Yuzu has “off the shelf reports” we can send via Secure Email at any requested frequency and cadence. These reports include:
Eligibility
Medical Claims
Pharmacy Claims
Below are the fields included in each of these reports and a linked example. These reports will contain data for each group the relevant vendor is attached to.
Eligibility
Fields:
employeeId (9 digit ID of the subscriber)
employeeFirstName
employeeLastName
employeeGender (M or F)
employeeDob
employeeEffectiveDate
employeeAddress1
employeeAddress2
employeeCity
employeeState
employeeZip
memberFirstName
memberLastName
memberGender (M or F)
memberDob
memberRelationshipToEmployee (self, spouse, dependent)
memberEffectiveDate
groupId (4-6 character ID)
groupName (Legal name of the group)
subscriberMemberNumber (9 digit ID of the subscriber)
coverageStatus (Active, Inactive, Pending, Cobra, Annulled)
coverageType (EE, ES, EC, EF)
enrollmentTier (e.g., Gold)
employeeDateOfDeath
coverageLastUpdated
memberTerminationDate
memberTerminationReason
employeeHireDate
employeeTerminationDate
employeeTerminationReason
memberDateOfDeath
memberNumber (9 digit ID of the member)
Google drive link: https://docs.google.com/spreadsheets/d/1Nvoih3tN0heujObxKJH1pg7KQhq8YNRBa6AbmUHDeKA/edit?usp=sharing
Medical claims
Medical claim report with each line representing a code.
Fields:
memberId (9 digit ID of the member)
employeeId (9 digit ID of the subscriber)
employeeLastName
employeeFirstName
groupName (Legal name of the group)
groupNumber (4-6 character ID)
paidDate
checkNumber
patientDob
patientFirstName
patientLastName
patientRelationship (subscriber, spouse, dependent)
patientPaidAmount
claimStatus
claimNumber
providerName
claimLineNumber
discountAmount
ineligibleReason
ineligibleAmount
coinsuranceAmount
copayAmount
billedAmount
planPaidAmount
allowedAmount
dateOfServiceFromDate
dateOfServiceToDate
deductibleAmount
processedDate
cpt1
cpt2
cpt3
cpt4
cpt5
cpt6
modifierCode1
modifierCode2
modifierCode3
modifierCode4
modifierCode5
modifierCode6
icd10_1
icd10_1Description
icd10_2
icd10_3
icd10_4
icd10_5
icd10_6
networkStatus
revenueCode
ucrCode
benefitCode
benefitCodeDescription
denialCode
denialCodeDescription
providerTIN
placeOfService
units
claimType
billType
providerNPI
isCashPay
Google drive link:
Pharmacy claims
Fields:
memberId (9 digit ID of the member)
employeeId (9 digit ID of the subscriber)
subscriberFirstName
subscriberLastName
allowedAmount
billedAmount
paidDate
groupName (Legal name of the group)
groupNumber (4-6 character ID)
patientFirstName
patientLastName
patientPaidAmount
planPaidAmount
claimStatus
claimNumber
patientDob
ingredientCost
dispensingFee
administrativeFee
salesTax
coinsuranceAmount
copayAmount
deductibleAmount
fillDate
isSpecialty
drugName
dosage
medicationForm
daysSupply
genericOrFormulary
ndcCode
prescribedDate
therapeuticClass
quantity
awp
daw
nabpNumber
Google drive link:
Aggregate reports
More details here: https://yuzu.health/docs/guides/aggregate-report
Months
EE Covered
ES Covered
EC Covered
EF Covered
Attachment Point
Plan-Level Claims Paid
Medical Claims Paid
Pharmacy Claims Paid
Total Claims Paid
Claims Over Spec
Rebates Received
Out of Policy Claims
Total Agg Adjustments
Agg (Surplus) Deficit
PTD Agg (Surplus) Deficit
PTD % of Attachment Point (Net Loss Ratio)