Gsln: 12

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: CUT


6 Indicator Name: Covered Card-years


CCY


The number of cards which were covered and the time duration they were covered when expressed in card years (is termed as coverd card years)



11 Formula: (Cards covered x {(To date - From date)/365} for a specified period (usually policy period))/100000

12 Data required: Number of cards covered and the time period for which they were covered

109

13 Frequency of

Monitoring:

14 Data source: Bid Documents of RAS


Output

16 Indicator use: Standardized measure of expressing number of cards covered in a given period in card years (accouting for the changes that take place in a year). Example: During a financial year 100 therapies were done for 100 cards (who were covered for 4 months (minor policy period) in present financial year) and later 500 cards were added during the next policy period and thus for the next 8 months 600 cards were covered and 200 therapies were performed in the next 8 months(major policy period) of the financial year. So the number of therapies performed during a financial year needs to take into account the changes in the number of cards covered during that period. Similarly all measures are calculated per card year. In the consideredfinancial year the first 4 months consists of 121 days and the remaining 8 months consists of 245 days. The card year during this financial year is (100*121/366 + 600*245/366) 435.8904 card years. Number of therapies performed per one card year during this financial year is (100+200 / 435.8904) = 0.688. The number of therapies per 100 card years in this financial year is 68.8


lakh card-years

18 Type: Re

19 Remarks: If the report is for successive periods then ‘Sum of Covered Card-years’ is used. It is calculated using the formula: Sum of [ [Cards Covered x {(To date - From date)/365}] for each specified period(usually policy period)].

********************************************************************



110

13.ADM-SUT-CUT-003


1 Gsln: 13

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: CUT


6 Indicator Name: Utilised card-years


UCY


The number of cards used for a particular [dimension] if one lakh cards are covered over one year period.

9 Dimensions: Policy Period and Phase, Therapy, Category


11 Formula: (Frequency Count of utilised cards x {(To date - From date)/365} for a specified period (usually policy period))/100000

12 Data required: The number of cards that have been utilized during a specified period of time and the associated [dimension] data.

13 Frequency of

Monitoring:



Output

16 Indicator use: It represents the number of cards that have been used for a [dimension of interest] in one year (if one lakh cards were covered). It could be used for breakdown analysis/ profiling of usage of cards by [dimension of interest].



111


lakh card-years

18 Type: Re

19 Remarks: When a defined set of therapies dimension is used all the cards which were utilized for one or more therapies from that basket are considered in the formula

********************************************************************

14.ADM-SUT-PUT-001


1 Gsln: 14

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: PUT

5 Indicator Code: ADM-SUT-PUT-001

6 Indicator Name: Persons Utilized


P_UTI


The frequency count of persons for which preauthorisation is given for one or more procedures either one or more times during one or more specified periods (usually policy periods) . A person for which preauthorisation is given more than once needs to be counted as a single person utilised.



11 Formula: Count of persons (as per the indicator description)/100000

12 Data required: Persons Utilization Profile (i.e. how many persons have utilized our services and what procedures have been used)

112

13 Frequency of

Monitoring:



Outcome

16 Indicator use: Summary measure to see the utilization of our services by persons as a whole and also in [dimensions of interest].


Number of persons (In lakhs)

18 Type: Re

19 Remarks: Note1: While breaking down the utilization of persons per [dimension]: a person for which preauthorisation is given more than once, for the [dimension], needs to be counted as a single person who utilised the particular dimension.

Note2: This number can be taken for the whole scheme, for insurance mode, and for trust modes separately.

********************************************************************



113

15.ADM-SUT-PUT-002


1 Gsln: 15

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: PUT


6 Indicator Name: Covered Person-years


CPY


The number of persons who were covered and the time duration they were covered when expressed in person years (is termed as coverd person years)

9 Dimensions: Policy Period and Phase, District (to compare districts in terms of population during the particular time period)


11 Formula: (Population x {(To date - From date)/365} for that period(usually a policy period))/100000

12 Data required: Population covered and the time period during which they are covered

13 Frequency of

Monitoring:



14 Data source: Bid Documents of RAS


Output

114

16 Indicator use: Standardized measure of expressing number of persons covered in a given period in person years (accouting for the changes that take place in a year). Example: During a financial year 100 therapies were done for 100 persons (who were covered for 4 months (minor policy period) in present financial year) and later 500 persons were added during the next policy period and thus for the next 8 months 600 persons were covered and 200 therapies were performed for them in the next 8 months(major policy period) of the financial year. So the number of therapies performed during a financial year needs to take into accountthe changes that took place in the number of persons covered during that period. Similarly all other measures are calculated per person year. In theconsideredfinancial year the first 4 months consists of 121 days and the remaining 8 months consists of 245 days. The person year during this financial year is (100*121/366 + 600*245/366) 435.8904 person years. Number of therapies performed per one person year during this financial year is (100+200 / 435.8904) = 0.688. The number of therapies per 100 person years in this financial year is 68.8


lakh person-years

18 Type: Re

19 Remarks: If the report is for successive periods then ‘Sum of Covered Person-years’ is used. It is calculated using the formula: Sum of [ [Persons Covered x {(To date - From date)/365}] for each specified period(usually policy period)]

********************************************************************

16.ADM-SUT-PUT-003


1 Gsln: 16

2 Major Group: ADM

115

3 Minor Group: SUT

4 Sub Category: PUT


6 Indicator Name: Utilised person-years


UPY


The number of persons who used a particular [dimension] if one lakh persons are covered over one year period.



11 Formula: (Number of persons who utilized a [dimension] x {(To date - From date)/365} for a specified period (usually policy period))/100000

12 Data required: The number of persons that have utilized a [dimension] during a specified period of time if one lakh persons are covered over one year period.

13 Frequency of

Monitoring:





Output

16 Indicator use: It represents the number of persons that have utilized a [dimension of interest] in one year (if one lakh persons were covered). It could be used for breakdown analysis/ profiling of utilization of [dimension of interest ] by persons.


lakh person-years

116

18 Type: Re

19 Remarks: When a defined set of therapies dimension is used all the cards which were utilized for one or more therapies from that basket are considered in the formula

********************************************************************

17.ADM-SUT-TUT-001


1 Gsln: 17

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: TUT

5 Indicator Code: ADM-SUT-TUT-001

6 Indicator Name: Therapies done (TD=TrR_U)


TD


The frequency count of surgeries/therapies done for the pre-authorisations given during a specified period.



11 Formula: Count of surgeries/therapies as per indicator description

12 Data required: Data of individual case processing from patient registration to claims paid for every patient registered in RAS database during a particular time period.

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y Policy Period


117


Output

16 Indicator use: These are summary operational indicators which give us a picture of how many cases are processed during a particular period and how many of them are present at every level/exit point.


Number of therapies

18 Type: A

19 Remarks: This can be calculated for the whole scheme, for insurance mode, and for trust modes separately.

********************************************************************

18.ADM-SUT-TUT-002


1 Gsln: 18

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: TUT


6 Indicator Name: Therapies discharged


TDIS


The frequency count of surgeries/therapies discharged out of the pre-authorisations given during a specified period.




118


13 Frequency of

Monitoring:





Output



Number of therapies

18 Type: A


********************************************************************

19.ADM-SUT-TUT-003


1 Gsln: 19

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: TUT


6 Indicator Name: Therapies Claim raised


CL_RS

119


The frequency count of surgeries/therapies for which claim is raised out of the preauths given during a specified period.





13 Frequency of

Monitoring:





Output



Number of claims

18 Type: A


********************************************************************

120

20. ADM-SUT-TUT-004


1 Gsln: 20

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: TUT


6 Indicator Name: Therapy Claim Approved


CLA


The number of therapies approved for payment out of 'therapies claim raised'. Approved means those approved by Claim Head in case of insurance or CAO in case of Trust.



11 Formula: Sum of the Number of therapies approved by Insurance Claim Head and the Number of therapies approved by Trust CAO


13 Frequency of

Monitoring:





Output

121



Number of claims

18 Type: A

19 Remarks: NA

********************************************************************

21.ADM-SUT-TUT-005


1 Gsln: 21

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: TUT


6 Indicator Name: Therapy Claim Rejected


CLR


The number of therapies rejected for payment out of 'therapies claim raised'. Rejected means those rejected by Claim Head in case of insurance or CAO in case of Trust.



11 Formula: Sum of the Number of therapies rejected by Insurance Claim Head and the Number of therapies approved by Trust CAO 'out of the 'therapies claim raised'.

122


13 Frequency of

Monitoring:





Output



Number of claims

18 Type: A

19 Remarks: NA

********************************************************************

22.ADM-SUT-TUT-006


1 Gsln: 22

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: TUT


6 Indicator Name: Therapy Claim kept Pending


CLPN

123


The number of therapies pending approval out of 'therapies claim raised'.



11 Formula: Sum of the cases pending at panel doctor, trust doctor, claims head and claims authorization officer.


13 Frequency of

Monitoring:





Output



Number of claims

18 Type: A

19 Remarks: NA

********************************************************************

23.ADM-SUT-TUT-007


1 Gsln: 23

2 Major Group: ADM

3 Minor Group: SUT

124

4 Sub Category: TUT


6 Indicator Name: Therapy Claim Lapsed


CL_LP


The number of therapies waiting approval out of 'therapies claim raised' which have lapsed due to time barring or cancellation + the number of therapies discharged out of those preauthed which remain not submitted after 90 day period.





13 Frequency of

Monitoring:





Output



Number of claims

18 Type: A

125

19 Remarks: NA

********************************************************************

24. ADM-SUT-TUT-008


1 Gsln: 24

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: TUT


6 Indicator Name: Therapies Claim paid


CLB_A


The frequency count of therapies for which claim is paid for therapies preauthed during a specified period



11 Formula: Count of therapies as per the indicator description


13 Frequency of

Monitoring:





Output

126



Number of claims

18 Type: A

19 Remarks: NA

********************************************************************

25. ADM-SUT-TUT-009


1 Gsln: 25

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: TUT


6 Indicator Name: Claims amount paid for therapies preauthed during a specified period


CL_PCST_TP


Claim paid amount till date for all therapies preauthed during the period.



11 Formula: Sum of all amounts as per the indicator description

12 Data required: Claims paid data during a specified period

127

13 Frequency of

Monitoring:





Output

16 Indicator use: To see the amount of claims paid for a specified period and compare them across time-periods.


Rupees

18 Type: A

19 Remarks: Note: Generally claim paid term used would represent the amount paid till date for the therapies preauthed during a specified period. (unless specified otherwise) (in reports referred as 'Therapies Claim Paid Cost for a specified period ')

********************************************************************

26. ADM-SUT-TUT-010


1 Gsln: 26

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: TUT


6 Indicator Name: Claim amount paid for therapies during a specified period

7 Indicator

Acronym:

CL_PCST_D

128

8 Indicator

Description:

The claim paid cost of therapies during a month for all therapies preauthed during the past.



11 Formula: Sum of all amounts as per the indicator description

12 Data required: Claims paid data during a specified period

13 Frequency of

Monitoring:





Output

16 Indicator use: It records the amount that the institute is paying during a period in the form of claims and the moment of funds from our company periodically.

17 Unit of measure or the Indicator:

Rupees

18 Type: A

19 Remarks: (in reports referred as 'Therapies Claim Paid Cost during a specified period ')

********************************************************************

27.ADM-SUT-UTR-001


1 Gsln: 27

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: UTR

5 Indicator Code: ADM-SUT-UTR-001

129

6 Indicator Name: Card Utilization Rate


CUR


The number of cards utilized if one lakh cards are covered over one year period

9 Dimensions: Policy Period and Phase, District, Therapy, Category, Age, Sex, Community (caste), Region (Urban/Rural), Defined set of therapies


11 Formula: (Number of cards utilized during the specified period/Card years during the specified period)*100000

12 Data required: The number of cards covered during a specific period (in card years) and the number of cards utilized for the [associated dimension].

13 Frequency of

Monitoring:





Output

16 Indicator use: Profiling the utilization of cards [at dimensions of interest]


Number per lakh card-years

18 Type: R

19 Remarks: When a defined set of therapies dimension is used the cards which were utilized for one or more therapies from that basket are considered in the formula

********************************************************************

130

28.ADM-SUT-UTR-002


1 Gsln: 28

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: UTR


6 Indicator Name: Person Utilization Rate


PUR


The number of persons who utilized a particular [dimension] if one lakh persons are covered over one year period.

9 Dimensions: Policy Period and Phase, District, Therapy, Category, Age, Sex, Community (caste), Region (Urban/Rural), Defined set of therapies


11 Formula: (Number of persons who utilized a particular [dimension] during the specified period/ Person years during the specified period)*100000

12 Data required: The number of persons covered during a specific period (in person years) and the number of persons who utilized a particular [dimension].

13 Frequency of

Monitoring:




131


Output

16 Indicator use: Profiling the utilization of various therapies at person level


Number per lakh person-years

18 Type: R

19 Remarks: When a defined set of therapies dimension is used all the persons who utilized one or more therapies from that basket are considered in the formula

********************************************************************

29.ADM-SUT-UTR-003


1 Gsln: 29

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: UTR


6 Indicator Name: Average number of times a Therapy was performed per 100 card-years among the covered cards


ATPCC


Average number of therapies performed per one hundred card years among the covered cards.

9 Dimensions: Therapy, category, PD, HD, NWH


11 Formula: (Frequency count of performance of the therapy during successive periods / Card-years)

132

12 Data required: The number of cards that have been covered for given period of time (in card years) and the frequency count of the therapy done during the specified period (each time used is accounted as one count).

13 Frequency of

Monitoring:


N N N Y Y Y Y Policy Period



Output

16 Indicator use: Profiling the therapies (taking into account the number of times a person has used a particular therapy and the number of covered person years) during a particular period at person level. It gives us the picture of which therapies are being utilized most number of times. (A person can use haemodialysis procedure twice and this information is not being recorded in person utilization rate indicator.) It is profiling the load of the therapies among the covered cards during a specific period of time.


Number of therapies per 100 card years

18 Type: G

19 Remarks: ATPCC for all therapies: Sum of ATPCC for individual therapies.

*****************************************************************

30.ADM-SUT-UTR-004


1 Gsln: 30

2 Major Group: ADM

3 Minor Group: SUT

133

4 Sub Category: UTR


6 Indicator Name: Average number of times a Therapy was performed per 100 card-years among the utilized cards


ATPUC


Average number of therapies performed per one hundred card years among the utilised cards



11 Formula: Frequency count of performance of a given therapy during successive periods / Card-years

12 Data required: Number of times a particular therapy has been used and the number of cards that have been covered for a given period of time (card years) for the cards which were utilized for that therapy

13 Frequency of

Monitoring:





Output

16 Indicator use: To identify/profile the pattern of change in utility of therapies among the utilized cards/families during specific period of time. It is also used for profiling the load of the therapies among the utilized cards during a specific period of time.


Number of therapies per 100 card years

18 Type: G

134

19 Remarks: For all therapies it is calculated as: Sum of frequency count of performance of all therapies during successive periods / Total number of Card-years (for utilized cards.)

********************************************************************

31.ADM-SUT-UTR-005


1 Gsln: 31

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: UTR


6 Indicator Name: Average number of times a Therapy was performed per 100 person-years among covered persons


ATPCP


Average number of therapies performed per one hundred person years among the covered persons.



11 Formula: Frequency count of performance of a given therapy during successive periods / Person-years

12 Data required: The number of persons that have been covered during a specified period (in person years) and the frequency count of the therapy done during the specified period (each time used is accounted as one count).

13 Frequency of

Monitoring:




135


Output

16 Indicator use: Profiling the therapies (taking into account the number of times a person has used a particular therapy and the number of covered person years) during a particular period at person level. It gives us the picture of which therapies are being utilized most number of times. (A person can use haemodialysis procedure twice and this information is not being recorded in person utilization rate indicator.) It is profiling the load of the therapies among the covered persons during a specific period of time.


Number of therapies per 100 person years

18 Type: G

19 Remarks: ATPCP for all therapies: Sum of ATPCP for individual therapies.

********************************************************************

32.ADM-SUT-UTR-006


1 Gsln: 32

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: UTR


6 Indicator Name: Average number of times a Therapy was performed per 100 person-years among utilized persons


ATPUP


Average number of therapies performed per one hundred person years among the utilized persons.

136



11 Formula: Frequency count of performance of a given therapy during successive periods / Person-years

12 Data required: Number of times a particular therapy has been used and the number of persons who utilized that therapy (in person years)

13 Frequency of

Monitoring:





Output

16 Indicator use: To identify/profile the pattern of change in the number of therapies among the utilized persons during specific period of time


Number of therapies per 100 person years

18 Type: G

19 Remarks: For all therapies it is calculated as: Sum of frequency count of performance of all therapies during successive periods / Total number of person-years (for utilized persons)

********************************************************************

33.ADM-SUT-UTR-007


1 Gsln: 33

2 Major Group: ADM

3 Minor Group: SUT

137

4 Sub Category: UTR


6 Indicator Name: Average number of cards utilized per 100 card years among the covered cards


ACPCC


Average number of cards utilized per one hundred card years among the covered cards



11 Formula: Frequecy count of the number of cards which are preauthed atleast once / Card Years

12 Data required: The cards which were preauthed atleast once and the number of cards that were covered for a specified period of time (in card years)

13 Frequency of

Monitoring:



Output

16 Indicator use: It captures the change in utility pattern of cards (Card Utilization Pattern)


Number of cards per 100 card years

18 Type: G

19 Remarks: NA

********************************************************************



138

34. ADM-SUT-UTR-008


1 Gsln: 34

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: UTR


6 Indicator Name: Average number of Persons who Utilized a service per 100 card years among the covered cards


APPCC


Average number of persons who have utilized the services per one hundred card years among the covered cards



11 Formula: Frequency count of the number of people who were given preauth atleast once / Card years

12 Data required: The persons who were given preauth atleast once and the number of cards that were covered for a specified period of time (in card years)

13 Frequency of

Monitoring:



Output

16 Indicator use: It captures the change in the utility pattern of people/ persons (People Utilization Pattern)



139


Number of persons per 100 card years

18 Type: G

19 Remarks: NA

********************************************************************

35. ADM-SUT-UTR-009


1 Gsln: 35

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: UTR


6 Indicator Name: Average number of Persons who Utilized a service per 100 card years among utilized cards


APPUC


Average number of persons who have utilized the services per one hundred card years among the utilized cards



11 Formula: Frequency count of the number of people who were given preauth atleast once / Card years

12 Data required: The persons who were given preauth and the number of utilized cards that are covered for a specified period of time (in card years)

140

13 Frequency of

Monitoring:



Output

16 Indicator use: This is a measure to capture the change in the utility pattern of people/persons among the utilized cards (People Utilization Pattern).


Number of persons per 100 card years

18 Type: G

19 Remarks: NA

********************************************************************

36.ADM-SUT-UTR-010




1 Gsln: 36

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: UTR


6 Indicator Name: Average number of times a card is used per 100 card years among the covered cards


ATIPCC


Average number of times a card is used per one hundred card years among the covered cards


141


11 Formula: Sum(Frequency count of the number of times a card is used) for all the cards which were atleast preauthed once / Card years

12 Data required: The number of times a card is used, the details of every card transaction and the number of cards that were covered for a specified period of time (in card years)

13 Frequency of

Monitoring:



Output

16 Indicator use: It is a summary measure which shows the average number of times a card is used per one covered card year


Number of times a card is used per 100 card years

18 Type: G

19 Remarks: NA

********************************************************************

37. ADM-SUT-UTR-011


1 Gsln: 37

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: UTR




142

6 Indicator Name: Average number of times a utilized card is used per 100 card years among the utilized cards


ATIPUC


Average number of times a card is used per one hundred card years among the utilized cards



11 Formula: Sum(Frequency count of the number of times a card is used) for all the cards which were atleast preauthed once / Card years

12 Data required: The number of times a card is used, the details of every card transaction and the number of utilized cards that are covered for a specified period of time (in card years)

13 Frequency of

Monitoring:



Output

16 Indicator use: It captures the change in the utility of the number of times a card is used. (Times usage utilization pattern). i.e. load within the utilized cards


Number of times a card is used per 100 card years

18 Type: G

19 Remarks: Number of times a card is used is another parameter of interest among the utilization.

********************************************************************



143

38. ADM-SUT-UTR-012


1 Gsln: 38

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: UTR


6 Indicator Name: Average number of therapies used per one time usage of a card


AUPUC


Average number of therapies that are performed during a single instance of card utilization

9 Dimensions: Therapy


11 Formula: Sum(Frequency count of number of therapy uses for one time utilization of a card) for all the cards which were preauthed atleast once / Sum(Frequency count of the number of times each card is used) for all the cards which were preauthed atleast once

12 Data required: Card usage data and the associated therapy uses

13 Frequency of

Monitoring:



Output

16 Indicator use: It captures the load of usage of therapies per a single utilization of a card



144


Number of uses per one time utilization of the card

18 Type: G

19 Remarks: Note: It is always calculated from the utilized cards only

********************************************************************

39. ADM-SUT-CLR-001


1 Gsln: 39

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: CLR

5 Indicator Code: ADM-SUT-CLR-001

6 Indicator Name: Claim Rate for a [dimension]


CLR


The amount of money that is being spent on a particular therapy (or a set of therapies, as per the dimension) during a specific period per covered card year

9 Dimensions: Category, Reserved Therapies, Tertiary Care Therapies, All Therapies


11 Formula: For one therapy: (Package price x number of therapies done claim paid) for the specified period/Covered card- years (in that duration)

12 Data required: Therapies done for which claim has been paid, specified time duration, package price and covered card years

145

13 Frequency of

Monitoring:



Output

16 Indicator use: To profile and compare which therapies (or set of therapies)are costing maximum during a specified period


Rupees per covered card-year

18 Type: R

19 Remarks: Hint for caculating CLR for a set of therapies: For a set of therapies claim rate is calculated individually and summed up

********************************************************************

40.ADM-SUT-CLR-002




1 Gsln: 40

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: CLR

5 Indicator Code: ADM-SUT-CLR-002

6 Indicator Name: Claim Deduction Ratio


CDR


It is a ratio which indicates about the claim amount that has been reduced from the preauth estimate during a specified period.

146



11 Formula: 100 x (Therapies done Cost - Therapies Claim Paid Cost) / Therapies Done Cost

12 Data required: Therapies preauth cost and Therapies claim paid cost

13 Frequency of

Monitoring:



Output

16 Indicator use: To see how much of deduction has taken place for a period of time between preauths and claims


Number (without any specific unit)

18 Type: Rt

19 Remarks: NA

********************************************************************

41.ADM-SUT-WGT-001




1 Gsln: 41

2 Major Group: ADM

3 Minor Group: SUT

4 Sub Category: WGT

5 Indicator Code: ADM-SUT-WGT-001

6 Indicator Name: Weight

147


WT_DIM


Weight of a [dimension]

9 Dimensions: Therapy basket, Category Basket, Reserved Therapies, Tertiary care Therapies


11 Formula: Sum of Wts of therapies (as per the dimension) from the procedure basket

12 Data required: Weight of each individual therapy available in the therapy basket

13 Frequency of

Monitoring:



Output

16 Indicator use: It gives the proportion of cost bagged by a set of therapies (defined by the dimension)



18 Type: Rt

19 Remarks: Weight of any set of procedures will always be less than 1 and the weight of all the procedures will always be equal to 1.

******************************************************************** 42.ADM-SUT-WGT-002


1 Gsln: 42

2 Major Group: ADM



148

3 Minor Group: SUT

4 Sub Category: WGT

5 Indicator Code: ADM-SUT-WGT-002

6 Indicator Name: Bare Weight


BW_DIM


Bare Weight of a [dimension]

9 Dimensions: Therapy basket, Category Basket, Reserved Therapies, Tertiary care Therapies


11 Formula: Sum of BWs of therapies (as per the dimension) from the procedure basket

12 Data required: Bare Weight of each individual therapy available in the therapy basket

13 Frequency of

Monitoring:



Output

16 Indicator use: It gives the proportion of utilization for a set of therapies (defined by the dimension)



18 Type: Rt

19 Remarks: Bare Weight of any set of procedures will always be less than 1 and the weight of all the procedures will always be equal to 1.

********************************************************************



149

43.ADM-SEP-CRT-001


1 Gsln: 43

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CRT

5 Indicator Code: ADM-SEP-CRT-001

6 Indicator Name: Claim Ratio


CR


Ratio of the amount spent on claims and the amount invested as premium during a specified period



11 Formula: Therapies Claim paid Cost for the period/Premium paid for the period

12 Data required: Therapies Claims paid amount and premium paid amount

13 Frequency of

Monitoring:



Outcome

16 Indicator use: To look at a glance what has happened in the previous years in terms of the input amount(premium paid) and the spent amount(claims paid).





150

18 Type: Rt

19 Remarks: It is interpreted depending upon the value greater than 1 or lesser than 1 (or) by comparing with other values over different time periods.

********************************************************************

44.ADM-SEP-CRT-002




1 Gsln: 44

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CRT

5 Indicator Code:

ADM-SEP-CRT-002

6 Indicator Name:

Bare Claim Ratio


BCR


Ratio of the amount spent on claims and the amount invested as bare premium (void of service taxes) during a specified period.



11 Formula: Therapies Claim paid Cost for the period/ Bare Premium

12 Data required: Therapies Claim paid cost, premium paid, service tax during a specific period

13 Frequency of

Monitoring:


151


Outcome

16 Indicator use: To look at a glance what has happened in the previous years in terms of the input amount(premium paid) and the spent amount(claims paid). This a finer measure compared to the claim ratio and will be useful when there is variation in service taxes levied by the government.



18 Type: Rt

19 Remarks: It is interpreted depending upon the value greater than 1 or lesser than 1 (or) by comparing with other values over different time periods.

********************************************************************* 45.ADM-SEP-CRT-003


1 Gsln: 45

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CRT

5 Indicator Code:

ADM-SEP-CRT-003

6 Indicator Name:

Premium Claim Difference


PCD

8

Indicator Description:

Difference of the amount invested as premium during a policy period and the amount incurred as expenditure (Therapies Claim Paid Cost) during a Policy Period


152


11 Formula: Premium Paid for the Policy Period - Therapies Claim

Paid Cost for the Policy Period

12 Data required: Therapies Claims paid amount and premium paid

amount

13

Frequency of

Monitoring:





Outcome

16

Indicator use: This indicators too conveys the same information as above indicators i.e. to look at a glance what has happened in the previous years in terms of the input amount(premium paid) and the spent amount(claims paid). However this indicator specifies the exact amount that differs between the investment and expenditure amounts.

17

Unit of measure for the Indicator:

Rupees

18 Type: A

19 Remarks: NA

*****************************************************************

46.ADM-SEP-CRT-004


1 Gsln: 46

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CRT

153

5 Indicator Code:

ADM-SEP-CRT-004

6 Indicator Name:

Average Preauth Size


APS

8

Indicator Description:

Mean Preauth Size, It is a central tendency measure which represents the preauth cost during a specified period.



11 Formula: Therapy Preauth Cost / Number of Therapies

Preauthed

12 Data required: Therapies Preauth Cost and Number of therapies

which have been preauthed

13

Frequency of

Monitoring:





Output

16 Indicator use: It would be useful to monitor if the preauth cost is

decreasing or increasing over various time periods.

17

Unit of measure for the Indicator:

Rupees

18 Type: G

19 Remarks: NA

*****************************************************************

154

47. ADM-SEP-CRT-005


1 Gsln: 47

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CRT


6 Indicator Name: Average Claim Size

7 Indicator Acronym: ACS

8 Indicator Description: Mean Claim Size, It is a central tendency measure which represents the claim cost during a specified period.



11 Formula: Therapies Claim Paid Cost / Number of Therapies Claim Paid

12 Data required: Therapies claim paid cost and number of therapies claim paid

13 Frequency of

Monitoring:




15 Indicator Monitors: Output

16 Indicator use: It would be useful to monitor if the claim cost is decreasing or increasing over various time periods.


Rupees

155

18 Type: G

19 Remarks: NA

*****************************************************************

48. ADM-SEP-CRT-006


1 Gsln: 48

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CRT


6 Indicator Name: Interest Earned by Insurer on Unspent Premium

for a phase

7 Indicator Acronym: INT_INS


Interest earned by the insurer on unspent premium for a particular phase



11

Formula: Sum of [ {(0.94 x bare premium available with insurer at the beginning of the day) - claim payment for the day} x 0.75/30.5] for all the days in the specified period. This assumes that 0.06 percent of premium is spent for admin expenses on the day of premium payment; that month has 30.5 days; that rate of bank interest is 9% per annum.

12

Data required: Day wise bare premium available with the insurer and the claim payments made by the insurer per day

156

13

Frequency of

Monitoring:





Outcome

16 Indicator use: It conveys how much profit the insurer is making

on the unspent premium for a particular phase.


Crore Rupees

18 Type: Re

19 Remarks: NA

*****************************************************************

49.ADM-SEP-CCO-001


1 Gsln: 49

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CCO

5 Indicator Code:

ADM-SEP-CCO-001

6 Indicator Name:

Therapies Claim Outstanding for a specified period


TCO


Number of therapy claims which are yet to be processed (or) are in 'in process' state

9 Dimensions: Overall Scheme, Policy period and Phase

157


11 Formula: Count of therapy claims as per indicator description

12 Data required: Number of therapy claims which are 'in process'

13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity

16 Indicator use: To look at the number of cases which are 'in process' at a particular point of time duration


Number of claims

18 Type: A

19 Remarks: NA

*****************************************************************

50.ADM-SEP-CCO-002


1 Gsln: 50

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CCO

5 Indicator Code:

ADM-SEP-CCO-002

6 Indicator Name:

Therapies Claim Outstanding Cost for a specified period

158


TCOC


The cost that incurs for the 'in process' therapy claims



11 Formula: Sum of the amount

12 Data required: Cost of the claims which are 'in process'

13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity

16 Indicator use: To get an idea of the amount that we are thought to be liable for as these cases are not yet processed


Rupees

18 Type: A

19 Remarks: NA

*****************************************************************

51.ADM-SEP-CCO-003


1 Gsln: 51

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CCO

159

5 Indicator Code:

ADM-SEP-CCO-003

6 Indicator Name:

Therapies Claim Pending at Bank for a specified period


TCB


Number of therapy claims which have got approved but weren't yet paid by the bank (to the NWH)



11 Formula: Count of therapy claims as per indicator description

12 Data required: Case process data and bank payment data

13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity

16 Indicator use: To monitor the rate of movement of funds at bank level after processing this indicator is used. It gives the number of cases which are yet to be paid at the bank level.


Number of claims

18 Type: A

19 Remarks: NA

*****************************************************************

160

52. ADM-SEP-CCO-004


1 Gsln: 52

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CCO

5 Indicator Code:

ADM-SEP-CCO-004

6 Indicator Name:

Therapies Claim Pending at Bank Cost for a specified period


TCBC


The cost that incurs for the therapy claims which have got approved but weren't yet paid by the bank




12 Data required: Cost of the claims which were approved but weren't yet paid by the bank

13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity

16 Indicator use: To calculate the actual liquid amount we have we need to subtract this amount as well as the health camps claim pending amount from our liquid assets. (It helps us in calculating the exact liquid amount which we have at a particular point of time.)

161


Rupees

18 Type: A

19 Remarks: NA

*****************************************************************

53. ADM-SEP-CCO-005

# KPI Properties

Description

1 Gsln: 53

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category:

CCO

5 Indicator Code:

ADM-SEP-CCO-005

6 Indicator Name:

Health Camp Claim Outstanding


HC_CL_O


Number of health camp claims which are yet to be processed (or) are in 'in process' state


10 Role & Action:

NA

11 Formula: Count of health camps as per indicator description

12 Data required:

Number of health camp claims which are 'in process'

162

13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity

16 Indicator use: To look at the number of cases which are 'in process' at a particular point of time duration


Number of claims

18 Type: A

19 Remarks: NA

*****************************************************************

54. ADM-SEP-CCO-006


1 Gsln: 54

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CCO

5 Indicator Code:

ADM-SEP-CCO-006

6 Indicator Name:

Health Camp Claim Outstanding Cost


HC_CLOC


The cost that incurs for the 'in process' health camp claims

163




12 Data required: Cost of the health camp claims which are 'in process'

13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity

16 Indicator use: To get an idea of the amount that we are thought to be liable for as these cases are not yet processed


Rupees

18 Type: A

19 Remarks: NA

*****************************************************************

55. ADM-SEP-CCO-007


1 Gsln: 55

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CCO

5 Indicator Code:

ADM-SEP-CCO-007

164

6 Indicator Name:

Health Camp Claim pending


HC_CLPN


Number of health camp claims which have got approved but weren't yet paid by the bank (to the NWH)



11 Formula: Count of health camps as per indicator description

12 Data required: Health camp claim process data and bank payment data

13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity

16 Indicator use: To monitor the rate of movement of funds at bank level after processing this indicator is used. It gives the number of cases which are yet to be paid at the bank level.


Number of claims

18 Type: A

19 Remarks: NA

*****************************************************************

165

56. ADM-SEP-CCO-008


1 Gsln: 56

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: CCO

5 Indicator Code:

ADM-SEP-CCO-008

6 Indicator Name:

Health Camp Claim Pending Cost


HC_CLPNC


The cost that incurs for the health camp claims which have got approved but weren't yet paid by the bank




12 Data required: Cost of the health camp claims which were approved but weren't yet paid by the bank

13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity

16 Indicator use: To calculate the actual liquid amount we have we need to subtract this amount as well as the therapies claim pending amount from our liquid assets. (It helps us in calculating the exact liquid amount which we have at a particular point of time.)

166


Rupees

18 Type: A

19 Remarks: NA

*****************************************************************

57.ADM-SEP-FFO-001


1 Gsln: 57

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: FFO

5 Indicator Code:

ADM-SEP-FFO-001

6 Indicator Name:

The R² value (also known as Coefficient of Determination)


M_PA


Forecast Model Diagnostics measure

9 Dimensions: NA


11 Formula: It is provided by the software

12 Data required: Forecast dataset prepared for analysis

13 Frequency of

Monitoring:


N N N Y Y Y N Policy Period


167


None

16 Indicator use: Goodness of model fit parameter



18 Type: NA

19 Remarks: Model Diagnostic Measures

*****************************************************************

58.ADM-SEP-FFO-002


1 Gsln: 58

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: FFO

5 Indicator Code:

ADM-SEP-FFO-002

6 Indicator Name:

The curve that is fitted


M_CU


Forecast Model Description

9 Dimensions: NA


11 Formula: None


168

13 Frequency of

Monitoring:





None

16 Indicator use: Type of curve that is fitted to the data


Descriptive Field (no units present)

18 Type: NA


*****************************************************************

59.ADM-SEP-FFO-003


1 Gsln: 59

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: FFO

5 Indicator Code: ADM-SEP-FFO-003

6 Indicator Name:

Error Plot


M_ERRPLT


Forecast Model Diagnostics measure

9 Dimensions: NA


169

11 Formula: None


13 Frequency of

Monitoring:





None

16 Indicator use: Shows the variations from the actual data and the values obtained from the prediction model. It is useful for residual analysis and outlier analysis.


Plot Diagram (no units present)

18 Type: NA


********************************************************************

60.ADM-SEP-FFO-004


1 Gsln: 60

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: FFO


6 Indicator Name: Forecast data date


M_FCST_DT

170


Forecast data description in terms of time period

9 Dimensions: NA


11 Formula: None


13 Frequency of

Monitoring:





None

16 Indicator use: The time period of the data that has been used for building the prediction model. (From date and end date of the data used for forecasting)


Date Description (Date format)

18 Type: NA


********************************************************************

61.ADM-SEP-FFO-005


1 Gsln: 61

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: FFO


171

6 Indicator Name: Weight of Specified Procedure Basket


FCST_RF_WT


Weights calculated as on 1st Jan/1st July of current year (whichever is latest). They can also be considered as reference weights.

9 Dimensions: NA


11 Formula: Weights calculated as on 1st Jan/1st July of current year (from the cumulative data)

12 Data required: Claim Rate of every therapy available in the procedure basket during the "fully loaded state" year

13 Frequency of

Monitoring:





None

16 Indicator use: This set of weights are used as reference weights which we apply for preparing forecast analysis dataset assuming that the same utility rates would be present at any given point of time in the past.(Note: this is done for a particular method of forecasting which is in use at present only)



18 Type: A

19 Remarks: Defintion of "Reference Weights"

********************************************************************

172

62. ADM-SEP-FFO-006


1 Gsln: 62

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: FFO


6 Indicator Name: Weight of month's Procedure Basket


FCST_MN_WT


The reference weights are applied to the retrospective (or) partially loaded set of procedures data during a time period of one month to calculate the weight of the month's procedure basket

9 Dimensions: NA


11 Formula: Sum of [Wts for therapies available for the month for Insurance mode + Wts for therapies available for the month under Trust mode]

12 Data required: Claim Rate of every therapy available in the procedure basket during the "fully loaded state" year

13 Frequency of

Monitoring:





None

173

16 Indicator use: These weights indicate the percentage of cost the partially loaded set of procedures would account for if the fully loaded set of procedures were made available at that point of time



18 Type: A

19 Remarks: This is an intermediate variable

********************************************************************

63. ADM-SEP-FFO-007


1 Gsln: 63

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: FFO


6 Indicator Name: Therapy Claim Paid-Total for a month


FCST_TH_CLM


The total claim amount for a particular month (usually the previous years data (of 'partially loaded state' years).

9 Dimensions: NA


11 Formula: Sum of [Claim paid for the month for Insurance mode + Claim paid for the same month for Trust mode]

12 Data required: Claims paid amount during the specified time period (usually month-wise)

174

13 Frequency of

Monitoring:





None

16 Indicator use: This is an intermediate variable which is used for preparing the forecasting dataset.


Crore Rupees

18 Type: A

19 Remarks: Intermediate variable

********************************************************************

64.ADM-SEP-FFO-008


1 Gsln: 64

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: FFO


6 Indicator Name: Relative claim Paid for the month for RAS


FCST_RL_CLM


This is a derived variable which is used for calculating the amount that would have costed us in previous years(partially loaded state) if we were fully loaded.

9 Dimensions: NA

175


11 Formula: Total Claim paid for a month/ Month's Procedure Basket Wt. This gives the proportionate claim for given basket of procedures

12 Data required: Indicator coded (Therapy Claim paid - Total for a month) and the reference weights

13 Frequency of

Monitoring:





None

16 Indicator use: This is used for calculating the amount that we would incur if we were "fully loaded" in the past time periods


Crore Rupees

18 Type: A

19 Remarks: Final variable of interest (when we consider all the procedures available in the procedure basket during forcasting)

********************************************************************

65.ADM-SEP-FFO-009


1 Gsln: 65

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: FFO


176

6 Indicator Name: Relative Total Claim


FCST_RL_TCLM


This is a derived variable which is used for calculating the amount that would have costed us in previous years (partially loaded state) for a specific set of procedures (say a set of procedures in AS-II and AS_I etc.).

9 Dimensions: NA


11 Formula: (Therapy claim paid for period/Wt of month's procedure basket) x Specified Procedure Basket Wt

12 Data required: Intermediate variables: Therapy Claim paid for the month (past data), reference weights, therapies available in the specified duration (past)

13 Frequency of

Monitoring:





None

16 Indicator use: This is used for calculating the amount for a specific set of procedures that we would incur if we were "fully loaded" in the past time periods


Crore Rupees

18 Type: A

19 Remarks: Final variable of interest (when we consider a subset of procedures and the cost it incurs to us during forecasting)

********************************************************************

177

66. ADM-SEP-FFO-010


1 Gsln: 66

2 Major Group: ADM

3 Minor Group: SEP

4 Sub Category: FFO


6 Indicator Name: Cumulative relative Claim (Cr)


FCST_CL_RCLM


Sum of previous months relative claim and present months claim

9 Dimensions: NA


11 Formula: Relative claim Paid for the month + cumulative relative claim for the previous months

12 Data required: "Relative Total Claim" variable

13 Frequency of

Monitoring:





None

16 Indicator use: This is a running sum of the estimated amount used in forecasting report


Crore Rupees

18 Type: A

178

19 Remarks: Variable of interest defined for forecasting report

********************************************************************

67. FOP-NWH-***-001


1 Gsln: 67

2 Major Group: FOP

3 Minor Group: NWH

4 Sub Category: ***

5 Indicator Code: FOP-NWH-***-001

6 Indicator Name: Hospital Beds


HB


Total number of beds available in a NWH

9 Dimensions: NWH, HD


11 Formula: No formula (fixed quantity)

12 Data required: Hospital capacity in terms of beds

13 Frequency of

Monitoring:


N N N Y Y Y N N



Input

16 Indicator use: Indicator set to capture the capacity and utilization pattern of the NWH in the scheme

179


Number of beds

18 Type: A

19 Remarks: NA

********************************************************************

68.FOP-NWH-***-002


1 Gsln: 68

2 Major Group: FOP

3 Minor Group: NWH

4 Sub Category: ***


6 Indicator Name: Reserved Beds in a NWH


RB


Number of beds reserved for Dr.NTR Vaidya Seva out of total Hospital beds



11 Formula: No formula (fixed quantity)

12 Data required: Reserved number of beds for Dr.NTR Vaidya Seva

13 Frequency of

Monitoring:


N N N Y Y Y N N



Input

180



Number of beds

18 Type: A

19 Remarks: NA

********************************************************************

69.FOP-NWH-***-003


Y N N N N N N N


1 Gsln: 69

2 Major Group: FOP

3 Minor Group: NWH

4 Sub Category: ***


6 Indicator Name: Occupied Beds in a NWH


OB


Number of beds occupied by Dr.NTR Vaidya Seva patients out of total Hospital beds



11 Formula: Count of beds occupied by Dr.NTR Vaidya Seva patients in a hospital

12 Data required: Number of beds occupied in a hospital by Dr.NTR Vaidya Seva

13 Frequency of

Monitoring:

181



Output



Number of beds

18 Type: A

19 Remarks: NA

********************************************************************

70.FOP-NWH-***-004


1 Gsln: 70

2 Major Group: FOP

3 Minor Group: NWH

4 Sub Category: ***


6 Indicator Name: Occupied Bed-days in a NWH, during a specified period


OBD


Occupied bed days represents the duration a NWH has been utilized by patients during a specific period of time



11 Formula: Sum of occupied beds in days for all cases

12 Data required: Number of beds occupied during a specific time period

182

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output



Number of occupied bed-days

18 Type: A

19 Remarks: NA

********************************************************************

71.FOP-NWH-***-005


1 Gsln: 71

2 Major Group: FOP

3 Minor Group: NWH

4 Sub Category: ***


6 Indicator Name: Hospital OP in a NWH


OP


Frequency count of OP cases registered



183

11 Formula: Same as indicator description

12 Data required: OP case registration details

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output



Number of cases

18 Type: A

19 Remarks: NA

********************************************************************

72.FOP-NWH-***-006


1 Gsln: 72

2 Major Group: FOP

3 Minor Group: NWH

4 Sub Category: ***


6 Indicator Name: Hospital IP in a NWH


IP


Frequency count of IP cases registered

184



11 Formula: Same as indicator description

12 Data required: IP case registration details

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output



Number of cases

18 Type: A

19 Remarks: NA

********************************************************************

73.FOP-NWH-***-007


1 Gsln: 73

2 Major Group: FOP

3 Minor Group: NWH

4 Sub Category: ***


6 Indicator Name: Dr.NTR Vaidya Seva Bed Occupancy Rate, during a specified period

185


BOR


The occupancy rate is a calculation used to show the actual utilization of an inpatient health facility for a given time period.



11 Formula: Occupied Bed-days in a NWH / Reserved Beds in the NWH x number of days in the period

12 Data required: Occupied Beds in a hospital, Reserved beds in a hospital, time period

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output



Percent (like x% etc.)

18 Type: R

19 Remarks: NA

********************************************************************

186

74. FOP-NWH-***-008


1 Gsln: 74

2 Major Group: FOP

3 Minor Group: NWH

4 Sub Category: ***


6 Indicator Name: Therapy-month for a given therapy, during a specified period


THR_MTH


1 therapy month denotes that one particular therapy has been provided by the NWH for a period equivalent to that of 1 month. Therapy month is a standard used to see which therapies are utilized mostly in a NWH. (In other words, it shows which therapies are being provided mostly by a particular network hospital).



11 Formula: 1 x (number of days in the specified period/30.5)Ex: One therapy made available in a NWH for patients to utilise as and when required for one month will mean 1 therapy-month

12 Data required: Therapies done by a NWH

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output

187



Number of Therapy Months

18 Type: Re

19 Remarks: NA

********************************************************************

75. FOP-NWH-***-009


1 Gsln: 75

2 Major Group: FOP

3 Minor Group: NWH

4 Sub Category: ***


6 Indicator Name: Bed Occupancy updation time


OB


Average time at which the bed occupancy updation was done by the NWH



11 Formula: (Sum(Time taken by the NWH to update bed occupancy in each case))/Number of cases

12 Data required: Time taken by the NWH to update bed occupancy and the number of cases

188

13 Frequency of

Monitoring:



Activity



Units of time (Ex: mins, hrs etc.)

18 Type: G

19 Remarks: NA

********************************************************************

76.FOP-HCA-***-001


Y Y Y Y Y Y Y N


1 Gsln: 76

2 Major Group: FOP

3 Minor Group: HCA

4 Sub Category: ***

5 Indicator Code: FOP-HCA-***-001

6 Indicator Name: Health Camps Conducted


HCC


Number of health camps conducted during a specified period

9 Dimensions: Policy Period and Phase, PD, NWH


189

11 Formula: Count Of health camps

12 Data required: Data of the health camps conducted during a particular period

13 Frequency of

Monitoring:





Input

16 Indicator use: Indicator set to monitor the efficiency of health camps referral system


Number of health camps

18 Type: A

19 Remarks: NA

********************************************************************

77.FOP-HCA-***-002


1 Gsln: 77

2 Major Group: FOP

3 Minor Group: HCA

4 Sub Category: ***


6 Indicator Name: Patients Screened


HCPS

190


Number of patients screened in all the health camps conducted during a specified period

9 Dimensions: Policy Period and Phase, PD, NWH


11 Formula: Count of patients

12 Data required: Number of patients screened in a health camp and the time period

13 Frequency of

Monitoring:





Activity



Number of patients screened

18 Type: A

19 Remarks: NA

********************************************************************

78.FOP-HCA-***-003


1 Gsln: 78

2 Major Group: FOP

3 Minor Group: HCA

4 Sub Category: ***


191

6 Indicator Name: Patients Referred


HCPR


Number of patients referred to Network Hospitals from all the health camps conducted during a specified period

9 Dimensions: Policy Period and Phase, PD


11 Formula: Count of patients

12 Data required: Number of patients referred to Network Hospitals during a health camp and the time period

13 Frequency of

Monitoring:





Output



Number of patients referred

18 Type: A

19 Remarks: NA

********************************************************************

192

79.FOP-HCA-***-004


1 Gsln: 79

2 Major Group: FOP

3 Minor Group: HCA

4 Sub Category: ***


6 Indicator Name: Health Camp Rate


HCR


Number of health camps conducted per week (during a specific period of time)

9 Dimensions: Policy Period and Phase, PD, HD


11 Formula: Number of health camps conducted during a specified period / Number of weeks in the period

12 Data required: Number of health camps conducted and the time duration in which they were conducted

13 Frequency of

Monitoring:


N Y Y Y Y Y Y Policy Period



Input


193


Number of health camps conducted per one week

18 Type: A

19 Remarks: NA

********************************************************************

80.FOP-HCA-***-005


1 Gsln: 80

2 Major Group: FOP

3 Minor Group: HCA

4 Sub Category: ***


6 Indicator Name: Patients Screening Rate


HCSR


Number of patients screened (in all the health camps conducted during a specified period) per week



11 Formula: Number of patients screened in all the health camps conducted during a specified period / Number of weeks in the period

12 Data required: Number of health camps, number of patients screened and the time duration

13 Frequency of

Monitoring:



194



Activity



Number of patients screened per one week

18 Type: R

19 Remarks: NA

********************************************************************

81.FOP-HCA-***-006


1 Gsln: 81

2 Major Group: FOP

3 Minor Group: HCA

4 Sub Category: ***


6 Indicator Name: HC patient referral capture rate


HCAP


One patient out of every 'n patients' who were screened get referred to a hospital, this is calculated as HCAP



11 Formula: Number of patients referred to NWH / Number of patients screened in health camps

195

12 Data required: Number of patients screened in a health camp and the number of patients referred to a hospital

13 Frequency of

Monitoring:





Output



One patient referred per every 'n' number of patients screened

18 Type: R

19 Remarks: NA

********************************************************************

82.FOP-HCA-***-007


1 Gsln: 82

2 Major Group: FOP

3 Minor Group: HCA

4 Sub Category: ***


6 Indicator Name: HC patient referral conversion rate


HCON


One patient out of every 'n patients' who were referred get registered in a hospital, this is calculated as HCON

196



11 Formula: Number of patients registered in NWH / Number of patients referred to NWH

12 Data required: Number of patients referred in a health camp and the number of patients registered to a hospital

13 Frequency of

Monitoring:





Outcome



One patient registered per every 'n' number of patients referred

18 Type: R

19 Remarks: NA

********************************************************************

83.FOP-FUC-***-001


1 Gsln: 83

2 Major Group: FOP

3 Minor Group: FUC

4 Sub Category: ***

5 Indicator Code: FOP-FUC-***-001

6 Indicator Name: Follow-up eligible cases

197


FU_ECS


Number of follow-up eligible cases at any specified point of time



11 Formula: Count of cases

12 Data required: Cases which are eligible for follow-up

13 Frequency of

Monitoring:





Input

16 Indicator use: Summary indicators for follow-up at each level of process flow


Number of cases

18 Type: A

19 Remarks: NA

********************************************************************

84.FOP-FUC-***-002


1 Gsln: 84

2 Major Group: FOP

3 Minor Group: FUC

4 Sub Category: ***

198


6 Indicator Name: Follow-up availed cases


FU_ACS


Number of follow-up availed cases at any specified point of time




12 Data required: Cases which availed follow-up

13 Frequency of

Monitoring:





Input



Number of cases

18 Type: A

19 Remarks: NA

********************************************************************

199

85. FOP-FUC-***-003


1 Gsln: 85

2 Major Group: FOP

3 Minor Group: FUC

4 Sub Category: ***


6 Indicator Name: Follow-up claim submitted cases


FU_CSCS


Number of follow-up availed cases for which claim has been submitted




12 Data required: Claim data for follow-up availed cases with their status

13 Frequency of

Monitoring:





Activity



Number of cases

18 Type: A

200

19 Remarks: NA

********************************************************************

86. OP-FUC-***-004


1 Gsln: 86

2 Major Group: FOP

3 Minor Group: FUC

4 Sub Category: ***


6 Indicator Name: Follow-up claim approved cases


FU_CACS


Number of follow-up availed cases for which claim has been approved




12 Data required: Claim data for follow-up availed cases with their status

13 Frequency of

Monitoring:





Output


201


Number of cases

18 Type: A

19 Remarks: NA

********************************************************************

87.FOP-GHP-***-001


1 Gsln: 87

2 Major Group: FOP

3 Minor Group: GHP

4 Sub Category: ***

5 Indicator Code: FOP-GHP-***-001

6 Indicator Name: Percentage of therapies done in Government hospitals


PCT_TDN_GH


(Indicator Name is self descriptive)

9 Dimensions: Policy Period and Phase, HD, Category


11 Formula: (Therapies done by Government Hospitals during a specified period / Therapies done in all NWHs for the period)*100

12 Data required: Number of therapies done and the type of the hospital where the therapy has been done

13 Frequency of

Monitoring:



202



Output

16 Indicator use: To monitor the percentage of therapies done by government hospitals during a specific period


Percentage of therapies

18 Type: P

19 Remarks: NA

********************************************************************

88.FOP-GHP-***-002


1 Gsln: 88

2 Major Group: FOP

3 Minor Group: GHP

4 Sub Category: ***


6 Indicator Name: Percentage of the cost for therapies done in Government hospitals


PCT_CSTTDN_GH


(Indicator Name is self descriptive)

9 Dimensions: Policy Period and Phase, HD, Category


11 Formula: (Cost of Therapies done for Government Hospitals during a specified period / Cost of all Therapies done in all NWHs during the period)*100

203

12 Data required: Cost of the therapies and the type of the hospital where the therapy has been done

13 Frequency of

Monitoring:





Output

16 Indicator use: To monitor the percentage of cost of the therapies that are being done by government hospitals


Percentage of cost

18 Type: P

19 Remarks: NA

********************************************************************

89. FOP-GHP-***-003


1 Gsln: 89

2 Major Group: FOP

3 Minor Group: GHP

4 Sub Category: ***


6 Indicator Name: Government Hospital Preauths through Health Camp Route


HC_RT_GH)

204


Number of therapies preauthed (PaPAO_A + PaT_A) in Government Hospitals, from the patients referred from Health Camps during a specified period

9 Dimensions: Policy Period and Phase, HD, Therapy, Category


11 Formula: Number of Preauths from preauth authorization officer (PaPAO_A)+ Number of Preauths from preauth trust doctor(PaT_A)

12 Data required: Patient referral route data and the Number of therapies preauthed by government hospitals

(Note: Records whose source of Referral is healthcamp are used)

13 Frequency of

Monitoring:





Output

16 Indicator use: To compare the share of preauths routed to the government and private hospitals during a specific period of time. We want to see if there is any uneven distribution between the number of preauths that are routed to government and private hospitals


Number of preauths

18 Type: A

19 Remarks: NA

********************************************************************

205

90. FOP-GHP-***-004


1 Gsln: 90

2 Major Group: FOP

3 Minor Group: GHP

4 Sub Category: ***


6 Indicator Name: Private Hospital Preauths through Health Camp Route


HC_RT_PH


Number of therapies preauthed (PaPAO_A + PaT_A) in Private Hospitals, from the patients referred from Health Camps during a specified period

9 Dimensions: Policy Period and Phase, HD, Therapy, Category


11 Formula: Number of Preauths from preauth authorization officer (PaPAO_A)+ Number of Preauths from preauth trust doctor(PaT_A)

12 Data required: Patient referral route data and the Number of therapies preauthed by private hospitals

(Note: Records whose source of Referral is healthcamp are used)

13 Frequency of

Monitoring:





Output

206

16 Indicator use: To compare the share of preauths routed to the government and private hospitals during a specific period of time. We want to see if there is any uneven distribution between the number of preauths that are routed to government and private hospitals


Number of preauths

18 Type: A

19 Remarks: NA

********************************************************************

91. GRE-GRE-***-001


1 Gsln: 91

2 Major Group: GRE

3 Minor Group: GRE

4 Sub Category: ***

5 Indicator Code: GRE-GRE-***-001

6 Indicator Name: Grievance Arrivals during a specified period


GR_ARRV


Frequency count of Grievances received during the specified period

9 Dimensions: Policy Period and Phase, HD, NWH


11 Formula: Count Of Grievances

12 Data required: Number of grievances during a specific period

207

13 Frequency of

Monitoring:





Output

16 Indicator use: Summary measure to see the number of grievances received during a period


Number of grievances

18 Type: A

19 Remarks: NA

********************************************************************

92.GRE-GRE-***-002


1 Gsln: 92

2 Major Group: GRE

3 Minor Group: GRE

4 Sub Category: ***


6 Indicator Name: Relative Frequency of Grievances during a specified period


RFG


Number of grievances arrived relating to the disaggregation variable during the period / total number of grievances received during the period


208


11 Formula: Same as the indicator description

12 Data required: Number of grievances and data related to the disaggregation variable (category)

13 Frequency of

Monitoring:





Output

16 Indicator use: Breakdown analysis of the number of grievances received by category. The category could be either a hospital/therapy etc depending on the analysis.


Number of grievances related to the category of interest

18 Type: N

19 Remarks: NA

********************************************************************

93. GRE-GRE-***-003


1 Gsln: 93

2 Major Group: GRE

3 Minor Group: GRE

4 Sub Category: ***


6 Indicator Name: Grievance Rate during a specified period

209


GR


Grievance arrivals per 100 therapies preauthed during the specified period



11 Formula: (Number of grievances / Number of preauths during a specified period)*100

12 Data required: Number of grievances and the number of therapies preauthed

13 Frequency of

Monitoring:





Outcome

16 Indicator use: To see the number of grievances per 100 preauths during a specific period of time and compare across various time periods.


Number of grievances per 100 preauths

18 Type: R

19 Remarks: NA

********************************************************************

210

94. GRE-GRE-***-004


1 Gsln: 94

2 Major Group: GRE

3 Minor Group: GRE

4 Sub Category: ***


6 Indicator Name: Feedback letter Return Rate during a specified period


FB_RR


Feed back response rate is the percentage of people who responded to our feed back letters.



11 Formula: (Number of letters returned / Number of letters dispatched during the period)*100

12 Data required: Number of feedback letters returned to us and the number of feedback letters sent by us

13 Frequency of

Monitoring:





Output

16 Indicator use: The response rate tells us how many have given feedback to us and if the given feedback is a representative of the current situation or not. For example, people who encountered adverse events might be more prone to give a feedback which will introduce bias into what we are measuring.

211


Percentage of people who responded to feedback letters

18 Type: R

19 Remarks: NA

********************************************************************

95.GRE-GRE-***-005


1 Gsln: 95

2 Major Group: GRE

3 Minor Group: GRE

4 Sub Category: ***


6 Indicator Name: Adverse Feedback Rate during a specified period


AFR


Number of adverse feedback letters received per 100 feedback letters received during the specified period



11 Formula: (Number of adverse feed back letters received/ Number of feed back letters received)*100

12 Data required: Number of adverse feedback letters and total number of feedback letters received

13 Frequency of

Monitoring:




212


Outcome

16 Indicator use: To see the proportion of adverse feedback letters among the feed back letters which we received during a specified period of time and compare them over various time periods.


Number of adverse feedback letters received per 100 feedback letters received

18 Type: R

19 Remarks: NA

********************************************************************

96.EDM-EMP-HUT-001


1 Gsln: 96

2 Major Group: EDM

3 Minor Group: EMP

4 Sub Category: HUT

5 Indicator Code: EDM-EMP-HUT-001

6 Indicator Name: Relative Bed Units for a NWH


RBU


Relative bed units is a measure used for describing the capacity of the hospitals in a standard form (Bed Units).



11 Formula: Number of Hospital Beds in the NWH/ Bed Unit

12 Data required: Hospital Bed capacity and the time period during which they were empanelled

213

13 Frequency of

Monitoring:


N N Y Y Y Y N N



Input

16 Indicator use: This indicator is used for comparing hospitals with different capacity and the quantity of services they offer. For ex: a 50 bedded NWH providing 50 therapies and a 100 bedded NWH providing 50 therapies performance can be compared using this indicator. (Hypothetical example)


Number of Relative Bed Units

18 Type: Rt

19 Remarks: NA

********************************************************************

97. EDM-EMP-HUT-002


1 Gsln: 97

2 Major Group: EDM

3 Minor Group: EMP

4 Sub Category: HUT


6 Indicator Name: Empanelment Weight for a NWH


EW

214


Empanelment weight denotes the capacity of an hospital in terms of what services it can provide for Dr.NTR Vaidya Seva (and how much demand/utilization is there for those NWH services (captured by bare weights) over a period of time



11 Formula: Sum of (BWs for all therapies in the category) for all categories/specialities empanelled in the NWH

12 Data required: All the categories a NWH has empanelled for during a specific period of time and the bare weights (for all the therapies which are covered under those categories)

13 Frequency of

Monitoring:


N N N Y Y Y N N



Output

16 Indicator use: It is useful to compare various hospitals in terms of their capacity.



18 Type: Re

19 Remarks: NA

********************************************************************

215

98. EDM-EMP-HUT-003


1 Gsln: 98

2 Major Group: EDM

3 Minor Group: EMP

4 Sub Category: HUT


6 Indicator Name: Weighted Average Cases per month for a NWH, for a specified period


WAC


It is the average number of cases per empanelled category/therapy which a hospital is providing services to.



11 Formula: (1/RBU) x Sum of (Frequency count of a therapy preauthed during the period x BW of the therapy) for all therapies in the specialities empanelled in the NWH / (30.5 x Total BWs of all Categories for which the NWH is empanelled) (Using Software: (1/RBU) x (1/30.5) x (weighted mean), where weight = BW and variable = frequency of therapy preauth count)

12 Data required: Hospital capacity in terms of Relative Bed Units, Therapies preauthed during the specific period from the NWH, Categories empanelled in a NWH and therapies present in those categories, Bare weights for all the therapies

13 Frequency of

Monitoring:


N N Y Y Y Y N N

216



Output

16 Indicator use: It is used to monitor how a hospital is performing as per the Dr.NTR Vaidya Seva Scheme. If a hospital doesn't provide sufficient services to Dr.NTR Vaidya Seva patients then it's average goes below the normal range


Number of cases per empanelled category/therapy

18 Type: G

19 Remarks: Hospitals empanel by specialities and not by therapies. Thus category can be considered as level 1 and therapy can be considered as level 2 (level 2 is bottom or finer level of measurement)

********************************************************************

99.EDM-EMP-HUT-004


1 Gsln: 99

2 Major Group: EDM

3 Minor Group: EMP

4 Sub Category: HUT


6 Indicator Name: Weighted Standard Deviation for a NWH


WSD


It is the weighted standard deviation for the above indicator. (i.e. Weighted Average Cases per month for a NWH, for a specified period)


217


11 Formula: (1/RBU) x (1/30.5) x (weighted standard deviation formula), where weight = BW (Using Software: (1/RBU) x (1/30.5) x (weighted standard deviation), where weight = BW and variable = frequency of therapy preauth count)

12 Data required: Hospital capacity in terms of Relative Bed Units, Therapies preauthed during the specific period from the NWH, Categories empanelled in a NWH and therapies present in those categories, Bare weights for all the therapies

13 Frequency of

Monitoring:


N N Y Y Y Y N N



Output

16 Indicator use: When the averages of two hospitals or the average of a particular hospital during two time points is same, then we look at the standard deviations to see which hospital is more reliable/consistent in providing the services to Dr.NTR Vaidya Seva patients.



18 Type: Re

19 Remarks: Weighted Standard Deviation can be calculated by SAS / other statistical softwares and excel

********************************************************************

218

100.EDM-EMP-HUT-005


1 Gsln: 100

2 Major Group: EDM

3 Minor Group: EMP

4 Sub Category: HUT


6 Indicator Name: Average Categories per NWH during a specified period


ACN


In a particular time period on average how many categories have been empanelled per a NWH.



11 Formula: sum of (categories for a given NWH) for all NWHs / total NWHs empanelled during the period

12 Data required: Number of categories empanelled for all the NWH during a specific period of time

13 Frequency of

Monitoring:


N N N Y Y Y N N



Input

16 Indicator use: To monitor the change in the supply of services from the NWH's

219


Number of categories per one NWH

18 Type: G

19 Remarks: NA

********************************************************************

101.EDM-EMP-HUT-006


1 Gsln: 101

2 Major Group: EDM

3 Minor Group: EMP

4 Sub Category: HUT


6 Indicator Name: Therapies preauthed per Category in a given NWH


THR_PA_CA


Indicator name is self descriptive



11 Formula: Frequency count of therapies preauthed for a category available with the specified NWH

12 Data required: Therapies Preauthed from a particular NWH and the category to which this therapy belongs to. (Category code, Surgery Code, NWH_CD))

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N

220



Output

16 Indicator use: Profiling of the therapies preauthed for a particular category during a specific period of time and analyse the patterns.


Number of therapies preauthed

18 Type: A

19 Remarks: NA

********************************************************************

102.EDM-EMP-HUT-007


1 Gsln: 102

2 Major Group: EDM

3 Minor Group: EMP

4 Sub Category: HUT

5 Indicator Code:

EDM-EMP-HUT-007

6 Indicator Name:

Percentage of therapies done by Government Doctors in Private hospitals during a specified period


PCT_THR_GVTDOC




10 Role & Action:

NA

221

11 Formula: (Number of therapies done by Government doctors in Private hospitals during the specified period/ Total number of therapies done out of preauths given during the specified period)*100

12 Data required:

Records of surgeries done by doctors in private hospitals along with their medical registration number and the doctors registered with government hospitals along with their medical registration number

13 Frequency of

Monitoring:


N N Y Y Y Y N N



Output

16 Indicator use: It is done to see if the government doctors are practising mostly in the private hospitals


Percent of therapies

18 Type: P

19 Remarks: NA

*******************************************************************

103.EDM-EMP-HUT-008


1 Gsln: 103

2 Major Group: EDM

3 Minor Group: EMP

4 Sub Category: HUT

5 Indicator Code:

EDM-EMP-HUT-008

222

6 Indicator Name:

Revolving Fund from the Preauthorisation's done during a specific period of time


RF




10 Role & Action:

NA

11 Formula: Amount deducted from the payment to a Government NWH from amount of claims approved

12 Data required:

Therapies preauthed by government hospitals, the amount that it incurs and the amount deducted as revolving fund

13 Frequency of

Monitoring:


N N Y Y Y Y N N



Output

16 Indicator use: To monitor the amount that has been deducted from the amount of claims approved for government hospitals in the form of revolving fund. We can define a time period and see how much amount is being collected as revolving fund periodically.


Rupees

18 Type: A

19 Remarks: NA

*******************************************************************

223

104.EDM-MAU-***-001

# KPI Properties

Description

1 Gsln: 104

2 Major Group: EDM

3 Minor Group: MAU

4 Sub Category:

***

5 Indicator Code:

EDM-MAU-***-001

6 Indicator Name:

Case Fatality Rate


CFR


1000 x Number of deaths/Number of therapies done

9 Dimensions: NWH, HD, Hospitalwise Category

10 Role & Action:

NA

11 Formula: 1000 x Number of deaths/Number of therapies done

12 Data required:

Number of deaths occurred and number of surgeries done out of preauths during the particular period

13 Frequency of

Monitoring:


N N Y Y Y Y N N



Output

224

16 Indicator use:

To monitor whether the quality of care is proper or not in a NWH. If the quality diminishes then the 'Case Fatality Rate' increases.


Number of deaths per number of therapies done

18 Type: R

19 Remarks: NA

*******************************************************************

105.OPR-PAU-SUB-001

# KPI Properties

Description

1 Gsln: 105

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category:

SUB

5 Indicator Code:

OPR-PAU-SUB-001

6 Indicator Name:

Therapies preauth submitted by MEDCO


PAU_S_R

PAUC_S_R


The number of therapies Preauth(Fresh preauth, Preauth cancellation) have been submitted by MEDCO to NAM.

9 Dimensions: Fresh preauth Cases

Preauth cancellation Cases

10 Role & Action:

MEDCO&

Preauth Submitted

225

11 Formula: NA

12 Data required:

NA

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity

16 Indicator use:

To monitor performance of MEDCO in disposal of preauth cases


Fresh preauth Cases


18 Type: A

19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.

*******************************************************************

106. OPR-PAU-SUB-002

# KPI Properties

Description

1 Gsln: 106

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category:

SUB

5 Indicator Code:

OPR-PAU-SUB-002

226

6 Indicator Name:

Therapies Preauth Submitted by MEDCO and Live


LPAU_S_R

LPAUC_S_R


The number of therapies for which Preauths(Fresh preauth,Preauth cancellation) have been submitted by MEDCO and awaiting final disposal at various levels of Trust at this moment.



10 Role & Action:

MEDCO&

Preauth Submitted

11 Formula: NA

12 Data required:

NA

13 Frequency of

Monitoring:


Y Y N N N N N N



Activity

16 Indicator use: To monitor performance of MEDCO in disposal of preauth cases


Fresh preauth Cases


18 Type: A


*******************************************************************

227

107. OPR-PAU-SUB-003


1 Gsln: 107

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: SUB

5 Indicator Code:

OPR-PAU-SUB-003

6 Indicator Name:

Therapies Preauth Submitted by MEDCO in Past


PPAU_S_R

PPAUC_S_R


The number of therapies for which Preauths(Fresh preauth,Preauth cancellation) have been submitted by MEDCO in the past



10 Role & Action: MEDCO&Preauth Submitted

11 Formula: PAU_S_R (-)LPAU_S_R

PAUC_S_R(-)LPAUC_S_R

12 Data required: PAU_S_R; LPAU_S_R; PAUC_S_R; LPAUC_S_R

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output

16 Indicator use: To monitor performance of MEDCO in disposal of preauth cases

228


Fresh preauth Cases


18 Type: A


********************************************************************

108.OPR-PAU-UPD-001


1 Gsln: 108

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: UPD

5 Indicator Code: OPR-PAU-UPD-001

6 Indicator Name: Therapies Preauth Updated by MEDCO


PAU_U_R

PAUC_U_R


The number of therapies for which Preauths (Preauth,Preauth cancellation) have been updated by MEDCO after pendency and returned to Trust



10 Role & Action: MEDCO&Preauth Updated

11 Formula: NA

12 Data required: NA

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N

229



Activity

16 Indicator use: To monitor performance of MEDCO in disposal of preauth pendency cases


Preauth pendency Cases

18 Type: A


********************************************************************

109.OPR-PAU-UPD-002


1 Gsln: 109

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: UPD


6 Indicator Name: Therapies Preauth Updated by MEDCO and Live


LPAU_U_R

LPAUC_U_R


The number of therapies for which Preauths(Fresh preauth,Preauth cancellation) have been updated by MEDCO after pendency and awaiting final disposal at various levels of Trust at this moment




230

11 Formula: NA


13 Frequency of

Monitoring:


Y N N N N N N N



Activity




18 Type: A


********************************************************************

110.PR-PAU-UPD-003


1 Gsln: 110

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: UPD


6 Indicator Name: Therapies Preauth Updated by MEDCO in Past


PPAU_U_R

PPAUC_U_R

231


The number of therapies for which Preauths(Fresh preauth,Preauth cancellation) have been updated by MEDCO after pendency in the past and returned to Trust




11 Formula: PAU_U_R (-)LPAU_U_R

PAUC_U_R(-)LPAUC_U_R

12 Data required: PAU_U_R; LPAU_U_R; PAUC_U_R; LPAUC_U_R

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output




18 Type: A


********************************************************************

111.OPR-PAU-UPD-004


1 Gsln: 111

2 Major Group: OPR

3 Minor Group: PAU

232

4 Sub Category: UPD

5 Indicator Code:

OPR-PAU-UPD-004

6 Indicator Name:

Therapies Preauth Updated by MEDCO and sent to Preauth operator


PAU_U_R_PPD

PAU_U_R_PTD

PAU_U_R_PAO


The number of Therapies Preauth updated by MEDCO for therapies Preauths kept pendency and returned to preauth operator

9 Dimensions: PPD

PTD

PAO


11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity




18 Type: A

233


********************************************************************

112.OPR-PAU-UPD-005


1 Gsln: 112

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: UPD


6 Indicator Name: Therapies Preauth cancellation Updated by MEDCO and sent to Preauth operator


PAUC_U_R_PPD

PAUC_U_R_PTD

PAUC_U_R_PAO


The number of Therapies Preauth cancellation updated by MEDCO for therapies Preauths kept pendency and returned to preauth operator

9 Dimensions: PPD

PTD

PAO


11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N


234


Activity



Preauth Cancellation pendency Cases

18 Type: A


********************************************************************

113.OPR-PAU-FWD-001


1 Gsln: 113

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: FWD

5 Indicator Code: OPR-PAU-FWD-001

6 Indicator Name: Therapies Preauth Forwarded by NAM


PAU_F_N


The number of therapies for which Preauths have been forwarded by NAM after being raised for the first time by MEDCO

9 Dimensions: NA

10 Role & Action: NAM&Preauth Forwarded

11 Formula: NA


235

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity

16 Indicator use: To monitor performance of NAM in disposal of preauth cases


Fresh Preauth Cases

18 Type: A

19 Remarks: NA

********************************************************************

114.OPR-PAU-FWD-002


1 Gsln: 114

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: FWD


6 Indicator Name: Therapies Preauth Forwarded by NAM and Live


LPAU_F_N


The number of therapies for which Preauths have been forwarded by NAM after being raised for the first time by MEDCO and awaiting final disposal at various levels of Trust at this moment

9 Dimensions: NA

236

10 Role & Action: NAM &Preauth Forwarded

11 Formula: NA


13 Frequency of

Monitoring:


Y N N N N N N N



Activity



Fresh Preauth Cases

18 Type: A

19 Remarks: NA

********************************************************************

115.OPR-PAU-FWD-003


1 Gsln: 115

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: FWD


6 Indicator Name: Therapies Preauth Forwarded by NAM in Past


PPAU_F_N

237


The number of therapies for which Preauths have been forwarded by NAM in Past

9 Dimensions: NA

10 Role & Action: NAM &Preauth Forwarded

11 Formula: PAU_F_N ( -) LPAU_F_N

12 Data required: PAU_F_N; LPAU_F_N

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output



Fresh Preauth Cases

18 Type: A

19 Remarks: NA

********************************************************************

116.OPR-PAU-RAP-001


1 Gsln: 116

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: RAP

5 Indicator Code: OPR-PAU-RAP-001

238

6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Approval


PAU_RA_PPD

PAU_RA_PID

PAU_RA_PTD


The number of therapies Preauth which have been disposed with a Recommendation for Approval by preauth operator

9 Dimensions: PPD

PID

PTD

10 Role & Action: Preauth operator &Recommended approval

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity

16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern


Fresh Preauth Cases

18 Type: A


********************************************************************

239

117.OPR-PAU-RAP-002


1 Gsln: 117

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: RAP


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Approval and Live


LPAU_RA_PPD

LPAU_RA_PID

LPAU_RA_PTD


The number of therapies Preauth which have been disposed with a Recommendation for Approval by the preauth operator and awaiting final disposal at various levels of Trust at this moment

9 Dimensions: PPD

PID

PTD

10 Role & Action: Preauth operator&Recommended approval

11 Formula: NA


13 Frequency of

Monitoring:


Y N N N N N N N



Activity

240



Fresh Preauth Cases

18 Type: A


********************************************************************

118.OPR-PAU-RAP-003


1 Gsln: 118

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: RAP


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Approval in the Past


PPAU_RA_PPD

PPAU_RA_PID

PPAU_RA_PTD


The number of therapies Preauth which have been disposed with a Recommendation for Approval by the preauth operator in the Past

9 Dimensions: PPD

PID

PTD

10 Role & Action: Preauth operator&

Recommended approval

241

11 Formula: PAU_RA_PPD (-)LPAU_RA_PPD

PAU_RA_PID (-)LPAU_RA_PID

PAU_RA_PTD (-)LPAU_RA_PTD

12 Data required: PAU_RA_PPD; LPAU_RA_PPD; PAU_RA_PID; LPAU_RA_PID; PAU_RA_PTD; LPAU_RA_PTD

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output



Fresh Preauth Cases

18 Type: A


********************************************************************

119. OPR-PAU-RAP-004


1 Gsln: 119

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: RAP


242

6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Approval

without pendency


PAU_RA~NP_PPD

PAU_RA~NP_PID

PAU_RA~NP_PTD


The number of therapies which have been disposed with Recommendation of Approval without pendency by preauth operator

9 Dimensions: NA

10 Role & Action: Preauth Trust Doctor&Recommended Approval

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity

16 Indicator use: To monitor PTD performance and preauthorisation disposal pattern


Preauth Cases

18 Type: A


********************************************************************

243



1 Gsln: 120

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: PEN


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Approval after pendency


PAU_RA~P_PPD

PAU_RA~P_PID

PAU_RA~P_PTD


The number of therapies which have been disposed with a Recommendation of Approval after pendency by preauth operator

9 Dimensions: NA

10 Role & Action: Preauth Trust Doctor&Recommended Approval

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity


244


Preauth Cases

18 Type: A


********************************************************************

121.OPR-PAU-RAP-006


1 Gsln: 121

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: RAP


6 Indicator Name: Therapies Preauth Cancellation request Disposed by Preauth operator with Recommendation for Approval


PAUC_RA_PPD

PAUC_RA_PID

PAUC_RA_PTD


The number of therapies Preauth Cancellation request which have been disposed with a Recommendation for Approval by preauth operator

9 Dimensions: PPD

PID

PTD

10 Role & Action: Preauth operator &Recommended approval

11 Formula: NA


245

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity

16 Indicator use: To monitor Preauth operator performance and preauth cancellations disposal pattern



18 Type: A


********************************************************************



1 Gsln: 122

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: RAP


6 Indicator Name: Therapies Preauth Cancellation request Disposed by Preauth operator with Recommendation for Approval (RA)and Live


LPAUC_RA_PPD

LPAUC_RA_PID

LPAUC_RA_PTD

246


The number of therapies Preauth Cancellation request which have been disposed with a Recommendation for Approval by the preauth operator and awaiting final disposal at various levels of Trust at this moment

9 Dimensions: PPD

PID

PTD


11 Formula: NA


13 Frequency of

Monitoring:


Y N N N N N N N



Activity




18 Type: A


********************************************************************

247



1 Gsln: 123

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: RAP


6 Indicator Name: Therapies Preauth Cancellation request Disposed by with Preauth operator with Recommendation for Approval RA in the Past


PPAUC_RA_PPD

PPAUC_RA_PID

PPAUC_RA_PTD


The number of therapies Preauth Cancellation request which have been disposed with a Recommendation for Approval by the preauth operator

9 Dimensions: PPD (P)

PID (I)

PTD (T)


11 Formula: PAUC_RA_PPD (-)LPAUC_RA_PPD

PAUC_RA_PID (-)LPAUC_RA_PID

PAUC_RA_PTD (-)LPAUC_RA_PTD

12 Data required: PAUC_RA_PPD; LPAUC_RA_PPD; PAUC_RA_PID; LPAUC_RA_PID;PAUC_RA_PTD; LPAUC_RA_PTD

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N


248


Output




18 Type: A


********************************************************************

124.OPR-PAU-RRJ-001


1 Gsln: 124

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: RRJ

5 Indicator Code: OPR-PAU-RRJ-001

6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection(RR)


PAU_RR_PPD

PAU_RR_PID

PAU_RR_PTD


The number of therapies Preauth which have been disposed with a Recommendation for Rejection by the preauth operator

9 Dimensions: PPD

PID

PTD

249

10 Role & Action: Preauth Panel doctor&Recommended Rejection

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity



Fresh Preauth Cases

18 Type: A


********************************************************************

125. OPR-PAU-RRJ-002


1 Gsln: 125

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: RRJ


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection and live

250


LPAU_RR_PPD

LPAU_RR_PID

LPAU_RR_PTD


The number of therapies Preauth which have been disposed with a Recommendation for Rejection by the preauth operator and awaiting final disposal at various levels of Trust at this moment

9 Dimensions: PPD

PID

PTD

10 Role & Action: Preauth operator&Recommended Rejection

11 Formula: NA


13 Frequency of

Monitoring:


Y N N N N N N N



Activity



Fresh Preauth Cases

18 Type: A


********************************************************************

251

126. OPR-PAU-RRJ-003


1 Gsln: 126

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: RRJ


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection in the Past


PPAU_RR_PPD

PPAU_RR_PID

PPAU_RR_PTD


The number of therapies Preauth which have been disposed with a Recommendation for Rejection(RR) by the Preauth operator in the past

9 Dimensions: PPD

PID

PTD

10 Role & Action: Preauth operator&Recommended Rejection

11 Formula: PAU_RR_PPD (-) LPAU_RR_PPD

PAU_RR_PID (-) LPAU_RR_PID

PAU_RR_PTD (-) LPAU_RR_PTD

12 Data required: PAU_RR_PPD; LPAU_RR_PPD;PAU_RR_PID; LPAU_RR_PID;PAU_RR_PTD; LPAU_RR_PTD

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N


252


Output



Fresh Preauth Cases

18 Type: A


********************************************************************

127.OPR-PAU-RRJ-004


1 Gsln: 127

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: RRJ


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection without pendency


PAU_RR~NP_PPD

PAU_RR~NP_PID

PAU_RR~NP_PTD


The number of therapies Preauth which have been disposed with a Recommendation for Rejection without pendency by the preauth operator

9 Dimensions: NA

10 Role & Action: Preauth operator &Recommended rejection

11 Formula: NA

253


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity



Fresh Preauth Cases

18 Type: A


********************************************************************

128.OPR-PAU-RRJ-005


1 Gsln: 128

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: RRJ


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection after pendency


PAU_RR~P_PPD

PAU_RR~P_PID

PAU_RR~P_PTD

254


The number of therapies Preauth which have been disposed with a Recommendation for Rejection after pendency by the preauth operator

9 Dimensions: NA

10 Role & Action: Preauth operator &Recommended rejection

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity



Fresh Preauth Cases

18 Type: A


********************************************************************

129.OPR-PAU-PEN-001


1 Gsln: 129

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: PEN

255

5 Indicator Code: OPR-PAU-PEN-001

6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Pendency


PAU_P_PPD

PAU_P_PID

PAU_P_PTD


The number of therapies Preauth which have been disposed with a Pendency by the Preauth operator

9 Dimensions: PPD

PID

PTD

10 Role & Action: Preauth operator &Pendency

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity



Fresh Preauth Cases

18 Type: A


********************************************************************

256

130. OPR-PAU-PEN-002


1 Gsln: 130

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: PEN


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Pendency and Live


LPAU_P_PPD

LPAU_P_PID

LPAU_P_PTD


The number of therapies Preauth which have been disposed with a Pendency by the Preauth operator and awaiting final disposal at various levels of Trust at this moment

9 Dimensions: PPD

PID

PTD


11 Formula: NA


13 Frequency of

Monitoring:


Y N N N N N N N



Activity

257



Fresh Preauth Cases

18 Type: A


********************************************************************

131. OPR-PAU-PEN-003


1 Gsln: 131

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: PEN


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Pendency in the Past


PPAU_P_PPD

PPAU_P_PID

PPAU_P_PTD


The number of therapies which have been disposed with a Pendency by the Preauth operator in the past

9 Dimensions: PPD

PID

PTD


258

11 Formula: PAU_P_PPD (-) LPAU_P_PPD

PAU_P_PID (-) LPAU_P_PID

PAU_P_PTD (-) LPAU_P_PTD

12 Data required: PAU_P_PPD; LPAU_P_PPD; PAU_P_PID; LPAU_P_PID; PAU_P_PTD; LPAU_P_PTD

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output



Fresh Preauth Cases

18 Type: A


********************************************************************

132.OPR-PAU-PEN-004


1 Gsln: 132

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: PEN


6 Indicator Name: Total number of therapies preauthorisation kept pending during specified period

259


PAU_P_T


Total number of therapies preauth kept pending by Preauth operators

9 Dimensions: NA

10 Role & Action: Preauth operator &Total Pendency

11 Formula: PAU_P_PPD + PAU_P_PID + PAU_P_PTD

12 Data required: PAU_P_PPD; PAU_P_PID; PAU_P_PTD

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output



Fresh Preauth Cases

18 Type: A

19 Remarks: NA

********************************************************************

133.OPR-PAU-PEN-005


1 Gsln: 133

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: PEN

260


6 Indicator Name: Therapies Preauth cancellation request disposed by Preauth operator with Pendency


PAUC_P_PPD

PAUC_P_PID

PAUC_P_PTD


The number of therapies Preauth cancellation request which have been disposed with a Pendency by the Preauth operator

9 Dimensions: PPD

PID

PTD


11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity



Fresh Preauth Cancellation Cases

18 Type: A


********************************************************************

261

134.OPR-PAU-PEN-006


1 Gsln: 134

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: PEN


6 Indicator Name: Therapies Preauth cancellation request Disposed by Preauth operator with Pendency and Live


LPAUC_P_PPD

LPAUC_P_PID

LPAUC_P_PTD


The number of therapies Preauth cancellation request which have been disposed with a Pendency by the Preauth operator and awaiting final disposal at various levels of Trust at this moment

9 Dimensions: PPD

PID

PTD


11 Formula: NA


13 Frequency of

Monitoring:


Y N N N N N N N



Activity

262




18 Type: A


********************************************************************

135.OPR-PAU-PEN-007


1 Gsln: 135

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: PEN


6 Indicator Name: Therapies Preauth cancellation request disposed by Preauth operator with Pendency in the Past


PPAUC_P_PPD

PPAUC_P_PID

PPAUC_P_PTD


The number of therapies Preauth cancellation request which have been disposed with a Pendency by the Preauth operator in the past

9 Dimensions: PPD

PID

PTD


263

11 Formula: PAUC_P_PPD (-) LPAUC_P_PPD

PAUC_P_PID (-) LPAUC_P_PID

PAUC_P_PTD (-) LPAUC_P_PTD

12 Data required: PAUC_P_PPD; LPAUC_P_PPD;PAUC_P_PID; LPAUC_P_PID;PAUC_P_PTD; LPAUC_P_PTD

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output




18 Type: A


********************************************************************

136.OPR-PAU-APP-001


1 Gsln: 136

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: APP

5 Indicator Code: OPR-PAU-APP-001

6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Approval

264


PAU_A_PTD

PAU_A_PAO


The number of therapies which have been disposed with Final Approval by the preauth operator

9 Dimensions: PTD

PAO

10 Role & Action: Preauth operator&Preauth Approval

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity



Preauth Cancellation cases

18 Type: A


********************************************************************

137.OPR-PAU-APP-002


1 Gsln: 137

2 Major Group: OPR

3 Minor Group: PAU

265

4 Sub Category: APP


6 Indicator Name: Total number of therapies preauthorisation approved during specified period


PAU_A_T


Total number of therapies preauth approved by preauth operators

9 Dimensions: NA


11 Formula: PAU_A_PAO + PAU_A_PTD

12 Data required: PAU_A_PAO; PAU_A_PTD

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output

16 Indicator use: To monitor preauthorisation disposal pattern


Preauth Cases

18 Type: A

19 Remarks: NA

********************************************************************

266

138.OPR-PAU-APP-003


1 Gsln: 138

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: APP


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Approval without pendency


PAU_A~NP_PTD

PAU_A~NP_PAO


The number of therapies which have been disposed with Final Approval without pendency by the Preauth operator

9 Dimensions: PTD

PAO


11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity


267


Preauth Cases

18 Type: A


********************************************************************

139.OPR-PAU-APP-004


1 Gsln: 139

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: APP


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Approval after pendency


PAU_A~P_PTD

PAU_A~P_PAO


The number of therapies which have been disposed with Final Approval after pendency by the Preauth operator

9 Dimensions: PTD

PAO


11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N

268



Activity



Preauth Cases

18 Type: A


********************************************************************

140.OPR-PAU-APP-005


1 Gsln: 140

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: APP


6 Indicator Name: Therapies Preauth cancellation request Disposed by Preauth operator with Approval


PAUC_A_PTD

PAUC_A_PAO


The number of therapies cancellation request which have been disposed with Final Approval by the Preauth operator

9 Dimensions: PTD

PAO


269

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity




18 Type: A


********************************************************************

141.OPR-PAU-APP-006


1 Gsln: 141

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: APP


6 Indicator Name: Total number of Therapies Preauth cancellation request disposed by Approval


PAUC_A_T

270


The number of therapies cancellation request which have been disposed with Final Approval by the Preauth operators

9 Dimensions: NA

10 Role & Action: Preauth operator&Preauth Cancellation

11 Formula: PAUC_A_PTD + PAUC_A_PAO

12 Data required: PAUC_A_PTD; PAUC_A_PAO

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output



Preauth Cancellation Cases

18 Type: A

19 Remarks: NA

********************************************************************

142.OPR-PAU-REJ-001


1 Gsln: 142

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: REJ

5 Indicator Code: OPR-PAU-REJ-001

271

6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Rejection


PAU_R_PTD

PAU_R_PAO


The number of therapies which have been disposed with Final Rejection by the Preauth operator

9 Dimensions: PTD

PAO

10 Role & Action: Preauth operator&Preauth Rejection

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity



Preauth Cases

18 Type: A


********************************************************************

272

143.OPR-PAU-REJ-002


1 Gsln: 143

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: REJ


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Rejection without pendency


PAU_R~NP_PTD

PAU_R~NP_PAO


The number of therapies which have been disposed with Final Rejection without pendency by the Preauth operator

9 Dimensions: PTD

PAO

10 Role & Action: Preauth operator &Preauth Rejection

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity


273


Preauth Cases

18 Type: A


********************************************************************

144.OPR-PAU-REJ-003


1 Gsln: 144

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: REJ


6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Rejection after pendency


PAU_R~P_PTD

PAU_R~P_PAO


The number of therapies which have been disposed with Final Rejection after pendency by the Preauth operator

9 Dimensions: PTD

PAO

10 Role & Action: Preauth operator&Preauth Rejection

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N

274



Activity



Preauth Cases

18 Type: A


********************************************************************

145.OPR-PAU-REJ-004


1 Gsln: 145

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: REJ


6 Indicator Name: Total number of therapies preauthorisation rejected during specified period


PAU_R_T


Total number of therapies preauth rejected by the Preauth operator

9 Dimensions: NA

10 Role & Action: Preauth operator&Total Preauth approval

11 Formula: PAU_R_PAO + PAU_R_PTD

275

12 Data required: PAU_R_PAO; PAU_R_PTD

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output

16 Indicator use: To monitor preauthorisation disposal pattern


Preauth Cases

18 Type: A

19 Remarks: NA

********************************************************************

146.OPR-PAU-TDP-001


1 Gsln: 146

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: TDP

5 Indicator Code: OPR-PAU-TDP-001

6 Indicator Name: Total Therapies Preauth Disposed by PPD


PAU_D_PPD


Total Therapies Preauth Disposed by Preauth panel doctor with recommended approval,recommended rejection and pendency

9 Dimensions: NA

276

10 Role & Action: Preauth paneldoctor&Recommended Pendency

11 Formula: PAU_RA_PPD + PAU_RR_PPD + PAU_P_PPD

12 Data required: PAU_RA_PPD; PAU_RR_PPD;PAU_P_PPD

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output

16 Indicator use: To monitor PPD performance and preauthorisation disposal pattern


Fresh Preauth Cases

18 Type: A

19 Remarks: NA

********************************************************************

147.OPR-PAU-TDP-002


1 Gsln: 147

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: TDP


6 Indicator Name: Total Therapies Preauth Disposed by PTD


PAU_D_PTD

277


Total Therapies Preauth Disposed by Preauth trust doctor with approval,rejection,pendency,recommended approval and recommended rejection

9 Dimensions: PTD

PAO

10 Role & Action: Preauth Trust Doctor&Disposals

11 Formula: PAU_A_PTD + PAU_R _PTD+ PAU_P_PTD + PAU_RA_PTD + PAU_RR_PTD

12 Data required: PAU_A_PTD; PAU_R _PTD; PAU_P_PTD; PAU_RA_PTD; PAU_RR_PTD

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output



Preauth Cases

18 Type: A

19 Remarks: NA

********************************************************************

148.OPR-PAU-TDP-003


1 Gsln: 148

2 Major Group: OPR

3 Minor Group: PAU

278

4 Sub Category: TDP


6 Indicator Name: Total Therapies Preauth Disposed by PAO


PAU_D_PAO


Total Therapies Preauth Disposed by PAO with approval,rejection and pendency

9 Dimensions: PTD

PAO

10 Role & Action: Preauth Trust Doctor&Disposals

11 Formula: PAU_A_PAO + PAU_R _PAO+ PAU_P_PAO

12 Data required: PAU_A_PAO; PAU_R _PAO; PAU_P_PAO

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output

16 Indicator use: To monitor PAO performance and preauthorisation disposal pattern


Preauth Cases

18 Type: A

19 Remarks: NA

********************************************************************

279

149. OPR-PAU-AUC-001


1 Gsln: 149

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: AUC

5 Indicator Code: OPR-PAU-AUC-001

6 Indicator Name: Therapies Preauth disposed by auto cancellation


PAU_D_AUC


Number of Preauths auto cancelled due to expiry of time limit

9 Dimensions: NA

10 Role & Action: Preauth

Auto Cancellation

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity

16 Indicator use: To monitor preauth cancellations


Preauth Cases

18 Type: A

280

19 Remarks: NA

********************************************************************

150. OPR-TRT-UPD-001


1 Gsln: 150

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: UPD

5 Indicator Code: OPR-TRT-UPD-001

6 Indicator Name: Therapies treatment Updated by MEDCO


TRT_U_R_SUR

TRT_U_R_MTR


The number of preauthed therapies for which treatment has been updated by MEDCO

9 Dimensions: Surgery

Medical Treatment

10 Role & Action: MEDCO&Treatment Updated

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity

281

16 Indicator use: To monitor status of preauth approved cases at NWH and performance of MEDCO


Preauth Approved cases

18 Type: A


********************************************************************



1 Gsln: 151

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: UPD


6 Indicator Name: Therapies treatment Updated by MEDCO and Live


LTRT_U_R_SUR

LTRT_U_R_MTR


The number of therapies Preauths for which treatment have been updated by MEDCO and awaiting final discharge


Medical Treatment


11 Formula: NA


282

13 Frequency of

Monitoring:


Y N N N N N N N



Activity




18 Type: A


********************************************************************

152.OPR-TRT-UPD-003


1 Gsln: 152

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: UPD


6 Indicator Name: Therapies treatment Updated by MEDCO in Past


PTRT_U_R_SUR

PTRT_U_R_MTR


The number of therapies Preauths for which treatment have been updated by MEDCO in the past


Medical Treatment

283


11 Formula: TRT_U_R_SUR (-)LTRT_U_R_SUR

TRT_U_R_MTR (-) LTRT_U_R_MTR

12 Data required: TRT_U_R_SUR; LTRT_U_R_SUR;TRT_U_R_MTR; LTRT_U_R_MTR

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output




18 Type: A


********************************************************************

153.OPR-TRT-UPD-004


1 Gsln: 153

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: UPD


6 Indicator Name: Total Therapies Treatment Updated by MEDCO

284


TRT_U_R_T


The number of therapies Preauths for which Treatment has been updated by MEDCO

9 Dimensions: NA


11 Formula: TRT_U_R_SUR + TRT_U_R_MTR

12 Data required: TRT_U_R_SUR; TRT_U_R_MTR

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output




18 Type: A

19 Remarks: NA

********************************************************************

154.OPR-TRT-UPD-005


1 Gsln: 154

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: UPD

285


6 Indicator Name: Total Therapies Treatment Updated by MEDCO and Live


LTRT_U_R_T


The number of therapies Preauths for which Treatment has been updated by MEDCO and awaiting final discharge

9 Dimensions: NA


11 Formula: LTRT_U_R_SUR + LTRT_U_R_MTR

12 Data required: LTRT_U_R_SUR; LTRT_U_R_MTR

13 Frequency of

Monitoring:


Y N N N N N N N



Output




18 Type: A

19 Remarks: NA

********************************************************************

286



1 Gsln: 155

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: UPD


6 Indicator Name: Total Therapies Treatment Updated by MEDCO in Past


PTRT_U_R_T


Total number of therapies Preauths for which Treatment has been updated by MEDCO in the past

9 Dimensions: NA

10 Role & Action: MEDCO&Total Therapy Updated

11 Formula: PTRT_U_R_SUR + PTRT_U_R_MTR

12 Data required: PTRT_U_R_SUR; PTRT_U_R_MTR

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output




18 Type: A

287

19 Remarks: NA

********************************************************************

156. OPR-DSC-UPD-001


1 Gsln: 156

2 Major Group: OPR

3 Minor Group: DSC

4 Sub Category: UPD

5 Indicator Code: OPR-DSC-UPD-001

6 Indicator Name: Therapies Discharge Updated by MEDCO


DSC_U_R


The number of preauthed therapies for which Discharge has been updated by MEDCO

9 Dimensions: NA

10 Role & Action: MEDCO&Discharge Updated

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity


288



18 Type: A

19 Remarks: NA

********************************************************************

157.OPR-DEA-UPD-001


1 Gsln: 157

2 Major Group: OPR

3 Minor Group: DEA

4 Sub Category: UPD

5 Indicator Code: OPR-DEA-UPD-001

6 Indicator Name: Therapies Death Updated by MEDCO/Executive


DEA_U_R

DEA_U_X


The number of preauthed therapies for which Death has been updated by MEDCO/Executive

9 Dimensions: MEDCO Executive

10 Role & Action: MEDCO&Death Updated

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N


289


Activity




18 Type: A


********************************************************************

158.OPR-PAU-WTC-001


1 Gsln: 158

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: WTC

5 Indicator Code: OPR-PAU-WTC-001

6 Indicator Name: Therapies Preauth Waiting for <12 hrs at preauth operator


PAU_W<12hrs-NAM

PAU_W<12hrs-MEDCO

PAU_W<12hrs-PPD

PAU_W<12hrs-PTD

PAU_W<12hrs-PAO


The number of therapies preauth waiting for disposal for less than 12 hrs at preauth operator

9 Dimensions: NAM, MEDCO, PPD, PTD, PAO

10 Role & Action: Preauth operator&Preauthorisation

290

11 Formula: NA


13 Frequency of

Monitoring:


Y N N N N N N N



Activity

16 Indicator use: To monitor PPD performance in disposal of preauth cases


Preauth cases

18 Type: A


********************************************************************

159. OPR-PAU-WTC-002


1 Gsln: 159

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: WTC


6 Indicator Name: Therapies Preauth Waiting for >12 hrs at various levels

291


PAU_W>12hrs_NAM

PAU_W>12hrs_MEDCO

PAU_W>12hrs_PPD

PAU_W>12hrs_PTD

PAU_W>12hrs_PAO


The number of therapies preauths waiting for disposal for greater than 12 hrs at preauth operator

9 Dimensions: NAM

MEDCO

PPD

PTD

PAO


11 Formula: NA


13 Frequency of

Monitoring:


Y N N N N N N N



Activity



Preauth cases

18 Type: A


********************************************************************

292

160. OPR-PAU-WTC-003


1 Gsln: 160

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: WTC


6 Indicator Name: Therapies Preauth Waiting at Preauth operator afresh


PAUF_W_PPD

PAUF_W_PTD

PAUF_W_PAO


The number of fresh therapies preauths waiting for disposal at preauth operator

9 Dimensions: PPDPTDPAO


11 Formula: NA


13 Frequency of

Monitoring:


Y N N N N N N N



Activity



Preauth cases

293

18 Type: A


********************************************************************

161.OPR-PAU-WTC-004


1 Gsln: 161

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: WTC


6 Indicator Name: Therapies Preauth Waiting at Preauth operator after updation of pendency


PAUP_W_PPD

PAUP_W_PTD

PAUP_W_PAO


The number of therapies preauths which have been updated by MEDCO and waiting for disposal at preauth operator

9 Dimensions: PPD

PTD

PAO


11 Formula: NA


13 Frequency of

Monitoring:


Y N N N N N N N


294


Activity



Preauth cases

18 Type: A


********************************************************************

162.OPR-PAU-TWT-001


1 Gsln: 162

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: TWT

5 Indicator Code: OPR-PAU-TWT-001

6 Indicator Name: Total Therapies Preauth Waiting at NAM


PAU_W_N


The total number of therapies which have been Submitted by MEDCO to NAM and awaiting disposal at this moment

9 Dimensions: NA

10 Role & Action: NAM &Preauth Forwarding

11 Formula: PAU_W<12hrs_NAM + PAU_W>12hrs_NAM

12 Data required: PAU_W<12hrs_NAM; PAU_W>12hrs_NAM

295

13 Frequency of

Monitoring:


Y N N N N N N N



Output

16 Indicator use: To monitor NAM performance in disposal of preauth cases


Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

163.OPR-PAU-TWT-002


1 Gsln: 163

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: TWT


6 Indicator Name: Therapies Preauth Waiting at MEDCO


PAU_W_R


The total number of therapies which have been returned to MEDCO after pendency at PPD/PTD levels and awaiting disposal at this moment

9 Dimensions: NA

296

10 Role & Action: MEDCO &Preauth Submitting

11 Formula: PAU_W<12hrs_MEDCO + PAU_W>12hrs_MEDCO

12 Data required: PAU_W<12hrs_MEDCO; PAU_W>12hrs_MEDCO

13 Frequency of

Monitoring:


Y Y Y N N N N N



Output

16 Indicator use: To monitor MEDCO performance in disposal of preauth cases


Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

164.OPR-PAU-TWT-003


1 Gsln: 164

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: TWT


6 Indicator Name: Total Therapies Preauth Waiting at Preauth operator


PAU_W_PPD

297


The total number of therapies which have been forwarded by NAM/MEDCO and waiting for disposal at Preauth Panel Doctor

9 Dimensions: NA


11 Formula: PAU_W<12hrs_PPD+PAU_W>12hrs_PPD (or) FPAU_W_PPD+PPAU_W_PPD

12 Data required: PAU_W<12hrs_PPD; PAU_W>12hrs_PPD; FPAU_W_PPD; PPAU_W_PPD

13 Frequency of

Monitoring:


Y N N N N N N N



Output



Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

165.OPR-PAU-TWT-004


1 Gsln: 165

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: TWT

298




PAU_W_PTD


The total number of therapies which have been forwarded by Preauth Panel Doctor and waiting for disposal at Preauth Trust Doctor

9 Dimensions: NA


11 Formula: PAU_W<12hrs_PTD+PAU_W>12hrs_PTD (or) FPAU_W_PTD+PPAU_W_PTD

12 Data required: PAU_W<12hrs_PTD; PAU_W>12hrs_PTD; FPAU_W_PTD; PPAU_W_PTD

13 Frequency of

Monitoring:


Y N N N N N N N



Output

16 Indicator use: To monitor PTD performance in disposal of preauth cases


Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

299

166.OPR-PAU-TWT-005


1 Gsln: 166

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: TWT




PAU_W_PAO


The total number of therapies which have been forwarded by Preauth Trust Doctor and waiting for disposal at Preauth officer

9 Dimensions: NA


11 Formula: PAU_W<12hrs_PAO+PAU_W>12hrs_PAO (or) FPAU_W_PAO+PPAU_W_PAO

12 Data required: PAU_W<12hrs_PAO; PAU_W>12hrs_PAO; FPAU_W_PAO; PPAU_W_PAO

13 Frequency of

Monitoring:


Y N N N N N N N



Output

16 Indicator use: To monitor PAO performance in disposal of preauth cases

300


Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

167.OPR-PAU-TWT-006


1 Gsln: 167

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: TWT


6 Indicator Name: Therapies Preauth Waiting at Trust


PAU_W_TRU


The total number of therapies Preauth waiting for disposal at Trust

9 Dimensions: NA

10 Role & Action: Trust&Preauthorisation

11 Formula: PAU_W_PPD+PAU_W_PTD + PAU_W_PAO

12 Data required: PAU_W_PPD; PAU_W_PTD; PAU_W_PAO

13 Frequency of

Monitoring:


Y N N N N N N N



Output

301

16 Indicator use: To monitor disposal of preauth cases at Trust


Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

168.OPR-PAU-TWT-007


1 Gsln: 168

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: TWT


6 Indicator Name: Therapies Preauth Waiting at NWH


PAU_W_NWH


The total number of therapies Preauth waiting for disposal at NWH

9 Dimensions: NA

10 Role & Action: NWH&Preauthorisation

11 Formula: PAU_W_N + PAU_W_R

12 Data required: PAU_W_N; PAU_W_R

13 Frequency of

Monitoring:


Y N N N N N N N


302


Output

16 Indicator use: To monitor disposal of preauth cases at NWH


Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

169.OPR-PAU-TWT-008


1 Gsln: 169

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: TWT


6 Indicator Name: Total Therapies Preauth Waiting


PAU_W_T


The total number of therapies Preauth waiting for disposal at Trust and NWH

9 Dimensions: NA

10 Role & Action: Total&Preauthorisation

11 Formula: PAU_W_TRU + PAU_W_NWH

12 Data required: PAU_W_TRU; PAU_W_NWH

13 Frequency of

Monitoring:


Y N N N N N N N

303



Output

16 Indicator use: To monitor disposal of preauth cases


Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

170.OPR-TRT-WTC-001


1 Gsln: 170

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: WTC

5 Indicator Code: OPR-TRT-WTC-001

6 Indicator Name: Therapies preauthed waiting for Treatment for >15 days


TRT_W>15days_R_SUR

TRT_W>15days_R_MTR


The number of therapies preauthed for which Treatment updation by MEDCO has not taken place for >15 days from the time of preauthorisation


Medical Treatment

10 Role & Action: MEDCO&Treatment updation

11 Formula: NA

304


13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity

16 Indicator use: To monitor disposal of preauth approved cases at NWH and performance of MEDCO


Preauth approved cases

18 Type: A


********************************************************************

171.OPR-TRT-WTC-002


1 Gsln: 171

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: WTC


6 Indicator Name: Therapies preauthed waiting for Treatment for <15 days


TRT_W<15days_R SUR

TRT_W<15days_R_MTR

305


The number of therapies preauthed for which Treatment updation by MEDCO has not taken place for >15 days from the time of preauthorisation


Medical Treatment


11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity




18 Type: A


********************************************************************

172.OPR-TRT-WTC-003


1 Gsln: 172

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: WTC

306


6 Indicator Name: Total Therapies waiting for Treatment for >15 days


TRT_W>15days_R_T


Total number of therapies preauthed for which Treatment updation by MEDCO has not taken place for >15 days from the time of preauthorisation

9 Dimensions: NA

10 Role & Action: MEDCO&

Treatment updation

11 Formula: TRT_W>15days_R_SUR+TRT_W>15days_R_MTR

12 Data required: TRT_W>15days_R_SUR;TRT_W>15days_R_MTR

13 Frequency of

Monitoring:


Y Y Y N N N N N



Output




18 Type: A

19 Remarks: NA

********************************************************************

307

173.OPR-TRT-WTC-004


1 Gsln: 173

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: WTC


6 Indicator Name: Total Therapies waiting for <15 days Treatment


TRT_W<15days_R_T


Total number of therapies preauthed for which Treatment updation by MEDCO has not taken place for <15 days from the time of preauthorisation

9 Dimensions: NA


11 Formula: TRT_W<15days_R_SUR+TRT_W<15days_R_MTR

12 Data required: TRT_W<15days_R_SUR;TRT_W<15days_R_MTR

13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity




18 Type: A

308

19 Remarks: NA

********************************************************************

174.OPR-TRT-WTC-005


1 Gsln: 174

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: WTC


6 Indicator Name: Total Therapies preauthed waiting for Treatment


TRT_W_R_T


The number of live preauthed surgical therapies for which surgery has to be updated by MEDCO


Medical Treatment


11 Formula: TRT_W>15days_R_T + TRT_W<15days_R_T

12 Data required: TRT_W>15days_R_T; TRT_W<15days_R_T

13 Frequency of

Monitoring:


Y Y Y N N N N N



Output


309



18 Type: A

19 Remarks: NA

********************************************************************

175.OPR-DSC-WTC-001


1 Gsln: 175

2 Major Group: OPR

3 Minor Group: DSC

4 Sub Category: WTC

5 Indicator Code: OPR-DSC-WTC-001

6 Indicator Name: Therapies waiting for discharge after Treatment for <15 days


DSC_W<15days_R_SUR

DSC_W<15days_R_MTR


The number of Treatment updated therapies waiting for discharge updation for <15 days

9 Dimensions: After surgery

After Medical Treatment

10 Role & Action: MEDCO&Discharge updation

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y N N N N N


310


Activity

16 Indicator use: To monitor disposal of treatment updated cases at NWH and performance of MEDCO


Treatment updated Preauth cases

18 Type: A


********************************************************************

176.OPR-DSC-WTC-002


1 Gsln: 176

2 Major Group: OPR

3 Minor Group: DSC

4 Sub Category: WTC


6 Indicator Name: Therapies waiting for discharge after treatment for >15 days


DSC_W>15days_R_SUR

DSC_W>15days_R_MTR


The number of treatment updated therapies waiting for which discharge updation for >15 days

9 Dimensions: After surgery

After Medical Treatment

10 Role & Action: MEDCO&Treatment Discharge updation

11 Formula: NA


311

13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity




18 Type: A


********************************************************************

177.OPR-DSC-WTC-003


1 Gsln: 177

2 Major Group: OPR

3 Minor Group: DSC

4 Sub Category: WTC


6 Indicator Name: Total Therapies waiting for discharge after treatment


DSC_W_R_T


Total number of treatment updated therapies waiting for which discharge updation

9 Dimensions: NA

312

10 Role & Action: MEDCO&Treatment Discharge updation

11 Formula: DSC_W<15days_R_SUR + DSC_W<15days_R_MTR

+DSC_W>15days_R_SUR + DSC_W>15days_R_MTR

12 Data required: DSC_W<15days_R_SUR; DSC_W<15days_R_MTR;

DSC_W>15days_R_SUR; DSC_W>15days_R_MTR

13 Frequency of

Monitoring:


Y Y Y N N N N N



Activity




18 Type: A

19 Remarks: NA

********************************************************************

178.OPR-PAU-AWT-001


1 Gsln: 178

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: AWT

5 Indicator Code: OPR-PAU-AWT-001

6 Indicator Name: Average Case Waiting time for a therapy preauth case at NAM during a specified period

313


PAU_AWT N


Average time taken by NAM to forward a preauth case after arriving from MEDCO

9 Dimensions: NA

10 Role & Action: NAM&

Case Waiting Time

11 Formula: Sum of (The time at which a case is forwarded by NAM (- ) The time at which the case arrived at NAM from MEDCO)for all cases/ Number of cases

12 Data required: PaN_CWT; Number of cases

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity



Time hrs

18 Type: A

19 Remarks: NA

********************************************************************

314

179.OPR-PAU-AWT-002


1 Gsln: 179

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: AWT


6 Indicator Name: Average case waiting time for a therapy preauth case at MEDCO during a specified period


PAU_AWT_R


Average time taken by MEDCO to update a preauth case after pendency

9 Dimensions: NA

10 Role & Action: MEDCO&Case Waiting Time

11 Formula: Sum of( The time at which a case is updated by MEDCO (-) The time at which the case arrived at MEDCO from preauth operator after pendency) for all disposed cases/ Number of cases

12 Data required: PaR_CWT; Number of cases

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity


315


Time hrs

18 Type: A

19 Remarks: NA

********************************************************************

180.OPR-PAU-AWT-003


1 Gsln: 180

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: AWT


6 Indicator Name: Average case waiting time for a therapy preauth case at Preauth operator for a case during a specified period


PAU_AWT_PPD

PAU_AWT_PTD

PAU_AWT_PAO


Average time taken by Preauth operator to dispose a preauth case when afresh

9 Dimensions: PPD

PTD

PAO

10 Role & Action: PPD&Case Waiting Time

11 Formula: Sum of (The time at which a preauth case is disposed by Preauth operator (-) The time at which the preauth case arrived at Preauth operator)/ Number of cases

12 Data required: PaP_CWT1; Number of cases

316

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity



Time hrs

18 Type: A


********************************************************************

181.OPR-PAU-AWT-004


1 Gsln: 181

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: AWT


6 Indicator Name: Average case waiting time for a fresh therapy preauth case at Preauth operator during a specified period


PAUF_AWT_PPD

PAUF_AWT_PTD

PAUF_AWT_PAO


Average time taken by Preauth operator to dispose a case when afresh

317

9 Dimensions: PPD;PTD;PAO


11 Formula: Sum of (The time at which a fresh preauth case is disposed by Preauth operator (-) The time at which the preauth case arrived at Preauth operator)/ Number of cases

12 Data required: PaP_CWT1; Number of cases

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Activity



Time hrs

18 Type: A


********************************************************************

182.OPR-PAU-AWT-005


1 Gsln: 182

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: AWT


318

6 Indicator Name: Average case waiting time at Preauth operator for a pending preauth updated case during a specified period


PAUP_AWT_PPD

PAUP_AWT_PTD

PAUP_AWT_PAO


Average time taken by Preauth operator to dispose a pending updated preauth case

9 Dimensions: PPD

PTD

PAO


11 Formula: Sum of (The time at which a pending updated case is disposed by Preauth operator (-) The time at which the pending case arrived at Preauth operator)/ Number of cases

12 Data required: The time at which a pending updated case is disposed by PPD; The time at which the pending case arrived at PPD; Number of cases

13 Frequency of

Monitoring:


Y N N N N N N N



Activity



Time hrs

18 Type: A


319

********************************************************************

183.OPR-PAU-AWT-006


1 Gsln: 183

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: AWT


6 Indicator Name: Average waiting time at Trust for a preauth case during a specified period


PAU_AWT_TRU


Average total time taken at Trust to dispose a preauth case

9 Dimensions: NA

10 Role & Action: TRUST&Case Waiting Time

11 Formula: PAUF_AWT_PPD + PAUP_AWT_PPD+PAUF_AWT_PTD + PAUP_AWT_PTD+PAUF_AWT_PAO + PAUP_AWT_PAO

12 Data required: PAUF_AWT_PPD; PAUP_AWT_PPD;PAUF_AWT_PTD; PAUP_AWT_PTD;PAUF_AWT_PAO; PAUP_AWT_PAO

13 Frequency of

Monitoring:


Y N N N N N N N



Activity


320


Time hrs

18 Type: A

19 Remarks: NA

********************************************************************

184.OPR-PAU-AWT-007


1 Gsln: 184

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: AWT


6 Indicator Name: Average waiting time at NWH for a preauth case during a specified period


PAU_AWT_NWH


Average total time taken at NWH to dispose a preauth case

9 Dimensions: NA

10 Role & Action: NWH&Case Waiting Time

11 Formula: PAU_AWT N + PAU_AWT_R

12 Data required: PAU_AWT_N; PAU_AWT_R

13 Frequency of

Monitoring:


Y N N N N N N N


321


Activity



Time hrs

18 Type: A

19 Remarks: NA

********************************************************************

185.OPR-PAU-AWT-008


1 Gsln: 185

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: AWT


6 Indicator Name: Average total waiting time for a preauth case


PAU_AWT_T


Average total time taken to dispose a preauth case

9 Dimensions: NA

10 Role & Action: TRUST,NWH&Case Waiting Time

11 Formula: PAU_AWT_TRU + PAU_AWT_NWH

12 Data required: PAU_AWT_TRU; PAU_AWT_NWH

13 Frequency of

Monitoring:


Y N N N N N N N

322



Activity



Time hrs

18 Type: A

19 Remarks: NA

********************************************************************

186. OPR-TRT-AWT-001


1 Gsln: 186

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: AWT

5 Indicator Code: OPR-TRT-AWT-001

6 Indicator Name: Average waiting time for treatment updation for a preauth approved case


TRT_AWT_SUR

TRT_AWT_MTR


Average time taken for treatment updation for a preauth approved case


Medical treatment


323

11 Formula: Sum of(The time at which a case is Surgery/Medical treatment updated (-) The time at which the case is preauthed)/ Number of cases

12 Data required: The time at which a case is surgery updated; The time at which the case is preauthed; Number of cases

13 Frequency of

Monitoring:


Y N N N N N N N



Activity

16 Indicator use: To monitor disposal of preauth approved cases


Time hrs

18 Type: A


********************************************************************

187. OPR-DSC-AWT-001


1 Gsln: 187

2 Major Group: OPR

3 Minor Group: TRT

4 Sub Category: AWT

5 Indicator Code: OPR-DSC-AWT-001

6 Indicator Name: Average discharge updation waiting time for a preauth approved case during a specified period

324


DSC_AWT_SUR

DSC_AWT_MTR


Average time taken for a preauth approved case for discharge updation


Medical treatment

10 Role & Action: MEDCO&Discharge updation

11 Formula: Sum of(The time at which the case is discharge updated (-) The time at which the case is preauthed)/Number of cases

12 Data required: The time at which the case is discharge updated; The time at which the case is preauthed; Number of cases

13 Frequency of

Monitoring:


Y N N N N N N N



Activity

16 Indicator use: To monitor disposal of treatment updated cases


Time hrs

18 Type: A


********************************************************************

325

188. OPR-OBD-AWT-001


1 Gsln: 188

2 Major Group: OPR

3 Minor Group: OBD

4 Sub Category: AWT

5 Indicator Code: OPR-OBD-AWT-001

6 Indicator Name: On-bed time for a case


OBD_AWT_SUR

OBD_AWT_MTR


Average time taken for case from preauth initiation to discharge updation

9 Dimensions: NA

10 Role & Action: CaseOn Bed time

11 Formula: Sum of(Time at which the case is discharge updated (-) the time at which the preauth is initiated)/Number of cases

12 Data required: Time at which the case is discharge updated; The time at which the preauth is initiated; Number of cases

13 Frequency of

Monitoring:



Activity



Time hrs


Y N N N N N N N

326

18 Type: Time


********************************************************************

189.OPR-PAU-HPA-001


Y N N N N N N N


1 Gsln: 189

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: HPA

5 Indicator Code: OPR-PAU-HPA-001

6 Indicator Name: Hourly Preauth Arrival for each of the 24 hours in a day


PAU_HA


Number of cases forwarded for preauth by NAM every hour during the 24 hours

9 Dimensions: NA

10 Role & Action: NAM&Preauth Arrivals

11 Formula: NA

12 Data required: PAU_F_N

13 Frequency of

Monitoring:



Activity

327

16 Indicator use: To monitor disposal of preauth cases and performance of NAM


Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

190.OPR-PAU-ART-001


1 Gsln: 190

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: ART

5 Indicator Code: OPR-PAU-ART-001

6 Indicator Name: Preauth Arrival Rate


PAU_ART


Number of cases forwarded for preauth by NAM

9 Dimensions: NA

10 Role & Action: NAM&Preauth Arrivals

11 Formula: PAU_F_N in a given period / number of days in the period

12 Data required: PAU_F_N in a given period;

Number of days in the period

328

13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor disposal of preauth cases and performance of NAM


Preauth cases

18 Type: R

19 Remarks: NA

********************************************************************

191.OPR-PAU-HAP-001


Y Y Y Y Y Y Y N


1 Gsln: 191

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: HAP

5 Indicator Code: OPR-PAU-HAP-001

6 Indicator Name: Hourly Preauth approval for each of the 24 hours in a day


PAU_HAP


Hourly Preauth approval for each of the 24 hours in a day

9 Dimensions: NA

10 Role & Action: Preauth operator&Preauth Approvals

329

11 Formula: (PAU_A_PTD + PAU_A_PAO ) every hour during the 24 hours

12 Data required: PAU_A_PTD; PAU_A_PAO

13 Frequency of

Monitoring:



Activity



Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

192.OPR-PAU-APR-001


Y N N N N N N N


1 Gsln: 192

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: APR

5 Indicator Code: OPR-PAU-APR-001

6 Indicator Name: Preauth Approval rate


PAU_APR


Number of cases preauth approved per day

330

9 Dimensions: NA

10 Role & Action: Preauth operator&Preauth Approvals

11 Formula: Number of therapies preauth approved

(PAU_A_PTD + PAU_A_PAO) during a specified period / number of days in the period

12 Data required: PAU_A_PTD; PAU_A_PAO

13 Frequency of

Monitoring:



Activity



Preauth cases

18 Type: R

19 Remarks: NA

********************************************************************

193. OPR-PAU-DTO-001


1 Gsln: 193

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: DTO

5 Indicator Code: OPR-PAU-DTO-001

6 Indicator Name: Daily Turnover of preauth cases by Preauth operator


Y Y Y Y Y Y Y N

331


PAU_DTO_PPD

PAU_DTO_PTD

PAU_DTO_PAO


Actual number of preauth cases disposed by Preauth operator in specified day

9 Dimensions: PPD

PTD

PAO

10 Role & Action: Preauth operator& Preauth cases disposals

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Preauth cases

18 Type: A


********************************************************************


Y N N N N N N N

332

194. OPR-PAU-TOR-001


1 Gsln: 194

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: TOR

5 Indicator Code: OPR-PAU-TOR-001

6 Indicator Name: Preauth Turnover Rate for Preauth operator


PAU_TOR_PPD

PAU_TOR_PTD

PAU_TOR_PAO


Average number of Preauth cases disposed by Preauth operator

9 Dimensions: PPD

PTD

PAO

10 Role & Action: Preauth operator& Preauth cases disposals

11 Formula: Number of preauth cases disposed by Panel doctor during the period / Number of days in the period

12 Data required: Preauth cases disposed by Preauth operator; Number of days in the period

13 Frequency of

Monitoring:



Activity



Y Y Y Y Y Y Y N

333


Preauth cases

18 Type: R


********************************************************************

195.OPR-PAU-CPT-001


Y Y Y Y Y Y Y N


1 Gsln: 195

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CPT

5 Indicator Code: OPR-PAU-CPT-001

6 Indicator Name: Average Case Processing Time of Preauth Operator, during a specified period


PAU_ACPT


Average time taken to process a preauth case by preauth operator

9 Dimensions: NA

10 Role & Action: Preauth operator&Preauth case processing time

11 Formula: Sum of the (time taken from opening the case to closing the case) for all cases of that operator / number of cases

12 Data required: Time taken from opening the case to closing the case for all cases of that operator; Number of cases

13 Frequency of

Monitoring:

334



Activity



Time hrs

18 Type: A

19 Remarks: NA

********************************************************************

196.OPR-PAU-PPP-001


1 Gsln: 196

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: PPP

5 Indicator Code: OPR-PAU-PPP-001

6 Indicator Name: Preauth Pendency Percentage for Preauth Operator during a specified period


PAU_PPP_PPD

PAU_PPP_PTD

PAU_PPP_PAO


The percentage of preauth cases disposed with pendency by Preauth Operator

9 Dimensions: PPD

PTD

PAO

10 Role & Action: Preauth Operator&Preauth cases pendency

335

11 Formula: PAU_P_PPD/PAU_D_PPD*100

PAU_P_PTD/PAU_D_PTD*100

PAU_P_PAO/PAU_D_PAO*10

0 12 Data required: PAU_P_PPD; PAU_D_PPD;

PAU_P_PTD; PAU_D_PTD;

PAU_P_PAO; PAU_D_PAO

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor disposal pattern of preauth cases


Time hrs

18 Type: P


********************************************************************

197.OPR-PAU-TIN-001


Y Y Y Y Y Y Y N


1 Gsln: 197

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: TIN

5 Indicator Code: OPR-PAU-TIN-001

6 Indicator Name: Telephonic Intimations PEX Approved

336


PAU_TIN_A_X


Number of emergency preauth cases approved

9 Dimensions: NA

10 Role & Action: PEX&Telephonic Intimations

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor disposal of emergency preauth cases


Emergency preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

198.OPR-PAU-BUF-001


Y Y Y Y Y Y Y N


1 Gsln: 198

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: BUF

337

5 Indicator Code: OPR-PAU-BUF-001

6 Indicator Name: Preauthorisations-Regular-With buffer PTD Recommended Approval


BPAU_RA_PTD


Number of preauth cases approved for buffer by PTD

9 Dimensions: NA

10 Role & Action: PTD&Preauthorisations-Regular-With buffer

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor disposal pattern of preauth cases for buffer


Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************


Y Y Y Y Y Y Y N

338

199.OPR-PAU-BUF-002


1 Gsln: 199

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: BUF


6 Indicator Name: Preauthorisations-Regular-With buffer PTD Recommended Rejection


BPAU_RR_PTD


Number of preauth cases Rejected for buffer by PTD

9 Dimensions: NA


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Preauth cases

18 Type: A


Y Y Y Y Y Y Y N

339

19 Remarks: NA

********************************************************************

200.OPR-PAU-BUF-003


Y Y Y Y Y Y Y N


1 Gsln: 200

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: BUF


6 Indicator Name: Preauthorisations-Regular-With buffer PTD Pending


BPAU_P_PTD

BPAU_P_PAO


Number of preauth cases kept pending for buffer by PTD

9 Dimensions: PTD

PAO


11 Formula: NA


13 Frequency of

Monitoring:



Activity


340


Preauth cases

18 Type: A


******************************************************************** 201.OPR-PAU-BUF-004


1 Gsln: 201

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: BUF


6 Indicator Name: Preauthorisations-Regular-With buffer PAO Approved


BPAU_A_PAO


Number of preauth cases approved for buffer by PAO

9 Dimensions: NA

10 Role & Action: PAO&Preauthorisations-Regular-With buffer

11 Formula: NA


13 Frequency of

Monitoring:



Activity


Y Y Y Y Y Y Y N

341



Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

202.OPR-PAU-BUF-005


Y Y Y Y Y Y Y N


1 Gsln: 202

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: BUF


6 Indicator Name: Preauthorisations-Regular-With buffer PAO Rejected


BPAU_R_PAO


Number of preauth cases Rejected for buffer by PAO

9 Dimensions: NA

10 Role & Action: PAO&Preauthorisations-Regular-With buffer

11 Formula: NA


13 Frequency of

Monitoring:


342


Activity



Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

203.OPR-PAU-ENH-001


1 Gsln: 203

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: ENH

5 Indicator Code: OPR-PAU-ENH-001

6 Indicator Name: Pre-authorisations - Enhancement MEDCO Initiated


PAU_ENH_I_R


Number of preauth cases initiated by MEDCO for enhancement

9 Dimensions: NA

10 Role & Action: MEDCO&Pre-authorisations Enhancement

11 Formula: NA


343

13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor disposal pattern of preauth cases for enhancement


Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

204.OPR-PAU-ENH-002


Y Y Y Y Y Y Y N


1 Gsln: 204

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: ENH


6 Indicator Name: Pre-authorisations - Enhancement MEDCO Updated


PAU_ENH_U_R


Number of preauth cases Updated by MEDCO for enhancement after pendency

9 Dimensions: NA


344

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

205.OPR-PAU-ENH-003


Y Y Y Y Y Y Y N


1 Gsln: 205

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: ENH


6 Indicator Name: Pre-authorisations Enhancement updation waiting MEDCO


PAU_ENH_U_W_R


Pre-authorisations Enhancement updation waiting MEDCO

345

9 Dimensions: NA


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

206. OPR-PAU-ENH-004


1 Gsln: 206

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: ENH


6 Indicator Name: Pre-authorisations - Enhancement Preauth Operator Recommended Approval


Y Y N N N N N N

346


PAU_ENH_RA_PTD

PAU_ENH_RA_MC-ETC


Number of preauth Enhancement cases Recommended Approval by Preauth Operator

9 Dimensions: PTD

MC-ETC

10 Role & Action: Preauth Operator&Pre-authorisationsEnhancement

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Preauth cases

18 Type: A


********************************************************************


Y Y Y Y Y Y Y N

347



1 Gsln: 207

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: ENH


6 Indicator Name: Pre-authorisations - Enhancement Preauth Operator Rejected


PAU_ENH_R_PTD

PAU_ENH_R_MC-ETC

PAU_ENH_R_PAO


Number of preauth Enhancement cases Recommended rejection by Preauth Operator

9 Dimensions: PTD

MC-ETC

PAO

10 Role & Action: Preauth Operator &Pre-authorisationsEnhancement

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Y Y Y Y Y Y Y N

348


Preauth cases

18 Type: A


********************************************************************



1 Gsln: 208

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: ENH


6 Indicator Name: Pre-authorisations - Enhancement Preauth Operator Pending


PAU_ENH_P_PTD

PAU_ENH_P_MC-ETC

PAU_ENH_P_PAO


Number of preauth Enhancement cases Recommended pending by Preauth Operator

9 Dimensions: PTD

MC-ETC

PAO


11 Formula: NA


349

13 Frequency of

Monitoring:



Activity



Preauth cases

18 Type: A


********************************************************************

209.OPR-PAU-ENH-07


Y Y Y Y Y Y Y N


1 Gsln: 209

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: ENH


6 Indicator Name: Pre-authorisations - Enhancement PAO Approved


PAU_ENH_A_PAO


Number of preauth Enhancement cases Approval by PAO

9 Dimensions: NA

10 Role & Action: PAO&Pre-authorisations Enhancement

350

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Preauth cases

18 Type: A

19 Remarks: NA

********************************************************************

210.OPR-PAU-ENH-008


Y Y Y Y Y Y Y N


1 Gsln: 210

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: ENH


6 Indicator Name: Pre-authorisations Enhancement cases waiting at Preauth Operator


PAU_ENH_W_PTD

PAU_ENH_W_MC-ETC

PAU_ENH_W_PAO

351


Number of preauth enhancement cases waiting with Preauth Operator

9 Dimensions: PTD

MC-ETC

PAO


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Preauth cases

18 Type: A


********************************************************************

211.OPR-PAU-CCH-001


Y Y N N N N N N


1 Gsln: 211

2 Major Group: OPR

3 Minor Group: PAU

352

4 Sub Category: CCH

5 Indicator Code: OPR-PAU-CCH-001

6 Indicator Name: Pre-Authorisations-Cochlear Cases Initiated by MEDCO


PAU_CCH_I_R


Number of preauth Cochlear cases initiated by MEDCO

9 Dimensions: NA

10 Role & Action: MEDCO&Pre-AuthorisationsCochlear Cases

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor performance of MEDCO in disposal of Cochlear preauth cases


Preauth Cochlear cases

18 Type: A

19 Remarks: NA

********************************************************************


Y Y Y Y Y Y Y N

353

212.OPR-PAU-CCH-002


1 Gsln: 212

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-Authorisations-Cochlear Cases Updated by MEDCO


PAU_CCH_U_R


Number of preauth Cochlear cases updated by MEDCO after pendency

9 Dimensions: NA


11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


Y Y Y Y Y Y Y N

354

19 Remarks: NA

********************************************************************

213.OPR-PAU-CCH-003


Y Y N N N N N N


1 Gsln: 213

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-authorisations Cochlear cases updation waiting at MEDCO


PAU_CCH_W_R


Number of preauth Cochlear cases waiting with MEDCO for updation after pendency

9 Dimensions: NA


11 Formula: NA


13 Frequency of

Monitoring:



Activity


355



18 Type: A

19 Remarks: NA

********************************************************************

214.OPR-PAU-CCH-004


Y Y Y Y Y Y Y N


1 Gsln: 214

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-Authorisations-Cochlear Cases forwarded by Preauth Operator


PAU_CCH_F_N

PAU_CCH_F_X


Number of preauth Cochlear cases forwarded by Preauth Operator

9 Dimensions: NAM

PEX-C

10 Role & Action: Preauth Operator&Pre-AuthorisationsCochlear Cases

11 Formula: NA


13 Frequency of

Monitoring:


356


Activity

16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cases



18 Type: A


********************************************************************

215.OPR-PAU-CCH-005


1 Gsln: 215

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-authorisations Cochlear cases waiting at Preauth Operator


PAU_CCH_W_N

PAU_CCH_W_X


Number of preauth Cochlear cases waiting at Preauth Operator

9 Dimensions: NAM

PEX-C


11 Formula: NA

357


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

216.OPR-PAU-CCH-006


1 Gsln: 216

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-Authorisations-Cochlear Cases Recommended Approval by Preauth Operator


PAU_CCH_RA_MC-CC

PAU_CCH_RA_C-CC


Y Y N N N N N N

358


Number of preauth Cochlear cases recommended Approval by Preauth Operator

9 Dimensions: MC-CC

C-CC


11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

217.OPR-PAU-CCH-007


Y Y Y Y Y Y Y N


1 Gsln: 217

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH

359


6 Indicator Name: Pre-Authorisations-Cochlear Cases Recommended Rejection by Preauth Operator


PAU_CCH_RR_MC-

CC PAU_CCH_RR_C-

CC 8 Indicator Description:

Number of preauth Cochlear cases recommended rejection by Preauth Operator

9 Dimensions: MC-CC

C-CC


11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************


Y Y Y Y Y Y Y N

360

218. OPR-PAU-CCH-008


1 Gsln: 218

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-Authorisations-Cochlear Cases Pending with Preauth Operator


PAU_CCH_P_MC-CC

PAU_CCH_P_C-CC

PAU_CCH_P_PAO


Number of preauth Cochlear cases kept Pending with Preauth Operator

9 Dimensions: MC-CC

C-CC

PAO


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Y Y Y Y Y Y Y N

361



18 Type: A


********************************************************************



1 Gsln: 219

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-authorisations Cochlear cases waiting with Preauth Operator


PAU_CCH_W_MC-CC

PAU_CCH_W_C-CC

PAU_CCH_W_PAO


Number of preauth Cochlear cases waiting with Preauth Operator

9 Dimensions: MC-CC

C-CC

PAO


11 Formula: NA


362

13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

220.OPR-PAU-CCH-010


Y Y N N N N N N


1 Gsln: 220

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-Authorisations-Cochlear Cases C-CC Rejected by Preauth Operator


PAU_CCH_R_C-CC

PAU_CCH_R_PAO


Number of preauth Cochlear cases recommended rejection by Preauth Operator

363

9 Dimensions: C-CC

PAO


11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

221.OPR-PAU-CCH-011


Y Y Y Y Y Y Y N


1 Gsln: 221

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-Authorisations-Cochlear Cases PAO Approved

364


PAU_CCH_A_C-CC

PAU_CCH_A_PAO


Number of preauth Cochlear cases recommended Approval by PAO

9 Dimensions: C-CC

PAO


11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor performance of PAO in disposal of Cochlear preauth cases



18 Type: A


********************************************************************


Y Y Y Y Y Y Y N

365



1 Gsln: 222

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-auth Cochlear Cancel Requests MEDCO Initiated


PAUC _CCH_I_R


NWH Requested Cancellation of Pre-auth Cochlear cases

9 Dimensions: NA

10 Role & Action: MEDCO& Pre-auth Cochlear Cases Cancel Request

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor performance of MEDCO in disposal of Cochlear preauth cancellation cases


Preauth Cochlear cancellation cases

18 Type: A


Y Y Y Y Y Y Y N

366

19 Remarks: NA

********************************************************************



1 Gsln: 223

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-auth Cochlear cases Cancel Requests MEDCO Updated


PAUC_CCH_U_R


Number of preauth Cochlear Cancel Requests cases Committee Pending and Trust Pending Updated by MEDCO

9 Dimensions: NA

10 Role & Action: MEDCO&Pre-auth Cochlear Cases Cancel Request

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Y Y Y Y Y Y Y N

367



18 Type: A

19 Remarks: NA

********************************************************************



1 Gsln: 224

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-auth Cochlear cases Cancel Requests waiting with MEDCO


PAUC_CCH_W_R


Number of preauth Cochlear Cancel Requests cases waiting for Updation by MEDCO

9 Dimensions: NA

10 Role & Action: MEDCO&Pre-auth Cochlear Cases Cancel Request

11 Formula: CPAU_CCH_W>15days_R + CPAU_CCH_W<15days_R

12 Data required: CPAU_CCH_W>15days_R; CPAU_CCH_W<15days_R

13 Frequency of

Monitoring:



Y N N N N N N N

368


Activity




18 Type: A

19 Remarks: NA

********************************************************************

225.OPR-PAU-CCH-015


1 Gsln: 225

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-Authorisations-Cochlear Cases Cancel Requests Recommended Approval by preauth operator


PAUC_CCH_RA_MC-CC

PAUC_CCH_RA_C-CC


Number of preauth Cochlear Cancel Requests cases Recommended Approval by preauth operator

9 Dimensions: MC-CC

C-CC

10 Role & Action: Preauth operator&Pre-auth Cochlear Cases Cancel Request

11 Formula: NA


369

13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cancellation cases



18 Type: A


********************************************************************



1 Gsln: 226

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-Authorisations-Cochlear Cases Cancel Requests Recommended Rejection by preauth operator


PAUC_CCH_RR_MC-CC

PAUC_CCH_RR_C-CC


Number of preauth Cochlear Cancel Requests cases Recommended Rejection by MC-CC


Y Y Y Y Y Y Y N

370

9 Dimensions: MC-CC

C-CC


11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************



1 Gsln: 227

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH



Y Y Y Y Y Y Y N

371

6 Indicator Name: Pre-Authorisations-Cochlear Cases Cancel Requests Pending by preauth operator


PAUC_CCH_P_MC-CC

PAUC_CCH_P_C-CC


Number of preauth Cochlear Cancel Requests cases kept pending by MC-CC

9 Dimensions: MC-CC

C-CC


11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************


Y Y Y Y Y Y Y N

372



1 Gsln: 228

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-auth Cochlear cases Cancel Requests waiting with preauth operator


PAUC_CCH_W_MC-CC

PAUC_CCH_W_C-CC


Number of preauth Cochlear Cancel Requests cases waiting for disposal by MC-CC

9 Dimensions: MC-CC;C-CC


11 Formula: PAUC_CCH_W>15days_MC-CC + PAUC_CCH_W<15days_MC-CC

PAUC_CCH_W>15days_C-CC + PAUC_CCH_W<15days_C-CC

12 Data required: PAUC_CCH_W>15days_MC-CC; PAUC_CCH_W<15days_MC- CC; PAUC_CCH_W>15days_C-CC; PAUC_CCH_W<15days_C- CC

13 Frequency of

Monitoring:



Activity



Y N N N N N N N

373



18 Type: A


********************************************************************

229.OPR-PAU-CCH-019


Y Y Y Y Y Y Y N


1 Gsln: 229

2 Major Group: OPR

3 Minor Group: PAU

4 Sub Category: CCH


6 Indicator Name: Pre-Authorisations-Cochlear Cases Cancel Requests Rejected by preauth operator


PAUC_CCH_R_C-CC


Number of preauth Cochlear Cancel Requests cases Rejected by C-CC

9 Dimensions: NA


11 Formula: NA


13 Frequency of

Monitoring:


374


Activity

16 Indicator use: To monitor performance of C-CC in disposal of Cochlear preauth cancellation cases



18 Type: A

19 Remarks: NA

********************************************************************

230.OPR-CLM-ELG-001


1 Gsln: 230

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: ELG

5 Indicator Code: OPR-CLM-ELG-001

6 Indicator Name: Therapy Claims Eligible


CLM_ELG


The number of therapies whose discharge has been updated more than 11 days ago and number of days from date of discharge update has not crossed 90 days, and yet to be submitted for claim by MEDCO

9 Dimensions: NA

10 Role & Action: MEDCO&Claims disposal

11 Formula: NA


375

13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor claim submission for discharge updated cases by MEDCO


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

231.OPR-CLM-SUB-001


Y Y Y Y Y Y Y N


1 Gsln: 231

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: SUB

5 Indicator Code: OPR-CLM-SUB-001

6 Indicator Name: Therapy Claims submitted


CLM_S_R


The number of therapies for which Claims have been submitted by MEDCO

9 Dimensions: NA


376

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

232.OPR-CLM-SUB-002


Y Y Y Y Y Y Y N


1 Gsln: 232

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: SUB


6 Indicator Name: Therapy Claims submitted and Live


LCLM_S_R


The number of therapies for which Claims have been submitted by MEDCO and awaiting final disposal at various levels of Trust at this moment.

377

9 Dimensions: NA


11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor disposal of claim submitted by MEDCO cases


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

233.OPR-CLM-SUB-003


Y Y Y N N N N N


1 Gsln: 233

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: SUB


6 Indicator Name: Therapy Claims submitted in Past


PCLM_S_R

378


The number of therapies for which Claims have been submitted by MEDCO in the past

9 Dimensions: NA


11 Formula: CLM_S_R (-)LCLM_S_R

12 Data required: CLM_S_R; LCLM_S_R

13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

234.OPR-CLM-UPD-001


N Y Y Y Y Y Y N


1 Gsln: 234

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: UPD

5 Indicator Code: OPR-CLM-UPD-001

6 Indicator Name: Therapy Claims Updated by MEDCO

379


CLM_U_R


The number of therapies for which Claims have been updated by MEDCO after pendency and returned to Trust

9 Dimensions: NA


11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor claims pendency cases updation by MEDCO


Claim pendency cases

18 Type: A

19 Remarks: NA

********************************************************************

235.OPR-CLM-UPD-002


Y Y Y N N N N N


1 Gsln: 235

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: UPD


380

6 Indicator Name: Therapy Claims Updated by MEDCO and Live


LCLM_U_R


The number of therapies for which Claims have been updated by MEDCO after pendency and awaiting final disposal at various levels of Trust at this moment

9 Dimensions: NA


11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************


Y Y Y N N N N N

381

236.OPR-CLM-UPD-003


1 Gsln: 236

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: UPD


6 Indicator Name: Therapy Claims Updated by MEDCO in Past


PCLM_U_R


The number of therapies for which Claims have been updated by MEDCO after pendency in the past

9 Dimensions: NA


11 Formula: CLM_U_R (-) LCLM_U_R

12 Data required: CLM_U_R; LCLM_U_R

13 Frequency of

Monitoring:



Output




18 Type: A

19 Remarks: NA


Y Y Y Y Y Y Y N

382

********************************************************************

237.OPR-CLM-WTC-001


Y Y Y N N N N N


1 Gsln: 237

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: WTC

5 Indicator Code: OPR-CLM-WTC-001

6 Indicator Name: Therapy Claims Updated by MEDCO and sent to Claims operator


CLM_W_CPD

CLM_W_CTD

CLM_W_CH

CLM_W_CAO


The number of therapies for which Claims have been updated by MEDCO and waiting at Claims operator

9 Dimensions: CPD

CTD

CH

CAO


Claims disposal

11 Formula: NA


13 Frequency of

Monitoring:


383


Activity

16 Indicator use: To monitor disposal of claims updated cases by Claims operator



18 Type: A


********************************************************************

238.OPR-CLM-FWD-001


1 Gsln: 238

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: FWD

5 Indicator Code: OPR-CLM-FWD-001

6 Indicator Name: Therapy Claims Forwarded by CEX


CLM_F_X


The number of therapies for which Claims have been forwarded by CEX(Claims Executive) after being raised for the first time by MEDCO

9 Dimensions: NA

10 Role & Action: CEX&Claims disposal

11 Formula: NA


384

13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor claims cases disposal by CEX


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

239.OPR-CLM-FWD-002


Y Y Y Y Y Y Y N


1 Gsln: 239

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: FWD


6 Indicator Name: Therapy Claims Forwarded by CEX and Live


LCLM_F_X


The number of therapies for which Claims have been forwarded by CEX after being raised for the first time by MEDCO and awaiting final disposal at various levels of Trust at this moment

9 Dimensions: NA


385

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

240.OPR-CLM-FWD-003


Y Y Y Y N N N N


1 Gsln: 240

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: FWD


6 Indicator Name: Therapy Claims Forwarded by CEX in Past


PCLM_F_X


The number of therapies for which claims have been forwarded by CEX in the past after being raised for the first time by MEDCO

386

9 Dimensions: NA


11 Formula: CLM_F_X (-) LCLM_F_X

12 Data required: CLM_F_X; LCLM_F_X

13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

241. OPR-CLM-RAP-001


1 Gsln: 241

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: RAP

5 Indicator Code: OPR-CLM-RAP-001

6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommended for Approval


Y Y Y Y Y Y Y N

387


CLM_RA_CPD

CLM_RA_CTD

CLM_RA_CH


The number of claims which have been disposed with a Recommended for Approval by the Claims operator

9 Dimensions: CPD

CTD

10 Role & Action: Claims operator&Claims disposal

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor claims cases disposal by Claims operator


Claim cases

18 Type: A


********************************************************************


Y Y Y Y Y Y Y N

388

242. OPR-CLM-RAP-002


1 Gsln: 242

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: RAP


6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommended for Approval and Live


LCLM_RA_CPD

LCLM_RA_CTD

LCLM_RA_CH


The number of claims which have been disposed with a Recommended for Approval by the Claims operator and awaiting final disposal at various levels of Trust at this moment

9 Dimensions: CPD

CTD


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Y Y Y Y N N N N

389


Claim cases

18 Type: A


********************************************************************

243.OPR-CLM-RAP-003


1 Gsln: 243

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: RAP


6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommended for Approval in the Past


PCLM_RA_CPD

PCLM_RA_CTD

PCLM_RA_CH


The number of claims which have been disposed with a Recommended for Approval by the Claims operator in the past

9 Dimensions: CPD

CTD


11 Formula: CLM_RA_CPD(-)LCLM_RA_CPD

CLM_RA_CTD(-)LCLM_RA_CTD

CLM_RA_CH(-)LCLM_RA_CH

390

12 Data required: CLM_RA_CPD; LCLM_RA_CPD; CLM_RA_CTD; LCLM_RA_CTD; CLM_RA_CH; LCLM_RA_CH

13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A


********************************************************************

244.OPR-CLM-RAP-004


1 Gsln: 244

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: RAP


6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommended for Approval without pendency


CLM_RA~NP_CTD

CLM_RA~NP_CH


Y Y Y Y Y Y Y N

391


The claims which have been disposed with Recommendation of Approval without pendency by the Claims operator

9 Dimensions: CTD

CH


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A


********************************************************************

245.OPR-CLM-RAP-005


Y Y Y Y Y Y Y N


1 Gsln: 245

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: RAP

392


6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommended for Approval after pendency


CLM_RA~P_CTD

CLM_RA~P_CH


The claims which have been disposed with a Recommendation of Approval after pendency by the Claims operator

9 Dimensions: CTD

CH


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A


********************************************************************


Y Y Y Y Y Y Y N

393

246. OPR-CLM-RRJ-001


1 Gsln: 246

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: RRJ

5 Indicator Code: OPR-CLM-RRJ-001

6 Indicator Name: Therapy Claims Disposed by Claims operator with RR


CLM_RR_CPD

CLM_RR_CTD

CLM_RR_CH


The number of claims which have been disposed with a Recommended for Rejection(RR) by the CPD

9 Dimensions: CPD

CTD


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases


Y Y Y Y Y Y Y N

394

18 Type: A


********************************************************************

247. OPR-CLM-RRJ-002


1 Gsln: 247

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: RRJ


6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommendation for Rejection and Live


LCLM_RR_CPD

LCLM_RR_CTD

LCLM_RR_CH


The claims which have been disposed with a Recommendation for Rejection by the Claims operator and awaiting final disposal at various levels of Trust at this moment

9 Dimensions: CPD

CTD


11 Formula: NA


395

13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A


********************************************************************

248.OPR-CLM-RRJ-003


Y Y Y Y N N N N


1 Gsln: 248

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: RRJ


6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommendation for Rejection in the Past


PCLM_RR_CPD

PCLM_RR_CTD

PCLM_RR_CH


The claims which have been disposed with a Recommendation for Rejection by the Claims operator in the past

396

9 Dimensions: CPD

CTD


11 Formula: CLM_RR_CPD(-)CLML_RR_CPD

CLM_RR_CTD(-)CLML_RR_CTD

12 Data required: CLM_RR_CPD; CLML_RR_CPD; CLM_RR_CTD; CLML_RR_CTD

13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A


********************************************************************

249.OPR-CLM-RRJ-004


Y Y Y Y Y Y Y N


1 Gsln: 249

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: RRJ


397

6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommendation for Rejection without pendency


CLM_RR~NP_CTD

CLM_RR~NP_CH


The claims which have been disposed with a Recommendation for Rejection without pendency by the Claims operator

9 Dimensions: CTD

CH


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A


********************************************************************


Y Y Y Y Y Y Y N

398

250.OPR-CLM-RRJ-005


1 Gsln: 250

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: RRJ


6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommendation for Rejection after pendency


CLM_RR~P_CTD

CLM_RR~P_CH


The claims which have been disposed with a Recommendation for Rejection after pendency by the Claims operator

9 Dimensions: CTD

CH


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases


Y Y Y Y Y Y Y N

399

18 Type: A


********************************************************************

251.OPR-CLM-PEN-001


Y Y Y Y Y Y Y N


1 Gsln: 251

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: PEN

5 Indicator Code: OPR-CLM-PEN-001

6 Indicator Name: Therapy Claims Disposed by Claims operator with Pendency


CLM_P_CPD

CLM_P_CTD

CLM_P_CH

CLM_P_CAO


The claims which have been disposed with a Pendency by the Claims operator

9 Dimensions: CPD

CTD

CH

CAO


11 Formula: NA


13 Frequency of

Monitoring:

400



Activity



Claim cases

18 Type: A


********************************************************************

252.OPR-CLM-PEN-002


1 Gsln: 252

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: PEN


6 Indicator Name: Therapy Claims Disposed by Claims operator with Pendency and Live

7 Indicator LCLM_P_CPD Acronym: LCLM_P_CTD

LCLM_P_CH

LCLM_P_CAO


The claims which have been disposed with a Pendency by the Claims operator and awaiting final disposal at various levels of Trust at this moment

401

9 Dimensions: CPD

CTD

CH

CAO


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A


********************************************************************

253.OPR-CLM-PEN-003


Y Y Y Y N N N N


1 Gsln: 253

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: PEN


402

6 Indicator Name: Therapy Claims Disposed by Claims operator with Pendency in the Past


PCLM_P_CPD

PCLM_P_CTD

PCLM_P_CH

PCLM_P_CAO


The claims which have been disposed with a Pendency by the Claims operator in the past

9 Dimensions: CPD;CTD;CH;CAO


11 Formula: CLM_P_CPD(-)LCLM_RR_CPD

CLM_P_CTD(-)LCLM_RR_CTD

CLM_P_CH(-)LCLM_RR_CH

CLM_P_CAO(-)LCLM_RR_CAO

12 Data required: CLM_P_CPD; LCLM_RR_CPD; CLM_P_CTD; LCLM_RR_CTD; CLM_P_CH; LCLM_RR_CH;

CLM_P_CAO;LCLM_RR_CAO

13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A


********************************************************************


Y Y Y Y Y Y Y N

403

254.OPR-CLM-APP-001


1 Gsln: 254

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: APP

5 Indicator Code: OPR-CLM-APP-001

6 Indicator Name: Therapy Claims Disposed by Claims operator with Approval


CLM_A_CH

CLM_A_CAO


The claims which have been disposed with Approval by the Claims operator

9 Dimensions: CH;CAO


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A


Y Y Y Y Y Y Y N

404


********************************************************************

255.OPR-CLM-APP-002


Y Y Y Y Y Y Y N


1 Gsln: 255

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: APP


6 Indicator Name: Therapy Claims Disposed by Claims operator with Approval without pendency


CLM_A~NP_CH

CLM_A~NP_CAO


The claims which have been disposed with Approval without pendency by the Claims operator

9 Dimensions: CH

CAO


11 Formula: NA


13 Frequency of

Monitoring:



Activity


405


Claim cases

18 Type: A


********************************************************************

256.OPR-CLM-APP-003


Y Y Y Y Y Y Y N


1 Gsln: 256

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: APP


6 Indicator Name: Therapy Claims Disposed by Claims operator with Approval after pendency


CLM_A~P_CH

CLM_A~P_CAO


The claims which have been disposed with a Approval after pendency by the Claims operator

9 Dimensions: CH

CAO


11 Formula: NA


13 Frequency of

Monitoring:

406



Activity



Claim cases

18 Type: A


********************************************************************

257.OPR-CLM-REJ-001


1 Gsln: 257

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: REJ

5 Indicator Code: OPR-CLM-REJ-001

6 Indicator Name: Therapy Claims Disposed by Claims operator with Rejection


CLM_R_CH

CLM_R_CAO


The claims which have been disposed with a Rejection by the Claims operator

9 Dimensions: CH

CAO


11 Formula: NA


407

13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A


********************************************************************

258.OPR-CLM-REJ-002


Y Y Y Y Y Y Y N


1 Gsln: 258

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: REJ


6 Indicator Name: Therapy Claims Disposed by Claims operator with Rejection without pendency


CLM_R~NP_CH

CLM_R~NP_CAO


The claims which have been disposed with a Rejection without pendency by the Claims operator

9 Dimensions: CH

CAO

408


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A


********************************************************************

259.OPR-CLM-REJ-003


Y Y Y Y Y Y Y N


1 Gsln: 259

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: REJ


6 Indicator Name: Therapy Claims Disposed by Claims operator with Rejection after pendency


CLM_R~P_CH

CLM_R~P_CAO

409


The claims which have been disposed with a Rejection after pendency at CH level, by the Claims operator

9 Dimensions: CH

CAO


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A


********************************************************************

260.OPR-CLM-TDP-001


Y Y Y Y Y Y Y N


1 Gsln: 260

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TDP

5 Indicator Code: OPR-CLM-TDP-001

410

6 Indicator Name: Total Therapy claims Disposed by CPD


CLM_D_CPD


Total number of claims disposed by CPD

9 Dimensions: NA

10 Role & Action: CPD&Claims disposal

11 Formula: CLM_RA_CPD + CLM_RR_CPD + CLM_P_CPD

12 Data required: CLM_RA_CPD; CLM_RR_CPD; CLM_P_CPD

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal by Claims panel doctor


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

261.OPR-CLM-TDP-002


Y Y Y Y Y Y Y N


1 Gsln: 261

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TDP

411


6 Indicator Name: Total Therapy claims Disposed by CTD


CLM_D_CTD


Total number of claims disposed by CTD

9 Dimensions: NA

10 Role & Action: CTD&Claims disposal

11 Formula: CLM_RA_CTD + CLM_RR_CTD + CLM_P_CTD

12 Data required: CLM_RA_CTD; CLM_RR_CTD; CLM_P_CTD

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal by Claims trust doctor


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************


Y Y Y Y Y Y Y N

412

262.OPR-CLM-TDP-003


1 Gsln: 262

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TDP


6 Indicator Name: Total Therapy claims Disposed by CH


CLM_D_CH


Total number of claims disposed by CH

9 Dimensions: NA

10 Role & Action: CH&Claims disposal

11 Formula: CLM_RA_CH + CLM_RR_CH+CLM_A_CH+CLM_R_CH+CLM_P_CH

12 Data required: CLM_RA_CH; CLM_RR_CH; CLM_A_CH; CLM_R_CH; CLM_P_CH

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal by Claims head


Claim cases

18 Type: A


Y Y Y Y Y Y Y N

413

19 Remarks: NA

********************************************************************

263.OPR-CLM-TDP-004


Y Y Y Y Y Y Y N


1 Gsln: 263

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TDP


6 Indicator Name: Therapy claims Disposed by CH (for insurance)


CLM_D_ICH


Total claims disposed by ICH

9 Dimensions: NA

10 Role & Action: ICH&Claims disposal

11 Formula: CLM_RA_ICH + CLM_RR_ICH +CLM_A_ICH+CLM_R_CH+CLM_P_ICH

12 Data required: CLM_RA_ICH; CLM_RR_ICH; CLM_A_ICH; CLM_R_CH;

CLM_P_ICH

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal by Claims insurance Claims head

414


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

264.OPR-CLM-TDP-005


Y Y Y Y Y Y Y N


1 Gsln: 264

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TDP


6 Indicator Name: Therapy claims Disposed by CAO


CLM_D_CAO


Total claims disposed by CAO

9 Dimensions: NA

10 Role & Action: CH&Claims disposal

11 Formula: CLM_A_CAO+CLM_R_CAO+CLM_P_CAO

12 Data required: CLM_A_CAO; CLM_R_CAO; CLM_P_CAO

13 Frequency of

Monitoring:


415


Output

16 Indicator use: To monitor claims cases disposal by Claims authorisation officer


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

265.OPR-CLM-TDP-006


1 Gsln: 265

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TDP


6 Indicator Name: Therapy Claims Disposed by A/C with Approval


CLM_A_AC


The claims which have been disposed with Accounts Approval(A) by the A/C

9 Dimensions: NA

10 Role & Action: A/C&Claims disposal

11 Formula: NA


13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N

416



Activity

16 Indicator use: To monitor claims cases disposal by Claims accountant


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

266.OPR-CLM-TDP-007


1 Gsln: 266

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TDP


6 Indicator Name: Therapy Claims Paid by Bank


CLM_A_B


The claims which have been paid by the Bank

9 Dimensions: NA

10 Role & Action: Bank&Claims disposal

11 Formula: NA


417

13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor claims cases disposal by bank


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

267.OPR-CLM-HAR-001


Y Y Y Y Y Y Y N


1 Gsln: 267

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: HAR

5 Indicator Code: OPR-CLM-HAR-001

6 Indicator Name: Average Hourly Claims Arrival for each of the 24 hours in a day


CLM_HA


Average claims submitted by MEDCO every hour during the 24 hours

9 Dimensions: NA

10 Role & Action: MEDCO&Claims arrivals

418

11 Formula: NA

12 Data required: CLM_S_R

13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor claims cases disposal by MEDCO


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

268.OPR-CLM-CAR-001


Y N N N N N N N


1 Gsln: 268

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: CAR

5 Indicator Code: OPR-CLM-CAR-001

6 Indicator Name: Claims Arrival Rate


CLM_ART


Average claims submitted by MEDCO in a specified period

9 Dimensions: NA

419

10 Role & Action: MEDCO&Claims arrivals

11 Formula: CLM_S_R in a given period / number of days in the period

12 Data required: CLM_S_R; Number of days in the period

13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: R

19 Remarks: NA

********************************************************************

269.OPR-CLM-HCD-001


1 Gsln: 269

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: HCD

5 Indicator Code: OPR-CLM-HCD-001

6 Indicator Name: Average Hourly Claims Disposal for each of the 24 hours in a day


CLM_HD


N Y Y Y Y Y Y N

420


Average claims disposed every hour during the 24 hours

9 Dimensions: NA

10 Role & Action: Claims operator& Claims Disposal

11 Formula: CLM_CH_A + CLM_CAO_A+CLM_CH_R + CLM_CAO_R

12 Data required: CLM_CH_A; CLM_CAO_A; CLM_CH_R; CLM_CAO_R

13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: R

19 Remarks: NA

********************************************************************

270.OPR-CLM-CDR-001


Y N N N N N N N


1 Gsln: 270

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: CDR

5 Indicator Code: OPR-CLM-CDR-001

6 Indicator Name: Claims Disposal Rate

421


CLM_DR


Average claims disposed in a specified period

9 Dimensions: NA


11 Formula: CLM_CH_A + CLM_CAO_A+CLM_CH_R + CLM_CAO_R in a given period / number of days in the period

12 Data required: CLM_CH_A, CLM_CAO_A, CLM_CH_R, CLM_CAO_R, number of days in the period

13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: R

19 Remarks: NA

********************************************************************

271.OPR-CLM-WTC-001


N Y Y Y Y Y Y N


1 Gsln: 271

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: WTC

422


6 Indicator Name: Therapy Claims Waiting at MEDCO


CLM_W>7days_R

CLM_W<7days_R


The claims which have been returned to MEDCO after pendency and awaiting disposal at this moment, and have crossed 7 days since first raised by MEDCO

9 Dimensions: >7days

<7 days

10 Role & Action: MEDCO& Claims Disposal

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A


********************************************************************


Y Y Y Y N N N N

423

272.OPR-CLM-WTC-002


1 Gsln: 272

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: WTC


6 Indicator Name: Therapy Claims Waiting at CEX


CLM_W>7days_CX

CLM_W<7days_CX


The claims which have been Submitted by MEDCO to CEX and awaiting disposal at this moment, and have crossed 7 days since first raised by MEDCO

9 Dimensions: >7days

<7 days

10 Role & Action: CEX&Claims Disposal

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases


Y Y N N N N N N

424

18 Type: A


********************************************************************

273.OPR-CLM-WTC-003


Y Y Y Y N N N N


1 Gsln: 273

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: WTC


6 Indicator Name: Therapy Claims Waiting at Claims operator afresh


CLMF_W_CPD

CLMF_W_CTD

CLMF_W_CH

CLMF_W_CAO


The fresh/new claims which have been forwarded by CEX and waiting for disposal for the first time at CPD level

9 Dimensions: CPD

CTD

CH

CAO

10 Role & Action: Claims operator&Claims Disposal

11 Formula: NA


13 Frequency of

Monitoring:

425



Activity



Claim cases

18 Type: A


********************************************************************

274.OPR-CLM-WTC-004


1 Gsln: 274

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: WTC


6 Indicator Name: Therapy Claims Waiting at Claims operator after updation of pendency

7 Indicator CLMP_W_CPD Acronym: CLMP_W_CTD

CLMP_W_CH

CLMP_W_CAO


The claims which have been updated by MEDCO, after pendency by CPD, and waiting for disposal at CPD level

426

9 Dimensions: CPD

CTD

CH

CAO


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A


********************************************************************

275.OPR-CLM-WTC-005


Y Y Y Y N N N N


1 Gsln: 275

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: WTC


427

6 Indicator Name: Therapy Claims Waiting at CPD for <7 days


CLM_W<7_CPD

CLM_W<7_CTD

CLM_W<7_CH

CLM_W<7_CAO


The claims which have been forwarded by CEX and waiting for disposal for less than 7 days at CPD level

9 Dimensions: CPD

CTD

CH

CAO

10 Role & Action: CPD&Claims Disposal

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Claim cases

18 Type: A


********************************************************************


Y Y N N N N N N

428

276.OPR-CLM-WTC-006


1 Gsln: 276

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: WTC


6 Indicator Name: Therapy Claims Waiting at Claims operator for >7 days


CLM_W>7_CPD

CLM_W>7_CTD

CLM_W>7_CH

CLM_W>7_CAO


The claims which have been forwarded by CEX and waiting for disposal for greater than 7 days at CPD level

9 Dimensions: CPD

CTD

CH

CAO


11 Formula: NA


13 Frequency of

Monitoring:



Activity



Y Y Y Y N N N N

429


Claim cases

18 Type: A


********************************************************************

277.OPR-CLM-WTC-007


Y Y N N N N N N


1 Gsln: 277

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: WTC


6 Indicator Name: Therapy Claims Waiting at A/C


CLM_W<7days_AC

CLM_W>7days_AC


The claims which have been forwarded by CAO and waiting for disposal for less than 7 days at A/C

9 Dimensions: <7days

>7days

10 Role & Action: A/C&Claims Disposal

11 Formula: NA


13 Frequency of

Monitoring:

430



Activity



Claim cases

18 Type: A


********************************************************************

278.OPR-CLM-WTC-008


1 Gsln: 278

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: WTC


6 Indicator Name: Therapy Claims Waiting at Bank


CLM_W<7days_B

CLM_W>7days_B


Total therapies claims and waiting for disposal at bank

9 Dimensions: <7days

>7days

10 Role & Action: Bank&Claims Disposal

11 Formula: NA


431

13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor claims cases disposal by Bank


Claim cases

18 Type: A


********************************************************************

279.OPR-CLM-TWN-001


Y Y Y Y N N N N


1 Gsln: 279

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TWN

5 Indicator Code: OPR-CLM-TWN-001

6 Indicator Name: Total Therapy Claims Waiting at MEDCO


CLM_W_R_T


Total number of therapies claim waiting at MEDCO

9 Dimensions: NA

10 Role & Action: MEDCO& Claims Disposal

432

11 Formula: CLM_W>7days_R + CLM_W<7days_R

12 Data required: CLM_W>7days_R; CLM_W<7days_R

13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

280.OPR-CLM-TWN-002


Y Y Y Y N N N N


1 Gsln: 280

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TWN


6 Indicator Name: Total Therapy Claims Waiting at CEX


CLM_W_CX_T


Total number of therapies claim which have been Submitted by MEDCO to CEX and awaiting disposal at this moment

9 Dimensions: NA

433

10 Role & Action: CEX& Claims Disposal

11 Formula: CLM_W>7days_X + CLM_W<7days_X

12 Data required: CLM_W>7days_X;

CLM_W<7days_X

13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

281.OPR-CLM-TWN-003


Y Y Y Y N N N N


1 Gsln: 281

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TWN


6 Indicator Name: Total Therapy Claims Waiting at CPD


CLM_W_CPD_T

434


Total therapy claims waiting for disposal at CPD level

9 Dimensions: NA

10 Role & Action: CPD&Claims Disposal

11 Formula: CLMF_W_CPD+CLMP_W_CPD (or)

CLM_W<7_CPD+CLM_W>7_CPD

12 Data required: CLMF_W_CPD; CLMP_W_CPD; CLM_W<7_CPD; CLM_W>7_CPD

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal by CPD


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

282.OPR-CLM-TWN-004


Y Y Y Y N N N N


1 Gsln: 282

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TWN


435

6 Indicator Name: Total Therapy Claims Waiting at CTD


CLM_W_CTD_T


Total therapy claims waiting for disposal at CTD level

9 Dimensions: NA

10 Role & Action: CTD&Claims Disposal

11 Formula: CLMF_W_CTD + CLMP_W_CTD (or)

CLM_W<7_CTD + CLM_W>7_CTD

12 Data required: CLMF_W_CTD; CLMP_W_CTD; CLM_W<7_CTD; CLM_W>7_CTD

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal by CTD


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************


Y Y Y Y N N N N

436

283.OPR-CLM-TWN-005


1 Gsln: 283

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TWN


6 Indicator Name: Total Therapy Claims Waiting at CH


CLM_W_CH_T


Total therapy claims waiting for disposal at CH level

9 Dimensions: NA

10 Role & Action: CH&Claims Disposal

11 Formula: CLMF_W_CH +CLMP_W_CH (or)

CLM_W<7days_CH + CLM_W>7days_CH

12 Data required: CLMF_W_CH; PCLMP_W_CH;

CLM_W<7days_CH; CLM_W>7days_CH

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal by CH


Claim cases


Y Y Y Y N N N N

437

18 Type: A

19 Remarks: NA

********************************************************************

284.OPR-CLM-TWN-006


Y Y Y Y N N N N


1 Gsln: 284

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TWN


6 Indicator Name: Total Therapy Claims Waiting at CAO


CLM_W_CAO_T


Total therapy claims waiting for disposal at CAO level

9 Dimensions: NA

10 Role & Action: CAO&Claims Disposal

11 Formula: CLMF_W_CAO + CLMP_W_CAO (or)

CLM_W<7days_CAO+CLM_W>7days_CAO

12 Data required: CLMF_W_CAO; CLMP_W_CAO;CLM_W<7days_CAO; CLM_W>7days_CAO

13 Frequency of

Monitoring:



Output

438

16 Indicator use: To monitor claims cases disposal by CAO


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

285.OPR-CLM-TWN-007


Y Y Y Y N N N N


1 Gsln: 285

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TWN


6 Indicator Name: Total Therapy Claims Waiting at A/C


CLM_W_AC


Total therapy claims waiting for disposal at A/C

9 Dimensions: NA

10 Role & Action: A/C&Claims Disposal

11 Formula: CLM_W<7days_AC + CLM_W>7days_AC

12 Data required: CLM_W<7days_AC; CLM_W>7days_AC

13 Frequency of

Monitoring:


439


Output

16 Indicator use: To monitor claims cases disposal by A/C


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

286.OPR-CLM-TWN-008


Y Y N N N N N N


1 Gsln: 286

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TWN


6 Indicator Name: Total Therapy Claims Waiting at Bank


CLM_W_B


The claims which have been forwarded by CAO and waiting for disposal for less than 7 days at Bank

9 Dimensions: NA

10 Role & Action: Bank&Claims Disposal

11 Formula: CLM_W<7days_B + CLM_W>7days_B

12 Data required: CLM_W<7days_B; CLM_W>7days_B

13 Frequency of

Monitoring:

440



Output



Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

287.OPR-CLM-TWN-009


1 Gsln: 287

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TWN


6 Indicator Name: Total Therapy Claims Waiting for approval at Trust


CLM_W_TRU


Total therapy claims waiting for disposal at Trust

9 Dimensions: NA

10 Role & Action: Trust&Claims Disposal

11 Formula: CLM_W_CPD_T + CLM_W_CTD_T + CLM_W_CH_T + CM_W_CAO_T + CLM_W_AC

12 Data required: CLM_W_CPD_T; CLM_W_CTD_T; CLM_W_CH_T; CM_W_CAO_T; CLM_W_AC

441

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal at Trust


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

288.OPR-CLM-TWN-010


Y Y Y Y N N N N


1 Gsln: 288

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TWN


6 Indicator Name: Total Therapy Claims Waiting for approval at NWH


CLM_W_NWH


Total therapy claims waiting for disposal at NWH

9 Dimensions: NA

10 Role & Action: NWH&Claims Disposal

11 Formula: NA

442

12 Data required: CLM_W_R _T

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal at NWH


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

289.OPR-CLM-TWN-011


Y Y Y Y N N N N


1 Gsln: 289

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TWN


6 Indicator Name: Total Therapy Claims Waiting for Approval


CLM_W_T


Total therapy claims waiting for disposal at various levels

9 Dimensions: NA

443

10 Role & Action: Claims Disposal

11 Formula: CLM_W_TRT + CLM_W_NWH

12 Data required: CLM_W_TRT; CLM_W_NWH

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

290.OPR-CLM-AWT-001


Y Y Y Y N N N N


1 Gsln: 290

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: AWT

5 Indicator Code: OPR-CLM-AWT-001

6 Indicator Name: Average CWT for disposal of fresh claim cases at MEDCO during a specified period


CLMF_AWT_R

444


Average waiting time at MEDCO for disposal of fresh claim cases for a specified period

9 Dimensions: NA

10 Role & Action: MEDCO&Claim waiting times

11 Formula: Sum of (The time at which a Claim case is updated by MEDCO after pendency (-) The time at which the Claim case arrived at MEDCO due to pendency) for all disposed cases / Number of cases

12 Data required: Number of cases

13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

291.OPR-CLM-AWT-002


Y Y Y Y Y Y Y N


1 Gsln: 291

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: AWT


445

6 Indicator Name: Average CWT for updation of pending claim cases at MEDCO during a specified period


CLMP_AWT_R


Average waiting time at MEDCO for updation of pending claim cases for a specified period

9 Dimensions: NA

10 Role & Action: MEDCO&Claim waiting times

11 Formula: Sum of (The time at which a Claim case is updated by MEDCO after pendency (-) The time at which the Claim case arrived at MEDCO due to pendency) for all disposed cases / Number of cases


13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A

19 Remarks: NA

********************************************************************


Y Y Y Y Y Y Y N

446

292. OPR-CLM-AWT-003


1 Gsln: 292

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: AWT


6 Indicator Name: Average CWT at CEX for a fresh Claim case during a specified period


CLM_AWT_CX


Average Claim waiting time at CEX for disposal of a fresh claim cases specified period

9 Dimensions: NA

10 Role & Action: CEX&Claim waiting times

11 Formula: Sum of (The time at which a Claim case is forwarded by CEX(-) The time at which the Claim case arrived at CEX from MEDCO)for all disposed cases / Number of cases


13 Frequency of

Monitoring:



Output



Claim cases


Y Y Y Y Y Y Y N

447

18 Type: A

19 Remarks: NA

********************************************************************

293. OPR-CLM-AWT-004


1 Gsln: 293

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: AWT


6 Indicator Name: Average CWT at Claims operator for a fresh Claim case during a specified period


CLMF_AWT_CPD

CLMF_AWT_CTD

CLMF_AWT_CH

CLMF_AWT_CAO


Average waiting time at CPD for disposal of fresh claim cases in a specified period

9 Dimensions: CPD

CTD

CH

CAO

10 Role & Action: Claims operator&Claim waiting time

11 Formula: Sum of The time at which the fresh Claim case is disposed at Claims operator (-) The time at which the fresh Claim case arrived at Claims operator for all disposed cases / Number of cases


448

13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A


********************************************************************

294.OPR-CLM-AWT-005


Y Y Y Y Y Y Y N


1 Gsln: 294

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: AWT


6 Indicator Name: Average CWT at claims operator for a pending updated Claim case during a specified period

7 Indicator CLMP_AWT_CPD Acronym: CLMP_AWT_CTD

CLMP_AWT_CH

CLMP_AWT_CAO


Average waiting time at CPD for disposal of pending claim cases in a specified period

449



11 Formula: Sum of The time at which a pending updated Claim case is disposed by Claims operator (-) The time at which the pending Claim case arrived at Claims operator for all disposed cases / Number of cases


13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A


********************************************************************

295.OPR-CLM-AWT-006


1 Gsln: 295

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: AWT



Y Y Y Y Y Y Y N

450

6 Indicator Name: Average CWT at claims operator for a Claim case during a specified period


CLM_AWT_CPD

CLM_AWT_CTD

CLM_AWT_CH

CLM_AWT_CAO


Average waiting time at CPD for disposal of pending claim cases in a specified period



11 Formula: Sum of The (CLMF_AWT_CPD+CLMP_AWT_CPD) for all disposed cases / Number of cases

Sum of The (CLMF_AWT_CTD+CLMP_AWT_CTD) for all disposed cases / Number of cases

Sum of The (CLMF_AWT_CH+CLMP_AWT_CH) for all disposed cases / Number of cases

Sum of The (CLMF_AWT_CAO+CLMP_AWT_CAO) for all disposed cases / Number of cases

12 Data required: CLMF_AWT_CPD; CLMP_AWT_CPD; CLMF_AWT_CTD;

CLMP_AWT_CTD; CLMF_AWT_CH; CLMP_AWT_CH;

CLMF_AWT_CAO; CLMP_AWT_CAO; Number of cases

13 Frequency of

Monitoring:


Y Y Y Y Y Y Y N



Output



Claim cases

18 Type: A

451


********************************************************************

296.OPR-CLM-AWT-007


Y Y Y Y Y Y Y N


1 Gsln: 296

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: AWT


6 Indicator Name: Average CWT at A/C for a Claim case during a specified period


CLM_AWT_AC


Average Waiting time at A/C for disposal of a claim case

9 Dimensions: NA

10 Role & Action: A/C&Claim waiting time

11 Formula: Sum of The time at which the Claim case is disposed by A/C( -) The time at which the Claim case arrived at A/C for all disposed cases / Number of cases


13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal by A/C

452


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

297.OPR-CLM-AWT-008


Y Y Y Y Y Y Y N


1 Gsln: 297

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: AWT


6 Indicator Name: Average CWT at Bank for a Claim case during a specified period


CLM_AWT_B


Average Waiting time at A/C for disposal of a claim case

9 Dimensions: NA

10 Role & Action: Bank&

Claim waiting time

11 Formula: Sum of The time at which the Claim case is Paid by Bank (-) The time at which the Claim case arrived at Bank for all disposed cases / Number of cases


13 Frequency of

Monitoring:

453



Output



Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

298.OPR-CLM-AWT-009


1 Gsln: 298

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: AWT


6 Indicator Name: Average CWT at Trust for a Claim case


CLM_AWT_TRU


Total waiting time at trust for disposal of a claim case

9 Dimensions: NA

10 Role & Action: Trust&Claim waiting time

11 Formula: CLM_AWT_CX + CLM_AWT_CPD +CLM_AWT_CTD + CLM_AWT_CH +CLM_AWT_CAO /Number of cases

12 Data required: CLM_AWT_CX; CLM_AWT_CPD; CLM_AWT_CTD; CLM_AWT_CH; CLM_AWT_CAO; Number of cases

454

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal at Trust


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

299.OPR-CLM-AWT-010


Y N N N N N N N


1 Gsln: 299

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: AWT


6 Indicator Name: Average CWT at NWH for a Claim case


CLM_AWT_NWH


Total waiting time at NWH for disposal of a claim case

9 Dimensions: NA

10 Role & Action: NWH&Claim waiting time

455

11 Formula: CLMF_AWT_R + CLMP_AWT_R/ Number of cases

12 Data required: CLMF_AWT_R; CLMP_AWT_R;Number of cases

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal at NWH


Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

300.OPR-CLM-AWT-011


Y N N N N N N N


1 Gsln: 300

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: AWT


6 Indicator Name: Average CWT for approval of a claim case


CLM_AWT_TO


Total waiting time for disposal of a claim case

9 Dimensions: NA

456

10 Role & Action: TotalClaim waiting time

11 Formula: CLM_AWT_TRU + CLM_AWT_NWH/ Number of cases

12 Data required: CLM_AWT_TRU; CLM_AWT_NWH; Number of cases

13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

301.OPR-CLM-AWT-012


Y Y Y Y N N N N


1 Gsln: 301

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: AWT


6 Indicator Name: Average CWT for payment of a claim case during a specified period


CLM_AWT_P

457


Average waiting time for payment of a claim case

9 Dimensions: NA

10 Role & Action: Payment&Claim waiting time

11 Formula: CLM_AWT_TRU + CLM_AWT_NWH+CLM_AWT_AC+ CLM_AWT_B/ Number of cases

12 Data required: CLM_AWT_TRU; CLM_AWT_NWH; CLM_AWT_AC; CLM_AWT_B;Number of cases

13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A

19 Remarks: NA

********************************************************************

302.OPR-CLM-TOR-001


Y Y Y Y Y Y Y N


1 Gsln: 302

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TOR

5 Indicator Code: OPR-CLM-TOR-001

458

6 Indicator Name: Turn over Rate for claims, of claims operator for a specified period


CLM_TOR_CX

CLM_TOR_CPD

CLM_TOR_CTD

CLM_TOR_CH

CLM_TOR_CAO


Number of claims disposed by claims operator in a specific period

9 Dimensions: CX

CPD

CTD

CH

CAO


11 Formula: Number of cases disposed by Claim operator (CLM_D_CX or CLM_D_CPD or CLM_D_CTD or CLM_D_CH or CLM_D_CAO) during the period / Number of days in the period

12 Data required: CLM_D_CX; CLM_D_CPD; CLM_D_CTD; CLM_D_CH;

CLM_D_CAO; Number of days in the period

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor claims cases disposal by Claim operator


Claim cases

18 Type: R


Y Y Y Y Y Y Y N

459


********************************************************************

303.OPR-CLM-TOR-002


Y Y Y Y Y Y Y N


1 Gsln: 303

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: TOR

5 Indicator Code: OPR-CLM-TOR-002

6 Indicator Name: TOR for a role during a specified period


CLM_TOR_RO


Average number of claims disposed by specific role in a specific period

9 Dimensions: NA

10 Role & Action: Claims operator& Claims disposal

11 Formula: Sum cases disposed by all operators (CLM_D_CX + CLM_D_CPD + CLM_D_CTD + CLM_D_CH + CLM_D_CAO) in the role for the period / Number of days in the period

12 Data required: CLM_D_CX; CLM_D_CPD; CLM_D_CTD; CLM_D_CH;

CLM_D_CAO; Number of days in the period

13 Frequency of

Monitoring:



Output

460



Claim cases

18 Type: R

19 Remarks: NA

********************************************************************

304.OPR-CLM-DTO-001


1 Gsln: 304

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: DTO

5 Indicator Code: OPR-CLM-DTO-001

6 Indicator Name: Daily Turnover of claims operator


CLM_DTO_CX

CLM_DTO_CPD

CLM_DTO_CTD

CLM_DTO_CH

CLM_DTO_CAO


Number of claims disposed by claims operator in a day

9 Dimensions: CX

CPD

CTD

CH

CAO


461

11 Formula: NA


13 Frequency of

Monitoring:



Output



Claim cases

18 Type: A


********************************************************************

305.OPR-CLM-CPP-001


1 Gsln: 305

2 Major Group: OPR

3 Minor Group: CLM

4 Sub Category: CPP

5 Indicator Code: OPR-CLM-CPP-001

6 Indicator Name: Claim Pendency Percentage for claims operator during a specified period


y N N N N N N N

462


CLM_CPP_CPD

CLM_CPP_CTD

CLM_CPP_CH

CLM_CPP_CAO


The percentage of claim cases disposed by CPD

9 Dimensions: CPD

CTD

CH

CAO

10 Role & Action: Claims operator& Claims disposal

11 Formula: CLM_P_CPD / CLM_D_CPD*100

CLM_P_CTD / CLM_D_CTD*100

CLM_P_CH / CLM_D_CH*100

CLM_P_CAO / CLM_D_CAO*100

12 Data required: CLM_P_CPD; CLM_D_CPD; CLM_P_CTD; CLM_D_CTD;

CLM_P_CH; CLM_D_CH;CLM_P_CAO; CLM_D_CAO

13 Frequency of

Monitoring:



Output



Claim cases

18 Type: P



N Y Y Y Y Y Y N

463

********************************************************************

306.EMP-EAP-INT-001


N Y Y Y Y Y Y N


1 Gsln: 306

2 Major Group: EMP

3 Minor Group: EAP

4 Sub Category: INT

5 Indicator Code: EMP-EAP-INT-001

6 Indicator Name: Empanelment Application Hospital User Initiated


EAP_I_R


Number of applications initiated by hospital user for Empanelment

9 Dimensions: NA

10 Role & Action: Hospital User&Empanelment Application Initiation

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor empanelment process


Empanelment applications

18 Type: A

464

19 Remarks: NA

********************************************************************

307.EMP-EAP-UPD-001


N Y Y Y Y Y Y N


1 Gsln: 307

2 Major Group: EMP

3 Minor Group: EAP

4 Sub Category: UPD

5 Indicator Code: EMP-EAP-UPD-001

6 Indicator Name: Empanelment Application Hospital User Updated


EAP_U_R


Number of Empanelment Application Updated by Hospital User after kept pending by EH

9 Dimensions: NA

10 Role & Action: Hospital User&Empanelment application updation

11 Formula: NA


13 Frequency of

Monitoring:



Activity




465

18 Type: A

19 Remarks: NA

********************************************************************

308.EMP-ERE-FWD-001


N Y Y Y Y Y Y N


1 Gsln: 308

2 Major Group: EMP

3 Minor Group: ERE

4 Sub Category: FWD

5 Indicator Code: EMP-ERE-FWD-001

6 Indicator Name: Empanelment Application Registration Forwarded by empanelment operator


EAP_RE_F_EEX

EAP_RE_F_EPO

EAP_RE_F_EPD


Number of Empanelment applications L1,L2,L3 Verified-for registration and forwarded by empanelment operator

9 Dimensions: EEX;EPO;EPD

10 Role & Action: Empanelment Operator & Empanelment application- registration

11 Formula: NA


13 Frequency of

Monitoring:



Activity

466




18 Type: A


********************************************************************

309.EMP-ERE-APP-002


N Y Y Y Y Y Y N


1 Gsln: 309

2 Major Group: EMP

3 Minor Group: ERE

4 Sub Category: APP

5 Indicator Code: EMP-ERE-APP-002

6 Indicator Name: Empanelment Application-Registration approved by EH


EAP_RE_A_EH


Number of Empanelment applications L4 Verified-for registration and approved by EH

9 Dimensions: NA

10 Role & Action: EH&Empanelment application-registration

11 Formula: NA


13 Frequency of

Monitoring:

467



Activity




18 Type: A

19 Remarks: NA

********************************************************************

310.EMP-ERE-PEN-003


1 Gsln: 310

2 Major Group: EMP

3 Minor Group: ERE

4 Sub Category: PEN

5 Indicator Code: EMP-ERE-PEN-003

6 Indicator Name: Empanelment Application-Registration kept pending by EH


EAP_RE_P_EH


Number of Empanelment applications L4 Verified-for registration and kept pending by EH

9 Dimensions: NA


11 Formula: NA


468

13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************

311.EMP-ERE-REJ-004


N Y Y Y Y Y Y N


1 Gsln: 311

2 Major Group: EMP

3 Minor Group: ERE

4 Sub Category: REJ

5 Indicator Code: EMP-ERE-REJ-004

6 Indicator Name: Empanelment Application-Registration rejected by EH


EAP_RE_R_EH


Number of Empanelment applications L4 Verified-for registration and rejected by EH

9 Dimensions: NA


11 Formula: NA

469


13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************

312.EMP-EIP-INT-001


N Y Y Y Y Y Y N


1 Gsln: 312

2 Major Group: EMP

3 Minor Group: EIP

4 Sub Category: INT

5 Indicator Code: EMP-EIP-INT-001

6 Indicator Name: Empanelment -Inspection EPO Initiated


EMP_IP_I_EPO


Number of Empanelment applications for which Inspection is assigned

9 Dimensions: NA

10 Role & Action: EPO (CMA)&EmpanelmentInspection

470

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************

313.EMP-EIP-UPD-002


N Y Y Y Y Y Y N


1 Gsln: 313

2 Major Group: EMP

3 Minor Group: EIP

4 Sub Category: UPD

5 Indicator Code: EMP-EIP-UPD-002

6 Indicator Name: Empanelment -Inspection MC-EDC Updated


EMP_IP_U_MC-EDC


Number of Empanelment applications for which Inspection is updated by MC-EDC

9 Dimensions: NA

471

10 Role & Action: Inspection team&EmpanelmentInspection

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************

314.EMP-EAU-RAP-001


N Y Y Y Y Y Y N


1 Gsln: 314

2 Major Group: EMP

3 Minor Group: EAU

4 Sub Category: RAP

5 Indicator Code: EMP-EAU-RAP-001

6 Indicator Name: Empanelment Authorisation Recommended Approval by empanelment operator


EMP_AU_RA_MC-EDC

EMP_AU_RA_EAO

472


Number of Empanelment applications for which MC-EDC Recommended Approval for Empanelment

9 Dimensions: MC-EDC

EAO

10 Role & Action: Empanelment Operator&Empanelment Authorisation

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

315.EMP-EAU-RRE-002


N Y Y Y Y Y Y N


1 Gsln: 315

2 Major Group: EMP

3 Minor Group: EAU

4 Sub Category: RRE

5 Indicator Code: EMP-EAU-RRE-002

473

6 Indicator Name: Empanelment Authorisation Recommended Rejection by empanelment operator


EMP_AU_RR_MC-EDC

EMP_AU_RR_EAO


Number of Empanelment applications for which MC-EDC Recommended Rejection for Empanelment


EAO

10 Role & Action: Empanelment Operator&

Empanelment Authorisation

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************


N Y Y Y Y Y Y N

474

316.EMP-EAU-REJ-003


1 Gsln: 316

2 Major Group: EMP

3 Minor Group: EAU

4 Sub Category: REJ

5 Indicator Code: EMP-EAU-REJ-003

6 Indicator Name: Empanelment Authorisation Rejected by empanelment operator


EMP_AU_R_MC-EDC

EMP_AU_R_EAO

EMP_AU_R_EH


Number of Empanelment applications for which MC-EDC Rejected for Empanelment


EAO

EH


11 Formula: NA


13 Frequency of

Monitoring:



Activity



N Y Y Y Y Y Y N

475



18 Type: A


********************************************************************

317.EMP-EAU-PEN-004


N Y Y Y Y Y Y N


1 Gsln: 317

2 Major Group: EMP

3 Minor Group: EAU

4 Sub Category: PEN

5 Indicator Code: EMP-EAU-PEN-004

6 Indicator Name: Empanelment Authorisation Pending by empanelment operator


EMP_AU_P_MC-EDC

EMP_AU_P_EAO

EMP_AU_P_EH


Number of Empanelment applications for which MC-EDC kept pending for Empanelment

9 Dimensions: NA


11 Formula: NA


13 Frequency of

Monitoring:

476



Activity




18 Type: A


********************************************************************

318.EMP-EAU-APP-005


1 Gsln: 318

2 Major Group: EMP

3 Minor Group: EAU

4 Sub Category: APP

5 Indicator Code: EMP-EAU-APP-005

6 Indicator Name: Empanelment Authorisation-

EH Approved


EMP_AU_A_EH


Number of Empanelment applications for which EH Approved for Empanelment

9 Dimensions: NA

10 Role & Action: EH&Empanelment Authorisation

11 Formula: NA


477

13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************

319.EMP-EAS-INT-001


N Y Y Y Y Y Y N


1 Gsln: 319

2 Major Group: EMP

3 Minor Group: EAS

4 Sub Category: INT

5 Indicator Code: EMP-EAS-INT-001

6 Indicator Name: Additional Specialities Empanelment MEDCO Initiated


EAS_I_R


Number of applications initiated by hospital user for additional Specialities Empanelment

9 Dimensions: NA

10 Role & Action: MEDCO&Additional Specialities Empanelment

478

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor Additional specialities empanelment process


Additional specialities Empanelment applications

18 Type: A

19 Remarks: NA

********************************************************************

320.EMP-EAS-UPD-001


N Y Y Y Y Y Y N


1 Gsln: 320

2 Major Group: EMP

3 Minor Group: EAS

4 Sub Category: UPD

5 Indicator Code: EMP-EAS-UPD-001

6 Indicator Name: Additional Specialities Empanelment MEDCO Updated


EAS_U_R


Number of Applications for additional Specialities Empanelment updated by Hospital User after kept pending by EH

479

9 Dimensions: NA

10 Role & Action: MEDCO&Additional Specialities Empanelment

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************

321.EMP-EAS-RAP-001


N Y Y Y Y Y Y N


1 Gsln: 321

2 Major Group: EMP

3 Minor Group: EAS

4 Sub Category: RAP

5 Indicator Code: EMP-EAS-RAP-001

6 Indicator Name: Additional Specialities Empanelment Recommended Approval Empanelment Operator


EAS_RA_EEX

EAS_RA_EPO

480


Number of Applications for additional Specialities Empanelment Recommended Approval by Empanelment Operator

9 Dimensions: EEX

EPO

10 Role & Action: Empanelment Operator&Additional Specialities Empanelment

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

322.EMP-EAS-RRE-001


N Y Y Y Y Y Y N


1 Gsln: 322

2 Major Group: EMP

3 Minor Group: EAS

481

4 Sub Category: RRE

5 Indicator Code: EMP-EAS-RRE-001

6 Indicator Name: Additional Specialities Empanelment Recommended Rejection Empanelment Operator


EAS_RR_EEX

EAS_RR_EPO


Number of Applications for additional Specialities Empanelment Recommended Rejection by Empanelment Operator

9 Dimensions: EEX

EPO (CMA)


11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************


N Y Y Y Y Y Y N

482

323. EMP-EAS-PEN-001


1 Gsln: 323

2 Major Group: EMP

3 Minor Group: EAS

4 Sub Category: PEN

5 Indicator Code: EMP-EAS-PEN-001

6 Indicator Name: Additional Specialities Empanelment Pending Empanelment Operator


EAS_P_EEX

EAS_P_EPO

EAS_P_MC-EDC


Number of Applications for Additional Specialities Empanelment kept pending by Empanelment Operator

9 Dimensions: EEX

EPO

MC-EDC


11 Formula: NA


13 Frequency of

Monitoring:



Activity



N Y Y Y Y Y Y N

483



18 Type: A


********************************************************************

324. EMP-EAS-IAP-001


1 Gsln: 324

2 Major Group: EMP

3 Minor Group: EAS

4 Sub Category: IAP

5 Indicator Code: EMP-EAS-IAP-001

6 Indicator Name: Additional Specialities Empanelment inspection Approved Empanelment Operator


EAS_IP_A_MC-EDC

EAS_IP_A_EPO


Number of Applications for Additional Specialities Empanelment inspection Approved by Empanelment Operator


EPO


11 Formula: NA


484

13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

325.EMP-EAS-IRE-001


N Y Y Y Y Y Y N


1 Gsln: 325

2 Major Group: EMP

3 Minor Group: EAS

4 Sub Category: IRE

5 Indicator Code: EMP-EAS-IRE-001

6 Indicator Name: Additional Specialities Empanelment Inspection MC-EDC Rejected


EAS_IP_R_MC-EDC

EAS_IP_R_EH


Number of Applications for Additional Specialities Empanelment Rejected by Empanelment Operator


EH

485


11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

326.EMP-EAS-IUP-001


N Y Y Y Y Y Y N


1 Gsln: 326

2 Major Group: EMP

3 Minor Group: EAS

4 Sub Category: IUP

5 Indicator Code: EMP-EAS-IUP-001

6 Indicator Name: Additional Specialities Empanelment-Inspection MC-EDC Updated


EAS_IP_U_MC-EDC

486


Number of Applications for Additional Specialities Empanelment for which Inspection is updated by MC-EDC

9 Dimensions: NA

10 Role & Action: MC-EDC&Additional Specialities Empanelment-Inspection

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************

327.EMP-EAS-APP-001


N Y Y Y Y Y Y N


1 Gsln: 327

2 Major Group: EMP

3 Minor Group: EAS

4 Sub Category: APP

5 Indicator Code: EMP-EAS-APP-001

6 Indicator Name: Additional Specialities Empanelment EH Approved

487


EAS_A_EH


Number of Applications for Additional Specialities Empanelment for which EH Approved for Empanelment

9 Dimensions: NA

10 Role & Action: EH&Additional Specialities Empanelment-

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************

328.EMP-ECR-INT-001


N Y Y Y Y Y Y N


1 Gsln: 328

2 Major Group: EMP

3 Minor Group: ECR

4 Sub Category: INT

5 Indicator Code: EMP-ECR-INT-001

488

6 Indicator Name: Change Requests of MEDCO Initiated by MEDCO


ECR_I_R


Number of applications initiated by hospital user for Change request of MEDCO

9 Dimensions: NA

10 Role & Action: MEDCO&Change Requests of MEDCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor MEDCO Change requests empanelment process


MEDCO Change requests applications

18 Type: A

19 Remarks: NA

********************************************************************

329.EMP-ECR-UPD-001


N Y Y Y Y Y Y N


1 Gsln: 329

2 Major Group: EMP

3 Minor Group: ECR

4 Sub Category: UPD

489

5 Indicator Code: EMP-ECR-UPD-001

6 Indicator Name: Change Requests of MEDCO Updated by MEDCO


ECR_U_R


Number of Applications for Change request of MEDCO updated by Hospital User after kept pending by EH

9 Dimensions: NA

10 Role & Action: MEDCO&Change Requests of MEDCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************

330.EMP-ECR-RAP-001


N Y Y Y Y Y Y N


1 Gsln: 330

2 Major Group: EMP

3 Minor Group: ECR

490

4 Sub Category: RAP

5 Indicator Code: EMP-ECR-RAP-001

6 Indicator Name: Change Requests of MEDCO-Recommended Approval by Empanelment Operator


ECR_RA_ITEX

ECR_RA_EEX

ECR_RA_MD-EDC


Number of Applications for Change request of MEDCO Recommended Approval

9 Dimensions: ITEX

EEX

MC-EDC

10 Role & Action: Empanelment Operator&Change Requests of MEDCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************


N Y Y Y Y Y Y N

491

331.EMP-ECR-PEN-001


1 Gsln: 331

2 Major Group: EMP

3 Minor Group: ECR

4 Sub Category: PEN

5 Indicator Code: EMP-ECR-PEN-001

6 Indicator Name: Change Requests of MEDCO Pending by Empanelment Operator


ECR_P_ITEX

ECR_P_EEX

ECR_P_MD-EDC

ECR_P_EH


Number of Applications for Change request of MEDCO Kept pending

9 Dimensions: ITEX

EEX

MC-EDC

EH


11 Formula: NA


13 Frequency of

Monitoring:



Activity


N Y Y Y Y Y Y N

492




18 Type: A


********************************************************************

332.EMP-ECR-REJ-001


1 Gsln: 332

2 Major Group: EMP

3 Minor Group: ECR

4 Sub Category: REJ

5 Indicator Code: EMP-ECR-REJ-001

6 Indicator Name: Change Requests of MEDCO Rejected by Empanelment Operator


ECR_R_EEX

ECR_R_MD-EDC

ECR_R_EH


Number of Applications for Change request of MEDCO Rejected

9 Dimensions: EEX

MC-EDC

EH


11 Formula: NA


493

13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

333.EMP-ECR-APP-001


N Y Y Y Y Y Y N


1 Gsln: 333

2 Major Group: EMP

3 Minor Group: ECR

4 Sub Category: APP

5 Indicator Code: EMP-ECR-APP-001

6 Indicator Name: Change Requests of MEDCOApproved


ECR_A_EH


Number of Applications for Change request of MEDCO by Approved by EH

9 Dimensions: NA

10 Role & Action: EH&Change Requests of MEDCO

494

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************

334.EMP-ECA-INT-001


N Y Y Y Y Y Y N


1 Gsln: 334

2 Major Group: EMP

3 Minor Group: ECA

4 Sub Category: INT

5 Indicator Code: EMP-ECA-INT-001

6 Indicator Name: Change Requests of AMCCO Initiated by MEDCO


ECA_I_R


Number of applications initiated by hospital user for Change request of AMCCO

9 Dimensions: NA

495

10 Role & Action: MEDCO&Change Requests of NVMCCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor AMCO Change requests empanelment process


AMCO Change requests applications

18 Type: A

19 Remarks: NA

********************************************************************

335.EMP-ECA-UPD-001


N Y Y Y Y Y Y N


1 Gsln: 335

2 Major Group: EMP

3 Minor Group: ECA

4 Sub Category: UPD

5 Indicator Code: EMP-ECA-UPD-001

6 Indicator Name: Change Requests of AMCCO Updated by MEDCO


ECA_U_R


Number of Applications for Change request of AMCCO updated by Hospital User after kept pending by EH

496

9 Dimensions: NA

10 Role & Action: MEDCO&Change Requests of NVMCCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************

336.EMP-ECA-RAP-001


N Y Y Y Y Y Y N


1 Gsln: 336

2 Major Group: EMP

3 Minor Group: ECA

4 Sub Category: RAP

5 Indicator Code: EMP-ECA-RAP-001

6 Indicator Name: Change Requests of AMCCO Recommended Approval by Empanelment Operator

497


ECA_RA_ITEX

ECA_RA_EEX

ECA_RA_MD-EDC


Number of Applications for Change request of NVMCCO Recommended Approval

9 Dimensions: ITEX

EEX

MC-EDC

10 Role & Action: Empanelment Operator&Change Requests of NVMCCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************


N Y Y Y Y Y Y N

498

337.EMP-ECA-PEN-001


1 Gsln: 337

2 Major Group: EMP

3 Minor Group: ECA

4 Sub Category: PEN

5 Indicator Code: EMP-ECA-PEN-001

6 Indicator Name: Change Requests of NVMCCO Pending by Empanelment Operator


ECA_P_ITEX

ECA_P_EEX

ECA_P_MD-EDC

ECA_P_EH


Number of Applications for Change request of NVMCCO Kept pending

9 Dimensions: ITEX

EEX

MC-EDC

EH

10 Role & Action: Empanelment Operator&Change Requests of NVMCCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity


N Y Y Y Y Y Y N

499




18 Type: A


********************************************************************

338 .EMP-ECA-REJ-001


1 Gsln: 338

2 Major Group: EMP

3 Minor Group: ECA

4 Sub Category: REJ

5 Indicator Code: EMP-ECA-REJ-001

6 Indicator Name: Change Requests of AMCCO Rejected by Empanelment Operator


ECA_R_EEX

ECA_R_MD-EDC

ECA_R_EH


Number of Applications for Change request of AMCCO Rejected

9 Dimensions: EEX

MC-EDC

EH

10 Role & Action: Empanelment Operator&Change Requests of AMCCO

11 Formula: NA


500

13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

339.EMP-ECA-APP-001


N Y Y Y Y Y Y N


1 Gsln: 339

2 Major Group: EMP

3 Minor Group: ECA

4 Sub Category: APP

5 Indicator Code: EMP-ECA-APP-001

6 Indicator Name: Change Requests of AMCCO Approved by Empanelment Operator


ECA_A_EH


Number of Applications for Change request of AMCCO Approved by EH

9 Dimensions: NA

501

10 Role & Action: EH&Change Requests of NVMCCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A

19 Remarks: NA

********************************************************************

340.EMP-EAA-INT-001


1 Gsln: 340

2 Major Group: EMP

3 Minor Group: EAA

4 Sub Category: INT

5 Indicator Code: EMP-EAA-INT-001

6 Indicator Name: Change Requests of Additional NVMCCO Initiated by MEDCO


EAA_I_R


N Y Y Y Y Y Y N

502


Number of applications initiated by hospital user for Change request for additional NVMCCO

9 Dimensions: NA

10 Role & Action: MEDCO&Change Requests of Additional NVMCCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor Additional AMCO Change requests empanelment process


Change requests applications

18 Type: A

19 Remarks: NA

********************************************************************

341.EMP-EAA-UPD-001


N Y Y Y Y Y Y N


1 Gsln: 341

2 Major Group: EMP

3 Minor Group: EAA

4 Sub Category: UPD

5 Indicator Code: EMP-EAA-UPD-001

503

6 Indicator Name: Change Requests of Additional NVMCCO Updated by MEDCO


EAA_U_R


Number of Applications for Change request for additional NVMCCO updated by Hospital User after kept pending by EH

9 Dimensions: NA

10 Role & Action: MEDCO&Change Requests of Additional NVMCCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Additional AMCO Change requests applications

18 Type: A

19 Remarks: NA

********************************************************************


N Y Y Y Y Y Y N

504

342.EMP-EAA-RAP-001


1 Gsln: 342

2 Major Group: EMP

3 Minor Group: EAA

4 Sub Category: RAP

5 Indicator Code: EMP-EAA-RAP-001

6 Indicator Name: Change Requests of Additional NVMCCO Recommended Approval by Empanelment Operator


EAA_RA_ITEX

EAA_RA_EEX

EAA_RA_MD-EDC


Number of Applications for Change request for additional NVMCCO Recommended Approval

9 Dimensions: ITEX

EEX

MC-EDC

10 Role & Action: Empanelment Operator&Change Requests of Additional NVMCCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity



N Y Y Y Y Y Y N

505



18 Type: A


********************************************************************

343.EMP-EAA-PEN-001


1 Gsln: 343

2 Major Group: EMP

3 Minor Group: EAA

4 Sub Category: PEN

5 Indicator Code: EMP-EAA-PEN-001

6 Indicator Name: Change Requests of Additional AMCCO Pending by Empanelment Operator


EAA_P_ITEX

EAA_P_EEX

EAA_P_MD-EDC

EAA_P_EH


Number of Applications for Change request for additional AMCCO Kept pending

9 Dimensions: ITEX

EEX

MC-EDC

EH

10 Role & Action: Empanelment Operator&Change Requests of Additional AMCCO

11 Formula: NA

506


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

344. EMP-EAA-REJ-001


1 Gsln: 344

2 Major Group: EMP

3 Minor Group: EAA

4 Sub Category: REJ

5 Indicator Code: EMP-EAA-REJ-001

6 Indicator Name: Change Requests of Additional NVMCCO Rejected by Empanelment Operator


EAA_R_EEX

EAA_R_MD-EDC

EAA_R_EH


N Y Y Y Y Y Y N

507


Number of Applications for Change request for additional NVMCCO Rejected

9 Dimensions: EEX

MC-EDC

EH

10 Role & Action: Empanelment Operator&Change Requests of Additional NVMCCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************


N Y Y Y Y Y Y N

508

345. EMP-EAA-APP-001


1 Gsln: 345

2 Major Group: EMP

3 Minor Group: EAA

4 Sub Category: APP

5 Indicator Code: EMP-EAA-APP-001

6 Indicator Name: Change Requests of Additional NVMCCO Approved by EH


EAA_A_EH


Number of Applications for Change request for additional NVMCCO Approved by EH

9 Dimensions: NA

10 Role & Action: EH&Change Requests of Additional NVMCCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


N Y Y Y Y Y Y N

509

19 Remarks: NA

********************************************************************

346.EMP-EAR-INT-001


N Y Y Y Y Y Y N


1 Gsln: 346

2 Major Group: EMP

3 Minor Group: EAR

4 Sub Category: INT

5 Indicator Code: EMP-EAR-INT-001

6 Indicator Name: Change Requests of Additional MEDCO Initiated by MEDCO


EAR_I_R


Number of applications initiated by hospital user for Change request for additional MEDCO

9 Dimensions: NA

10 Role & Action: MEDCO&Change Requests of Additional MEDCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor AdditionalMEDCO Change requests empanelment process

510


Additional MEDCO Change requests applications

18 Type: A

19 Remarks: NA

********************************************************************

347.EMP-EAR-UPD-001


N Y Y Y Y Y Y N


1 Gsln: 347

2 Major Group: EMP

3 Minor Group: EAR

4 Sub Category: UPD

5 Indicator Code: EMP-EAR-UPD-001

6 Indicator Name: Change Requests of Additional MEDCO Updated by MEDCO


EAR_U_R


Number of Applications for Change request for additional MEDCO updated by Hospital User after kept pending by EH

9 Dimensions: NA

10 Role & Action: MEDCO&Change Requests of Additional MEDCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity

511

16 Indicator use: To monitor Additional MEDCO Change requests empanelment process



18 Type: A

19 Remarks: NA

********************************************************************

348.EMP-EAR-RAP-001


1 Gsln: 348

2 Major Group: EMP

3 Minor Group: EAR

4 Sub Category: RAP

5 Indicator Code: EMP-EAR-RAP-001

6 Indicator Name: Change Requests of Additional MEDCO Recommended Approval by Empanelment Operator


EAR_RA_ITEX

EAR_RA_EEX

EAR_RA_MD-EDC


Number of Applications for Change request for additional MEDCO Recommended Approval

9 Dimensions: ITEX

EEX

MC-EDC

10 Role & Action: Empanelment Operator& Change Requests of Additional MEDCO

11 Formula: NA


512

13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

349.EMP-EAR-PEN-001


1 Gsln: 349

2 Major Group: EMP

3 Minor Group: EAR

4 Sub Category: PEN

5 Indicator Code: EMP-EAR-PEN-001

6 Indicator Name: Change Requests of Additional MEDCO Pending by Empanelment Operator

7 Indicator EAR_P_ITEX Acronym: EAR_P_EEX

EAR_P_MD-EDC

EAR_P_EH


N Y Y Y Y Y Y N

513


Number of Applications for Change request for additional MEDCO Kept pending

9 Dimensions: ITEX

EEX

MC-EDC

EH

10 Role & Action: Empanelment Operator&Change Requests of Additional MEDCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

350.EMP-EAR-REJ-001


N Y Y Y Y Y Y N


1 Gsln: 350

2 Major Group: EMP

514

3 Minor Group: EAR

4 Sub Category: REJ

5 Indicator Code: EMP-EAR-REJ-001

6 Indicator Name: Change Requests of Additional MEDCO Rejected by Empanelment Operator


EAR_R_EEX

EAR_R_MD-EDC

EAR_R_EH


Number of Applications for Change request for additional MEDCO Rejected

9 Dimensions: EEX

MC-EDC

EH

10 Role & Action: Empanelment Operator& Change Requests of Additional MEDCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


N Y Y Y Y Y Y N

515


********************************************************************

351.EMP-EAR-APP-001


N Y Y Y Y Y Y N


1 Gsln: 351

2 Major Group: EMP

3 Minor Group: EAR

4 Sub Category: APP

5 Indicator Code: EMP-EAR-APP-001

6 Indicator Name: Change Requests of Additional MEDCO Approved by Empanelment Operator


EAR_A


Number of Applications for Change request for additional MEDCO Approved by EH

9 Dimensions: EH

10 Role & Action: EH&Change Requests of Additional MEDCO

11 Formula: NA


13 Frequency of

Monitoring:



Activity


516



18 Type: A

19 Remarks: NA

********************************************************************

352.EMP-EBA-INT-001


N Y Y Y Y Y Y N


1 Gsln: 352

2 Major Group: EMP

3 Minor Group: EBA

4 Sub Category: INT

5 Indicator Code: EMP-EBA-INT-001

6 Indicator Name: Change of Bank Account Number Initiated by MEDCO


EBA_I_R


Number of applications initiated by hospital user for Change of Bank Account Number

9 Dimensions: NA

10 Role & Action: MEDCOChange of Bank Account Number

11 Formula: NA


13 Frequency of

Monitoring:



Activity

517

16 Indicator use: To monitor Change of Bank Account Number requests empanelment process


Bank Account change requests Applications

18 Type: A

19 Remarks: NA

********************************************************************

353.EMP-EBA-UPD-001


N Y Y Y Y Y Y N


1 Gsln: 353

2 Major Group: EMP

3 Minor Group: EBA

4 Sub Category: UPD

5 Indicator Code: EMP-EBA-UPD-001

6 Indicator Name: Change of Bank Account Number Updated by MEDCO


EBA_U_R


Number of Applications for Change of Bank Account Number updated by Hospital User after kept pending by EH

9 Dimensions: NA

10 Role & Action: MEDCO&Change of Bank Account Number

11 Formula: NA


13 Frequency of

Monitoring:

518



Activity




18 Type: A

19 Remarks: NA

********************************************************************

354.EMP-EBA-RAP-001


1 Gsln: 354

2 Major Group: EMP

3 Minor Group: EBA

4 Sub Category: RAP

5 Indicator Code: EMP-EBA-RAP-001

6 Indicator Name: Change of Bank Account Number Recommended Approval by Empanelment Operator


EBA_RA_EEX

EBA_RA_DFO


Number of Applications for Change of Bank Account Number Recommended Approval

9 Dimensions: EEX

DFO

10 Role & Action: Empanelment Operator&Change of Bank Account Number

11 Formula: NA

519


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

355.EMP-EBA-REJ-001


1 Gsln: 355

2 Major Group: EMP

3 Minor Group: EBA

4 Sub Category: REJ

5 Indicator Code: EMP-EBA-REJ-001

6 Indicator Name: Change of Bank Account Number Rejected by Empanelment Operator


EBA_R_EEX

EBA_R_DFO

EBA_R_CH


N Y Y Y Y Y Y N

520


Number of Applications for Change of Bank Account Number Rejected

9 Dimensions: EEX

DFO

CH


11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

356.EMP-EBA-PEN-001


N Y Y Y Y Y Y N


1 Gsln: 356

2 Major Group: EMP

3 Minor Group: EBA

4 Sub Category: PEN

521

5 Indicator Code: EMP-EBA-PEN-001

6 Indicator Name: Change of Bank Account Number Pending by Empanelment Operator


EBA_P_EEX

EBA_P_DFO

EBA_P_CH


Number of Applications for Change request for additional MEDCO Kept pending

9 Dimensions: EEX

DFO

CH


11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************


N Y Y Y Y Y Y N

522

357.EMP-EBA-APP-001


1 Gsln: 357

2 Major Group: EMP

3 Minor Group: EBA

4 Sub Category: APP

5 Indicator Code: EMP-EBA-APP-001

6 Indicator Name: Change of Bank Account Number Approved by CH


EBA_A_CH


Number of Applications for Change of Bank Account Number Approved

9 Dimensions: NA

10 Role & Action: CH(EO-ASII)&Change of Bank Account Number

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


N Y Y Y Y Y Y N

523

19 Remarks: NA

********************************************************************

358.EMP-EXD-INT-001


N Y Y Y Y Y Y N


1 Gsln: 358

2 Major Group: EMP

3 Minor Group: EXD

4 Sub Category: INT

5 Indicator Code: EMP-EXD-INT-001

6 Indicator Name: Expertise Details Initiated by MEDCO


EXD_I_R


Number of applications initiated by hospital user for Expertise Details Request

9 Dimensions: NA

10 Role & Action: MEDCO&Expertise Details Request

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor Expertise Details requests empanelment process

524


Expertise Details applications

18 Type: A

19 Remarks: NA

********************************************************************

359.EMP-EXD-UPD-001


N Y Y Y Y Y Y N


1 Gsln: 359

2 Major Group: EMP

3 Minor Group: EXD

4 Sub Category: UPD

5 Indicator Code: EMP-EXD-UPD-001

6 Indicator Name: Expertise Details Updated by MEDCO


EXD_U_R


Number of Applications for Expertise Details Request updated by Hospital User after kept pending by EH

9 Dimensions: NA

10 Role & Action: MEDCO&Expertise Details Request

11 Formula: NA


13 Frequency of

Monitoring:



Activity

525




18 Type: A

19 Remarks: NA

********************************************************************

360.EMP-EXD-RAP-001


1 Gsln: 360

2 Major Group: EMP

3 Minor Group: EXD

4 Sub Category: RAP

5 Indicator Code: EMP-EXD-RAP-001

6 Indicator Name: Expertise Details Recommended Approval by Empanelment Operator


EXD_RA_EEX

EXD_RA_EPD

EXD_RA_MD-EDC


Number of Applications for Expertise Details Request Recommended Approval

9 Dimensions: EEX

EPD

MC-EDC

10 Role & Action: Empanelment Operator&Expertise Details Request

11 Formula: NA


526

13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************

361.EMP-EXD-REJ-001


N Y Y Y Y Y Y N


1 Gsln: 361

2 Major Group: EMP

3 Minor Group: EXD

4 Sub Category: REJ

5 Indicator Code: EMP-EXD-REJ-001

6 Indicator Name: Expertise Details Rejected Empanelment Operator

7 Indicator EXD_R_EEX Acronym: EXD_R_EPD

EXD_R_MD-EDC

EXD_R_EH


Number of Applications for Expertise Details Request Rejected

527

9 Dimensions: EEX;EPD;MC-EDC;EH

10 Role & Action: Empanelment Operator &Expertise Details Request

11 Formula: NA


13 Frequency of

Monitoring:



Output




18 Type: A


********************************************************************

362. EMP-EXD-PEN-001


1 Gsln: 362

2 Major Group: EMP

3 Minor Group: EXD

4 Sub Category: PEN

5 Indicator Code: EMP-EXD-PEN-001

6 Indicator Name: Expertise Details Pending Empanelment Operator


N Y Y Y Y Y Y N

528


EXD_P_EEX

EXD_P_EPD

EXD_P_MD-EDC

EXD_P_EH


Number of Applications for Expertise Details Request kept Pending

9 Dimensions: EEX

EPD

MC-EDC

EH

10 Role & Action: Empanelment Operator& Expertise Details Request

11 Formula: NA


13 Frequency of

Monitoring:



Activity




18 Type: A


********************************************************************


N Y Y Y Y Y Y N

529

363. EMP-EXD-APP-001


1 Gsln: 363

2 Major Group: EMP

3 Minor Group: EXD

4 Sub Category: APP

5 Indicator Code: EMP-EXD-APP-001

6 Indicator Name: Expertise Details Approved EH


EXD_A_EH


Number of Applications for Expertise Details Request Approved by EH

9 Dimensions: NA

10 Role & Action: EH &Expertise Details Request

11 Formula: NA


13 Frequency of

Monitoring:



Output




18 Type: A

19 Remarks: NA


N Y Y Y Y Y Y N

530

*****************************************************************

364. OPR-FOL-SUB-001


1 Gsln: 364

2 Major Group: OPR

3 Minor Group: FOL

4 Sub Category: SUB

5 Indicator Code: OPR-FOL-SUB-001

6 Indicator Name: Therapies Follow-up cases submitted by MEDCO


FOL_S_R


The number of therapies follow-up cases submitted by MEDCO

9 Dimensions: NA


Follow-up cases

11 Formula: NA


13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor performance of MEDCO in disposal of follow-up cases


Y Y Y Y Y Y Y N

531


Follow-up cases

18 Type: A

19 Remarks: NA

*****************************************************************

365. OPR-FOL-UPD-001


1 Gsln: 365

2 Major Group: OPR

3 Minor Group: FOL

4 Sub Category: UPD

5 Indicator Code: OPR-FOL-UPD-001

6 Indicator Name: Therapies Follow-up cases updated by MEDCO


FOL_U_R


The number of therapies follow-up cases updated by MEDCO

9 Dimensions: NA


Follow-up cases

11 Formula: NA


13 Frequency of

Monitoring:



Y Y Y Y Y Y Y N

532


Output

16 Indicator use: To monitor performance of MEDCO in disposal of follow-up cases


Follow-up cases

18 Type: A

19 Remarks: NA

*****************************************************************

366. OPR-FOL-FWD-001


1 Gsln: 366

2 Major Group: OPR

3 Minor Group: FOL

4 Sub Category: FWD

5 Indicator Code: OPR-FOL-FWD-001

6 Indicator Name: Therapies Follow-up cases forwarded by CEX


FOL_U_R


The number of therapies follow-up cases forwarded by CEX

9 Dimensions: NA

10 Role & Action: CEX &

Follow-up cases

11 Formula: NA


533

13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor performance of CEX in disposal of follow-up cases


Follow-up cases

18 Type: A

19 Remarks: NA

*****************************************************************

367. OPR-FOL-RAP-001


1 Gsln: 367

2 Major Group: OPR

3 Minor Group: FOL

4 Sub Category: RAP

5 Indicator Code: OPR-FOL-RAP-001

6 Indicator Name: Therapies Follow-up cases Recommended Approval


FOL_RA_CTD


The number of therapies follow-up cases Recommended Approval by CTD

9 Dimensions: NA


Y Y Y Y Y Y Y N

534

10 Role & Action: CTD&

Follow-up cases

11 Formula: NA


13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor performance of CTD in disposal of follow-up cases


Follow-up cases

18 Type: A

19 Remarks: NA

*****************************************************************

368. OPR-FOL-RRJ-001


1 Gsln: 368

2 Major Group: OPR

3 Minor Group: FOL

4 Sub Category: RRJ

5 Indicator Code: OPR-FOL-RRJ-001

6 Indicator Name: Therapies Follow-up cases Recommended Rejection


FOL_RR_CTD


Y Y Y Y Y Y Y N

535


The number of therapies follow-up cases Recommended Rejection by CTD

9 Dimensions: NA

10 Role & Action: CTD&

Follow-up cases

11 Formula: NA


13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor performance of CTD in disposal of follow-up cases


Follow-up cases

18 Type: A

19 Remarks: NA

*****************************************************************

369. OPR-FOL-PEN-001


1 Gsln: 369

2 Major Group: OPR

3 Minor Group: FOL

4 Sub Category: PEN

5 Indicator Code: OPR-FOL-PEN-001


Y Y Y Y Y Y Y N

536

6 Indicator Name: Therapies Follow-up cases kept pending


FOL_P_CTD

FOL_P_CAO


The number of therapies follow-up cases kept pending by claims operator

9 Dimensions: CTD

CAO

10 Role & Action: Claim operator&

Follow-up cases

11 Formula: NA


13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor performance of Claim operator in disposal of follow-up cases


Follow-up cases

18 Type: A


*****************************************************************


Y Y Y Y Y Y Y N

537

370. OPR-FOL-APP-001


1 Gsln: 370

2 Major Group: OPR

3 Minor Group: FOL

4 Sub Category: APP

5 Indicator Code: OPR-FOL-APP-001

6 Indicator Name: Therapies Follow-up cases approved


FOL_A_CTD

FOL_A_CAO

FOL_A_AC


The number of therapies follow-up cases approved by claims operator

9 Dimensions: CTD

CAO

AC


Follow-up cases

11 Formula: NA


13 Frequency of

Monitoring:



Output


Y Y Y Y Y Y Y N

538



Follow-up cases

18 Type: A


*****************************************************************

371. OPR-FOL-REJ-001


1 Gsln: 371

2 Major Group: OPR

3 Minor Group: FOL

4 Sub Category: REJ

5 Indicator Code: OPR-FOL-REJ-001

6 Indicator Name: Therapies Follow-up cases rejected


FOL_R_CTD

FOL_R_CAO


The number of therapies follow-up cases rejected by claims operator

9 Dimensions: CTD

CAO


Follow-up cases

11 Formula: NA


539

13 Frequency of

Monitoring:



Output



Follow-up cases

18 Type: A


*****************************************************************

372. OPR-FCH-SUB-001


1 Gsln: 372

2 Major Group: OPR

3 Minor Group: FCH

4 Sub Category: SUB

5 Indicator Code: OPR-FCH-SUB-001

6 Indicator Name: Cochlear Therapies Follow-up cases submitted by MEDCO


FCH_S_R


The number of Cochlear therapies follow-up cases submitted by MEDCO

9 Dimensions: NA


Y Y Y Y Y Y Y N

540


Cochlear Follow-up cases

11 Formula: NA


13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor performance of MEDCO in disposal of Cochlear follow-up cases


Cochlear follow-up cases

18 Type: A

19 Remarks: NA

*****************************************************************

373. OPR-FCH-UPD-001


1 Gsln: 373

2 Major Group: OPR

3 Minor Group: FCH

4 Sub Category: UPD

5 Indicator Code: OPR-FCH-UPD-001

6 Indicator Name: Cochlear Therapies Follow-up cases updated by MEDCO


FCH_U_R


N Y Y Y Y Y Y N

541


The number of Cochlear therapies follow-up cases updated by MEDCO

9 Dimensions: NA



11 Formula: NA


13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor performance of MEDCO in disposal of Cochlear follow-up cases



18 Type: A

19 Remarks: NA

*****************************************************************

374. OPR-FCH-FWD-001


1 Gsln: 374

2 Major Group: OPR

3 Minor Group: FCH

4 Sub Category: FWD

5 Indicator Code: OPR-FCH-FWD-001


N Y Y Y Y Y Y N

542

6 Indicator Name: Cochlear Therapies Follow-up cases forwarded by CEX


FCH_F_CEX


The number of Cochlear therapies follow-up cases forwarded by CEX

9 Dimensions: NA

10 Role & Action: CEX&


11 Formula: NA


13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor performance of CEX in disposal of Cochlear follow-up cases



18 Type: A

19 Remarks: NA

*****************************************************************

375. OPR-FCH-RAP-001


1 Gsln: 375

2 Major Group: OPR


N Y Y Y Y Y Y N

543

3 Minor Group: FCH

4 Sub Category: RAP

5 Indicator Code: OPR-FCH-RAP-001

6 Indicator Name: Cochlear Therapies Follow-up cases Recommended Approval


FCH_RA_MC-CC

FCH_RA_C-CC


The number of Cochlear therapies follow-up cases Recommended Approval by cochlear committee

9 Dimensions: MC-CC

C-CC

10 Role & Action: Cochlear Committee &


11 Formula: NA


13 Frequency of

Monitoring:



Output

16 Indicator use: To monitor performance of Cochlear Committee in disposal of Cochlear follow-up cases



18 Type: A


N Y Y Y Y Y Y N

544


*****************************************************************

376. OPR-FCH-RRJ-001


1 Gsln: 376

2 Major Group: OPR

3 Minor Group: FCH

4 Sub Category: RRJ

5 Indicator Code: OPR-FCH-RRJ-001

6 Indicator Name: Cochlear Therapies Follow-up cases Recommended Rejection


FCH_RR_MC-CC

FCH_RR_C-CC


The number of Cochlear therapies follow-up cases Recommended Rejection by cochlear committee

9 Dimensions: MC-CC

C-CC



11 Formula: NA


13 Frequency of

Monitoring:



N Y Y Y Y Y Y N

545


Output




18 Type: A


*****************************************************************

377. OPR-FCH-PEN-001


1 Gsln: 377

2 Major Group: OPR

3 Minor Group: FCH

4 Sub Category: PEN

5 Indicator Code: OPR-FCH-PEN-001

6 Indicator Name: Cochlear Therapies Follow-up cases kept pending


FCH_P_MC-CC

FCH_P_C-CC


The number of Cochlear therapies follow-up cases kept pending by cochlear committee

9 Dimensions: MC-CC

C-CC



11 Formula: NA

546


13 Frequency of

Monitoring:



Output




18 Type: A


*****************************************************************

378. OPR-FCH-APP-001


1 Gsln: 378

2 Major Group: OPR

3 Minor Group: FCH

4 Sub Category: APP

5 Indicator Code: OPR-FCH-APP-001

6 Indicator Name: Cochlear Therapies Follow-up cases approved


FCH_A_CAO

FCH_A_AC


The number of Cochlear therapies follow-up cases approved by claims operator


N Y Y Y Y Y Y N

547

9 Dimensions: CAO

AC



11 Formula: NA


13 Frequency of

Monitoring:



Output




18 Type: A


*****************************************************************

379. FOP-NAM-ATN-001


1 Gsln: 379

2 Major Group: FOP

3 Minor Group: NAM

4 Sub Category: ATN


N Y Y Y Y Y Y N

548

5 Indicator Code: FOP-NAM-ATN-001

6 Indicator Name: Attendance of NAM


ATN_N


Actual number and percentage of NAM attendance

9 Dimensions: Shift I

Shift II

Shift III


Attendance

11 Formula: Attendance of NAM/(Total number of NAMS who are to attend in the particular shift)*100


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor the attendance of NAM


Attendance

18 Type: A;P

19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by NAM. Using target and the count of cases we can calculate the percentage of achievement.

*****************************************************************


Y N N N N N N N

549

380. FOP-NAM-PCL-001


1 Gsln: 380

2 Major Group: FOP

3 Minor Group: NAM

4 Sub Category: PCL

5 Indicator Code: FOP-NAM-PCL-001

6 Indicator Name: Regular preauth cases cleared by NAM


PAU_F_N


Number of preauths forwarded by NAM

9 Dimensions: NA


Preauth cases

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor the performance of NAM and utility of scheme


Preauth cases


Y Y Y Y Y Y Y N

550

18 Type: A

19 Remarks: Same as in operations indicator

This set of indicators are used to calcuate the percentage of target that has been achieved by NAM. Using target and the count of cases we can calculate the percentage of achievement.

*****************************************************************

381. FOP-NAM-REG-001


1 Gsln: 381

2 Major Group: FOP

3 Minor Group: NAM

4 Sub Category: REG

5 Indicator Code: FOP-NAM-REG-001

6 Indicator Name: Patient registrations done by NAM


REG_N


Number of patient registrations performed by NAM in a day in NWH

9 Dimensions: NA


Registration of patients

11 Formula: NA


13 Frequency of

Monitoring:



Y Y Y Y Y Y Y N

551


Activity

16 Indicator use: To monitor the performance of NAM


Registrations

18 Type: A


*****************************************************************

382. FOP-NAM-CON-001


1 Gsln: 382

2 Major Group: FOP

3 Minor Group: NAM

4 Sub Category: CON

5 Indicator Code: FOP-NAM-CON-001

6 Indicator Name: OP/IP Conversions done by NAM


CON_N


Number of OP/IP Conversions performed by NAM

9 Dimensions: NA


OP to IP conversion of patients

11 Formula: NA

552


13 Frequency of

Monitoring:



Activity



Op/Ip conversion

18 Type: A


*****************************************************************

383. FOP-NAM-FOL-001


1 Gsln: 383

2 Major Group: FOP

3 Minor Group: NAM

4 Sub Category: FOL

5 Indicator Code: FOP-NAM-FOL-001

6 Indicator Name: Follow-up cases cleared by NAM


FOL_F_N


Y Y Y Y Y Y Y N

553


Number of follow-up preauths forwarded by NAM

9 Dimensions: NA


Follow-up cases

11 Formula: NA


13 Frequency of

Monitoring:



Activity



Follow-up cases

18 Type: A


*****************************************************************

384. FOP-NAM-REF-001


1 Gsln: 384

2 Major Group: FOP

3 Minor Group: NAM


Y Y Y Y Y Y Y N

554

4 Sub Category: REF

5 Indicator Code: FOP-NAM-REF-001

6 Indicator Name: 133 reserved procedure Cases referred by NAM


REF_N


Number of 133 reserved procedure Cases referred to Government NWH from private NWH by NAM

9 Dimensions: NA

10 Role & Action: NAM&Referral of 133 procedure cases

11 Formula: NA


13 Frequency of

Monitoring:



Activity



133 Procedures

18 Type: A


*****************************************************************


Y Y Y Y Y Y Y N

555

385. FOP-NAM-BUP-001


1 Gsln: 385

2 Major Group: FOP

3 Minor Group: NAM

4 Sub Category: BUP

5 Indicator Code: FOP-NAM-BUP-001

6 Indicator Name: On bed updation by NAM


BUP_N


Number of on bed updation done by NAM in a day


Shift III

10 Role & Action: NAM&On bed updation

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor the performance of NAM in on-bed updation of patient status as per target - SHIFT I 25% and SHIFT III 75%


Onbed updation


Y N N N N N N N

556

18 Type: A

19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by PAM. Using target and the count of cases we can calculate the percentage of achievement.

*****************************************************************

386. FOP-PAM-ATN-001


1 Gsln: 386

2 Major Group: FOP

3 Minor Group: PAM

4 Sub Category: ATN

5 Indicator Code: FOP-PAM-ATN-001

6 Indicator Name: Attendance of PAM


ATN_PAM


Actual number and percentage of PAM attendance


Shift II

Shift III

10 Role & Action: PAM&Attendance

11 Formula: (Attendance of PAM/Total number of PAMS who are to attend in the particular shift)*100


13 Frequency of

Monitoring:


Y N N N N N N N

557



Activity

16 Indicator use: To monitor the attendance of PAM


Attendance

18 Type: A;P


*****************************************************************

387. FOP-PAM-REG-001


1 Gsln: 387

2 Major Group: FOP

3 Minor Group: PAM

4 Sub Category: REG

5 Indicator Code: FOP-PAM-REG-001

6 Indicator Name: Patient registrations done by PAM


REG_PAM


Number of patient registrations performed by PAM in a day

9 Dimensions: PHC

Health camps

10 Role & Action: PAM&Registration of patients

558

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor the performance of PAM in Registration of patients as per target - @ 30 PATIENT REGESTRATIONS per PHC in a day


Registrations

18 Type: A


*****************************************************************

388. FOP-PAM-REF-001


1 Gsln: 388

2 Major Group: FOP

3 Minor Group: PAM

4 Sub Category: REF

5 Indicator Code: FOP-PAM-REF-001

6 Indicator Name: Referral Capture count by PAM


Y N N N N N N N

559


REF_PAM


Number of Patients referred to NWH by PAM in a day

9 Dimensions: PHC

Health camps

10 Role & Action: PAM&

Referral of patients

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor the performance of PAM in Referral of patients as per target -@ 2 REFERRAL CAPTURE Per PHC in a day


Referrals

18 Type: A


*****************************************************************


Y N N N N N N N

560

389. FOP-PAM-CON-001


1 Gsln: 389

2 Major Group: FOP

3 Minor Group: PAM

4 Sub Category: CON

5 Indicator Code: FOP-PAM-CON-001

6 Indicator Name: Referral Conversion Count by PAM


CON_PAM


Number of Patients converted to Dr.NTR Vaidya Seva cases from cases referred by PAM in a day

9 Dimensions: PHC

Health camps

10 Role & Action: PAM&

Conversion of patients

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor the performance of PAM as per target -@ REFERRAL CONVERSION 1 PER WEEK Per PHC by PAM


N Y N N N N N N

561


Op/Ip conversion

18 Type: A


*****************************************************************

390. FOP-PAM-FVS-001


1 Gsln: 390

2 Major Group: FOP

3 Minor Group: PAM

4 Sub Category: FVS

5 Indicator Code: FOP-PAM-FVS-001

6 Indicator Name: Dr.NTR Vaidya Seva discharged patients visited by PAM


FVS_PAM


Number of Dr.NTR Vaidya Seva discharged patients visited by PAM in a day

9 Dimensions: NA

10 Role & Action: PAM&Field visits

11 Formula: NA


13 Frequency of

Monitoring:


Y N N N N N N N

562



Activity

16 Indicator use: To monitor the performance of PAM in field visits as per target @ 5 PER DAY


Field visits

18 Type: A


*****************************************************************

391. FOP-PAM-FOL-001


1 Gsln: 392

2 Major Group: FOP

3 Minor Group: PAM

4 Sub Category: FOL

5 Indicator Code: FOP-PAM-FOL-001

6 Indicator Name: Dr.NTR Vaidya Seva patients mobilised for follow-up treatment by PAM


FOL_PAM


Number of Dr.NTR Vaidya Seva patients mobilised for follow-up treatment by PAM in a day

9 Dimensions: NA

563

10 Role & Action: PAM &Follow-up mobilisation

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor the performance of PAM in follow-up mobilisation as per target –FOLLOW-UP CASES TARGET ACTUALS SET BY FIELD OPERATIONS DEPT in a day


Follow-up mobilisation

18 Type: A


*****************************************************************

392. FOP-PAM-IEC-001


1 Gsln: 393

2 Major Group: FOP

3 Minor Group: PAM

4 Sub Category: IEC

5 Indicator Code: FOP-PAM-IEC-001

6 Indicator Name: IEC Conducted by PAM


Y N N N N N N N

564


IEC_PAM


Number of IEC activities done for a Health Camp in a day by PAM

9 Dimensions: NA

10 Role & Action: PAM & IEC activities

11 Formula: NA


13 Frequency of

Monitoring:



Activity

16 Indicator use: To monitor the performance of PAM in fin IEC activities as per target -5 PER FOR HC


IEC activities

18 Type: A


*****************************************************************


Y N N N N N N N

565

16. APPENDIX

Forecast Notes:

Forecasting

Scenario:

In Dr.NTR Vaidya Seva Project, the implementation took place in a scale up manner. So in previous years, the project might not have the whole set of procedures. We term these different states of the project as 1. Fully loaded state of the project 2.Partially loaded state of the project. We want to forecast the amount that would incur for a specified period of time but since the past data we have is from a different state of business compared to the present state, the amount we get from forecasting wouldn't be appropriate. For this purpose, we use a method for calculating the amount that would have incurred to our business if our past status would be fully loaded state rather than a partially loaded state.

Data Preparation:

Weights are calculated from the fully loaded state on either 1st Jan/ 1st July of the current year.

Next, we want to find out the cost that would have incurred to us at a particular point of time if we were in a fully loaded state. For this purpose, under various assumptions we use the following methodology.

1. Weights calculated on 1st Jan/ 1st July of the current year (using cumulative data) are taken as the reference weights.

2. Next, to find the cost that would have been incurred at a past date when the scheme was not fully loaded, we calculate the sum of the reference weights for the available procedures at that particular point of time in the past. This would give us the percentage of contribution of the procedures available as on the past date.

3. So if x is the amount consumed for the set of procedures on the past date and p% is the contribution of those therapies as per todays weights then the total expenditure had the scheme been fully loaded as on the past date would have been x/p.

4. This scaled up amount would be considered as the amount that would have been

incurred by the scheme at the past time period, had it been fully loaded.

This is referred to as "Relative claim Paid for the month for RAS"

566

5. To calculate the amount of money that would be incurred by the scheme for a specific set of procedures, ex: a basket of 268 procedures, first calculate the weight of the 268 basket say q% The amount incurred on this basket had it existed in the past would have been (x/p)q . This is termed as "Relative Total Claim".

Depending on the requirements we either use "Relative claim paid for the month for RAS" or "Relative Total Claim" as the input dataset for final forecasting.

Note: Other approaches for making more reliable and accurate forecasts are being planned and would be tried while performing forecasting.

Weights used in our present system (Weights and Bare Weights):

Number 1 Formula Name

Bare weight of Therapy, as on a given date

Term Acronym

BW

Formula Description

A set of weights are calculated depending on the number of times a therapy has been performed during successive periods. These are termed as bare weights.

Formula ATPCC/ sum of ATPCCs for all the therapies available in all Categories (Note: ATPCC = Average Therapies Performed Per Covered Card Year)

Data Required

Average Therapies Performed Per Covered Card Year for every procedure available in the procedure basket during a specific period. Usually they are calculated cumulatively using the data from the inception of the scheme.

Data Source

RAS

Use Bare weights can be used for comparing various therapies or categories of therapies depending on the demand for them in the market and could also be used for creating other complex indicators. They could help in looking at a glance which therapies are in high demand and therapies which aren't being utilized at all if any etc and could be useful while re-designing the procedures basket.

Remarks Bare Weight of any set of procedures will always be less than 1 and the weight of all the procedures will always be equal to 1. They are

calculated on 1st Jan/ 1st July.

567

Number 2 Formula Name

Weight of Therapy as on a given date

Term Acronym

Wt

Formula Description

A set of weights are calculated depending on the amount that a particular therapy has bagged during a specific period. These are termed as weights.

Formula CLR of the Therapy / sum of CLRs for all the Therapies available

Data Required

Claim Rate of every therapy available in the procedure basket during a specific period. Usually they are calculated cumulatively using the data from the inception of the scheme.

Data Source

RAS

Use Weights can be used for comparing various therapies or categories depending upon the cost incurred for them during a specified period.

Remarks Weight of any set of procedures will always be less than 1 and the weight of all the procedures will always be equal to 1.

Dimensions of interest which were used for an indicator wherever applicable

Category Dimensions available in this category

Time

Financial Year (Ex: 1st April Year 1998 – 31st March Year 1999),

Calendar Year (Ex: 1st Jan 2001 – 31st Dec 2001),

Cumulative Year, Policy Period, Month, Quarter, Day, Hour

Scheme RAS, AS-1, AS-2, CMCO, Journalist

Geography PD, HD, Phase

Provider NWH, Provider Type (Government and Private)

Socio Economic Dimensions

Age, Community, Sex

Role

Preauth - MEDCO, NAM, PEX, PPD, PTD, PAO

Claims - MEDCO, CEX, CPD, CTD, CH, A/C, CAO

Empanelment - EEX, EPO, EPD, EAO, EH, MC-EDC, ITEX, DFO, CH

Preauth Cochlear Cases -MEDCO, NAM, PEX-C, MC- CC, C-CC, PAO

568

Levels of analyses which are of interest:

Our system could be affected by any of these parameters, so all of these levels of

analysis are of interest to the company.

For example, if the cards covered remain the same and population density per card

increases then the utility rates will go up.

The above mentioned example is just to make one visualize the various factors that

impact our company and are of interest for us to monitor.