Purpose and Availability
High-Cost claimant reports are specific to a Group Policy (e.g. one sponsor and one plan year) but incorporate information about all Plans the group offers. The purpose of the High Cost Claimant Report is to help the TPA file spec stoploss claims. Since the report has overall information about how the plan is performing, it is valuable to employers and brokers too.
You can view the HCC Report at https://portal.yuzu.health/group/${id}/reports. See the general Reports documentation for instructions on how to navigate to Generate and Download reports: https://yuzu.health/docs/guides/reports.
Filters and Filtering
The high-cost claimant report can be configured based on the following filters:
Start Date and End Date
This controls the range of paid dates that are considered in the report.
These default to the first date and last date of the Group Policy (plan year), but can be set to any date.
Threshold
This controls the limit for which members show up on the report. Only members who have had over the threshold amount of claims paid during the specified date range are included.
This defaults to half of the specific attachment point for the group unless the group does not have spec coverage where the report defaults to a $20k threshold.
Note: you can put the threshold as $0 if you would like to see all plan spending broken down by member for the specified date range.
Filter Type
The report can separately be filtered by either Paid Date or Service Date.
Paid Date: The report will indicate all claims paid between the Start and End date specified.
Service Date: The report will indicate all claims paid up through the current time that were incurred between the Start and End date specified.