Medical Claims Report

Description and Important Notes

The medical claims report is where you can find the most detailed reporting on a group’s medical claims. The report is found on the “Reports” tab of the portal and is designed to include more information than the summary view shown on the “Claims” tab.

A few important notes:

The medical claims report only shows adjudicated claims. Pending claims can be viewed on the “Claims” tab.
The report is a snapshot in time. In order to get up-to-date information, regenerate the claims report on a regular basis.
The report will be generated as a .csv file and will include a raw data view of all adjudicated claims.
This report contains Personal Health Information, it may be anonymized or redacted based on your access.

If you are unable to download the report, try normal troubleshooting steps. If you’re still unable to access, email partners@yuzu.health.

Interpretation Guide

1. Each row is one service, not one claim. A single claim often includes several services, and each one gets its own row. Rows that share a claimNumber belong to the same claim; claimLineNumber tells them apart. If you want the total for a claim, add up its rows. Summing a column without accounting for this can double count patient responsibility that appears once but relates to one visit.

2. Start with the claim status. claimStatus tells you whether the claim was approved or denied. For denied claims, look at remarkCodes and remarkCodeDescriptions, which explain the reason in plain language.

3. Know who the row is about. The patient is the person who received care; the employee is the subscriber (i.e., the person who holds the coverage). When an employee's spouse or child receives care, the patient fields and employee fields will differ. patientRelationship shows how they're connected.

4. Follow the money. The dollar columns tell one story: billedAmount is what the provider charged. discountAmount is the network discount taken off that charge, and allowedAmount is what remains, the price the plan recognizes. The allowed amount is then split between the plan (planPaidAmount) and the patient. The patient's share is broken into deductibleAmount, copayAmount, and coinsuranceAmount, and patientPaidAmount is what the patient paid out of pocket. ineligibleAmount is any portion the plan doesn't cover at all.

5. Check whether payment has gone out. paidDate works three ways: a date means the payment was issued, PENDING means the plan owes a payment that hasn't gone out yet, and blank means no plan payment applies (common when the full amount went to the patient's deductible). checkNumber lists the checks tied to the payment.

6. Use the code descriptions, not the codes. cpt1 identifies the service performed and icd10_1 identifies the diagnosis, but you rarely need to decipher them: the columns next to each code carry a written description. Modifier columns add detail about how a service was performed and are often blank.

7. Mind the dates. dateOfServiceFromDate and dateOfServiceToDate are when care happened. receivedDate, processedDate, and paidDate track the claim's path afterward. A claim from March may not be paid until May, so recent months in the report are usually incomplete.

8. Note the network status. networkStatus shows INN (in network) or OON (out of network). Out-of-network services typically cost the patient more. This field is sometimes blank when network pricing didn't apply.

9. Open the claim for full detail. Every row includes a linkToClaim that takes you to the claim in the portal, where you can see documents, history, and payment detail beyond what fits in the report.

For column-by-column definitions, see the data dictionary.

Data Definitions

This section explains each field, its format, any applicable calculations, and a basic definition.

Member and Employee Information

Column	Format	Calculation (if applicable)	What it means
memberId	String	Member number base + person code of the patient's coverage	Unique identifier for the patient (the person who received care).
employeeId	String	Member number base + person code of the subscriber's coverage	Identifier for the employee (subscriber) whose plan covers the patient.
employeeLastName	String	—	Employee's last name.
employeeFirstName	String	—	Employee's first name.
employeeLocation	String (optional)	—	Employee's assigned location, if applicable.
groupName	String	—	Name of the sponsoring employer group.
groupNumber	String	—	Group policy number for the employee's plan.

Patient Information

Column	Format	Calculation (if applicable)	What it means
patientDob	MM/DD/YYYY	—	Patient's date of birth.
patientFirstName	String	—	Patient's first name.
patientLastName	String	—	Patient's last name.
patientRelationship	Enum (Relationship)	Based on the patient's coverage type	Patient's relationship to the employee (e.g., Self, Spouse, Child).

Claim Details

Column	Format	Calculation (if applicable)	What it means
claimNumber	String	—	The claim's unique reference number.
claimLineNumber	String	—	The service line number within the claim. A single claim can include multiple lines, one per service.
claimStatus	Enum (claim status)	—	Where the claim stands in processing (e.g., Approved, Denied).
claimType	Enum (Professional / Institutional)	—	Whether the claim is Professional (doctor/office services) or Institutional (facility services, such as a hospital).
billType	String (nullable)	Facility type code + claim frequency code (frequency defaults to 1 if not provided)	Facility bill type (institutional claims only).
receivedDate	MM/DD/YYYY (optional)	—	Date the claim was first received.
processedDate	MM/DD/YYYY (optional)	—	Date the claim finished processing.
dateOfServiceFromDate	MM/DD/YYYY	—	First date the service was provided.
dateOfServiceToDate	MM/DD/YYYY	—	Last date the service was provided.
isCashPay	Boolean (optional)	True when the claim is associated with a cash card payment	Whether the claim was a cash-pay claim.
linkToClaim	URL	—	Direct link to view the claim in the Yuzu app.

Payment Information

Column	Format	Calculation (if applicable)	What it means
paidDate	MM/DD/YYYY, "PENDING", or blank	The claim's paid date; if unavailable, the most recent payment ledger date. Shows PENDING when the plan owes a payment that hasn't been issued yet	Date the claim was paid, or PENDING if payment is owed but not yet issued.
checkNumber	String (pipe-delimited)	All check numbers linked to the claim's payments, joined by "\|"	Check number(s) associated with the claim payment.

Dollar Amounts

All amounts below apply to the individual service line.

Column	Format	Calculation (if applicable)	What it means
billedAmount	Dollars	—	The amount the provider charged for the service.
allowedAmount	Dollars	—	The maximum amount the plan allows for the service, after network discounts.
discountAmount	Dollars	—	The discount applied to the provider's charge.
ineligibleAmount	Dollars	—	The portion not covered by the plan.
deductibleAmount	Dollars	—	The portion applied to the patient's deductible.
copayAmount	Dollars	—	The patient's copay for the service.
coinsuranceAmount	Dollars	—	The patient's coinsurance share of the cost.
patientPaidAmount	Dollars	—	The total amount the patient paid out of pocket.
planPaidAmount	Dollars	—	The amount the health plan paid.

Provider Information

Column	Format	Calculation (if applicable)	What it means
providerName	String	Billing provider name; shows "UNKNOWN" if unavailable	Name of the billing provider.
providerTIN	String (optional)	—	Provider's tax identification number.
providerNPI	String (optional)	—	Provider's National Provider Identifier.
networkStatus	String (optional)	Service-line network status; if unavailable, the claim-level network status	Whether the service was in-network or out-of-network.
placeOfService	String (optional)	Service-line place of service code; if unavailable, the claim-level code	Standard code indicating where the service took place (e.g., office, hospital).

Service and Diagnosis Codes

Column	Format	Calculation (if applicable)	What it means
cpt1	String (optional)	—	The procedure (CPT/HCPCS) code for the service performed.
cpt1Description	String (optional)	—	Description of the procedure code.
cpt2 – cpt6	String (optional)	Not currently populated	Additional procedure code fields.
modifierCode1 – modifierCode6	String (optional)	—	Modifier codes that provide extra detail about how the procedure was performed.
icd10_1	String (optional)	Service-line diagnosis code if present; otherwise the claim-level diagnosis code appears on the first line	The primary diagnosis (ICD-10) code.
icd10_1Description	String (optional)	—	Description of the primary diagnosis.
icd10_2 – icd10_6	String (optional)	Additional diagnosis codes in the order listed on the claim	Additional diagnosis (ICD-10) codes, when more than one applies.
principalCode	String (optional)	—	The principal diagnosis code for the claim.
principalCodeDescription	String (optional)	—	Description of the principal diagnosis.
revenueCode	String (optional)	—	Revenue code identifying the type of facility service (institutional claims only).
ucrCode	String (optional)	Not currently populated	UCR code (reserved for future use).
units	Number (optional)	—	Number of units of service provided (e.g., visits, items, time increments).

Benefits and Processing Notes

Column	Format	Calculation (if applicable)	What it means
benefitCode	String (optional)	—	The benefit category applied to the service (e.g., Office Visit, Lab).
benefitCodeDescription	String (optional)	—	Description of that benefit category.
remarkCodes	String (";"-joined)	Combined claim-level and line-level remark codes	Processing remark codes explaining how the claim was handled.
remarkCodeDescriptions	String (";"-joined)	—	Plain-language explanations of the remark codes.

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