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  • Health Insurance Report DAX

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    althhaf
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    The document contains a list of measures with expressions to calculate various metrics from insurance claim and eligibility request data. The measures are grouped into sections for overview, eligibility requests, preauthorization, claims, payment reconciliation, and additional metrics. Expressions use DAX functions like COUNT, CALCULATE, SUMX to aggregate and filter data from various tables like Claims, EligibilityRequest, PaymentReconciliation etc.

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    The document contains a list of measures with expressions to calculate various metrics from insurance claim and eligibility request data. The measures are grouped into sections for overview, eligibility requests, preauthorization, claims, payment reconciliation, and additional metrics. Expressions use DAX functions like COUNT, CALCULATE, SUMX to aggregate and filter data from various tables like Claims, EligibilityRequest, PaymentReconciliation etc.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    5 views5 pages

    Health Insurance Report DAX

    Uploaded by

    althhaf
    The document contains a list of measures with expressions to calculate various metrics from insurance claim and eligibility request data. The measures are grouped into sections for overview, eligibility requests, preauthorization, claims, payment reconciliation, and additional metrics. Expressions use DAX functions like COUNT, CALCULATE, SUMX to aggregate and filter data from various tables like Claims, EligibilityRequest, PaymentReconciliation etc.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 5

    List of Measures:

    Measure Name Expression


    Overview
    Total_TPA COUNT('Insurance TPA'[TPAID])
    CALCULATE(COUNT('InsuranceProviders'[InsuranceProviderID]),'InsuranceProviders'[InsuranceProviderType]
    Total_Insurance_Companies = 2)
    CALCULATE(COUNT('InsuranceProviders'[InsuranceProviderID]),'InsuranceProviders'[InsuranceProviderType]
    Total_Policy_Holders = 3)
    var result = SUM('PaymentReconciliation'[PaymentAmount])
    Total_received_amount return COALESCE(result,0)

    Eligibility Request
    Total_Eligibility_Requests_Sent COUNT('EligibilityRequest'[EligibilityRequestId])
    var result = CALCULATE([Total_Eligibility_Requests_Sent],DATEADD('Calender_table'[Date],-1,MONTH))
    Previous Month Eligibility Reqeuest RETURN COALESCE(result,0)
    Total_Refered_Patients CALCULATE(COUNTROWS('EligibilityRequest'),'EligibilityRequest'[IsReferral] = True())

    Preauthorization
    Pre_Auth_requests COUNTROWS(PreAuthorization)
    var result = CALCULATE([Pre_Auth_requests],DATEADD('Calender_table'[Date],-1,MONTH))
    Previous Month Pre Authorisation Reqeuest RETURN COALESCE(result,0)
    var temp = CALCULATE(COUNTROWS('Claim'),'Claim'[IsTransfer] = "True")
    var temp2 = CALCULATE(COUNTROWS(PreAuthorization), PreAuthorization[IsTransfer] = "True")
    Total_Transferred_Patients RETURN temp + temp2
    var result = CALCULATE([Total_Transferred_Patients],DATEADD('Calender_table'[Date],-1,MONTH))
    Previous Month Transfers RETURN COALESCE(result,0)
    Claim
    No_of_Claim_Requests sent CALCULATE(COUNTROWS('Claim'),'Claim'[ClaimUse] = 2)
    No_of_claim_request_approved CALCULATE(COUNTROWS('ClaimResponse'),'ClaimResponse'[AdjudicationOutcome] = "approved")
    var result = CALCULATE([No_of_Claim_Requests sent],DATEADD('Calender_table'[Date],-1,MONTH))
    Previous Month claim request RETURN COALESCE(result,0)

    Payment Reconciliation
    Previous month payments CALCULATE(SUM(PaymentReconciliation[PaymentAmount]), DATEADD(Calender_table[Date],-1,MONTH))
    Excess
    Measure Name Expression
    Total_Patients COUNT('Core Patients'[PatientID])
    Total_Departments_in_Hospital COUNT('HR Departments'[DepartmentID])
    Total_Eligible_patients CALCULATE(COUNT('EligibilityRequest'[SiteEligibility]),'EligibilityRequest'[SiteEligibility] = "eligible")
    var result = CALCULATE(COUNT('EligibilityRequest'[SiteEligibility]),'EligibilityRequest'[SiteEligibility] = "not-active") re
    Total_Non_Eligible_patients COALESCE(result,0)
    Pre_Authorisation_Requests_for_Institutional CALCULATE(COUNTROWS('Claim'),('Claim'[ClaimUse] = 1 && 'Claim'[ClaimType] = 1))
    Pre_Auth_Requests_for_Professional CALCULATE(COUNTROWS('Claim'),('Claim'[ClaimUse] = 1 && 'Claim'[ClaimType] = 2))
    Pre_Auth_Requests_for_Oral CALCULATE(COUNTROWS('Claim'),('Claim'[ClaimUse] = 1 && 'Claim'[ClaimType] = 3))
    Pre_Auth_Requests_for_Pharmacy CALCULATE(COUNTROWS('Claim'),('Claim'[ClaimUse] = 1 && 'Claim'[ClaimType] = 4))
    Pre_Auth_Requests_for_Vision CALCULATE(COUNTROWS('Claim'),('Claim'[ClaimUse] = 1 && 'Claim'[ClaimType] = 5))
    Total_Visitspr CALCULATE(COUNT('Core TreatmentVisits'[TreatmentVisitID]), 'Core TreatmentVisits'[VisitType] <> 3)
    Approved_PreAuthorisation CALCULATE(COUNTROWS('ClaimResponse'),'ClaimResponse'[AdjudicationOutcome] = "approved")
    var Result = calculate(COUNTROWS('ClaimResponse'),'ClaimResponse'[AdjudicationOutcome] = "partial") return
    Partially_Approved_Pre_Auth COALESCE(result,0)
    Pending_Pre_Authorisation CALCULATE(COUNTROWS('ClaimResponse'),'ClaimResponse'[AdjudicationOutcome] = "pended")
    var Result = CALCULATE(COUNTROWS('ClaimResponse'),'ClaimResponse'[AdjudicationOutcome] = "rejected") return
    Rejected_Pre_Auth COALESCE(result,0)
    Claim_Requests_for_Institutional CALCULATE(COUNTROWS('Claim'),('Claim'[ClaimUse] = 2 && 'Claim'[ClaimType] = 1))
    Claim_Requests_for_Professional CALCULATE(COUNTROWS('Claim'),('Claim'[ClaimUse] = 2 && 'Claim'[ClaimType] = 2))
    Claim_Requests_for_Oral CALCULATE(COUNTROWS('Claim'),('Claim'[ClaimUse] = 2 && 'Claim'[ClaimType] = 3))
    Claim_Requests_for_Pharmacy CALCULATE(COUNTROWS('Claim'),('Claim'[ClaimUse] = 2 && 'Claim'[ClaimType] = 4))
    Claim_Requests_for_Vision CALCULATE(COUNTROWS('Claim'),('Claim'[ClaimUse] = 2 && 'Claim'[ClaimType] = 5))
    No_of_Completed_Response CALCULATE(COUNTROWS('ClaimResponse'),'ClaimResponse'[Outcome] = "Complete")
    No_of_Queue_Response CALCULATE(COUNTROWS('ClaimResponse'),'ClaimResponse'[Outcome] = "Queued")
    Total_claim_items COUNT('ClaimItem'[NphiesClaimItemID])
    Total_claim_amount SUM('ClaimItem'[Net])
    Average_claim_amount_per_claim AVERAGE('ClaimItem'[Net])
    No_of_reconciliations COUNT('PaymentReconciliation'[NphiesPaymentReconciliationID])
    Total_payments_by_ins_company SUMX(VALUES('PaymentReconciliation'[InsuranceCompanyID]),CALCULATE(SUM('PaymentReconciliation'[PaymentA
    No_of_ payments_by_insurance_company SUMX(VALUES('PaymentReconciliation'[InsuranceCompanyID]),CALCULATE(COUNTROWS('PaymentReconciliation')))
    var Result = CALCULATE(COUNTROWS('ClaimResponse'),'ClaimResponse'[AdjudicationOutcome] = "partial") return
    No_of_claim_request_Partially_approved COALESCE(result,0)
    var result = CALCULATE(COUNTROWS('ClaimResponse'),'ClaimResponse'[AdjudicationOutcome] = "pended") return
    No_of_claim_request_pended COALESCE(result,0)
    var result = CALCULATE(COUNTROWS('ClaimResponse'),'ClaimResponse'[AdjudicationOutcome] = "rejected") retur
    No_of_claim_request_rejected COALESCE(result,0)
    No_of_service_order_requests_made COUNT('ClaimItem'[OrderID])
    No_of_services_orders_approved CALCULATE(COUNTROWS('ClaimResponseItem'),'ClaimResponseItem'[AdjudicationOutcome] = "approved")
    No_of_services_orders_rejected CALCULATE(COUNTROWS('ClaimResponseItem'),'ClaimResponseItem'[AdjudicationOutcome] = "rejected")
    No_of_services_orders_partially_approved CALCULATE(COUNTROWS('ClaimResponseItem'),'ClaimResponseItem'[AdjudicationOutcome] = "partial")
    No_of_services_orders_pended CALCULATE(COUNTROWS('ClaimResponseItem'),'ClaimResponseItem'[AdjudicationOutcome] = "pended")
    Total_payment_amount_received_for_each_order SUM('PaymentReconciliationItem'[Amount])
    var result = CALCULATE([Total_Eligibility_Requests_Sent],DATEADD('Calender_table'[Date],-1,YEAR)) RETURN
    Previous Year Eligibility Reqeuest COALESCE(result,0)
    var result = ([Total_Eligibility_Requests_Sent] - [Previous Year Eligibility Reqeuest])/[Previous Year Eligibility Reqeue
    YoY_ELigible_Growth RETURN COALESCE(result,0)
    var result = CALCULATE([Total_Eligibility_Requests_Sent],DATEADD('Calender_table'[Date],-1,MONTH)) RETURN
    Previous Month Reqeuest COALESCE(result,0)
    var result = ([Total_Eligibility_Requests_Sent] - [Previous Month Reqeuest])/[Previous Month Reqeuest] RETURN
    MoM_ELigible_Growth COALESCE(result,0)
    Eligible_request_rate ([Total_Eligible_patients]/[Total_Eligibility_Requests_Sent])*100
    Not_Eligible_request_rate ( [Total_Non_Eligible_patients]/[Total_Eligibility_Requests_Sent])*100
    Count Of Services COUNT(ClaimItem[ServiceCode])
    var result = CALCULATE([Total_Eligibility_Requests_Sent],DATEADD('Calender_table'[Date],-1,MONTH)) RETURN
    Previous Month Eligibility Reqeuest COALESCE(result,0)
    Previous Year Pre Authorisation Reqeuest var result = CALCULATE([Pre_Auth_requests],DATEADD('Calender_table'[Date],-1,YEAR)) RETURN COALESCE(result,0
    var selected_Value = SELECTEDVALUE(Parameter[Parameter Order])
    var result =
    SWITCH( TRUE(),
    selected_Value = 0 , "Payment Reconciliation",
    selected_Value =1, "Eligibility Requests",
    selected_Value = 2, "Claims"
    )
    chart_title return "Insurance Company wise "&result

    Calculated Columns:
    Calander Table

    Calender_table = CALENDAR(date(2022,1,1),today())
    day = DAY(Calender_table[Date])
    Month_Name = FORMAT(Calender_table[Date],"mmm")
    Months_ = MONTH(Calender_table[Date])
    Quarter = "Q"&QUARTER(Calender_table[Date])
    year = YEAR(Calender_table[Date])
    Week No = "W"&WEEKNUM(Calender_table[Date])

    Claim

    Adjudication Outcome = RELATED('ClaimResponse'[AdjudicationOutcome])


    ClaimItem

    Adjudication Outcome = RELATED('ClaimResponseItem'[AdjudicationOutcome])


    // Adding col from claim response item

    Eligibility Request

    Referred = IF(EligibilityRequest[IsReferral],"Referral", "Not Referral")

    Preauthorization

    Pre Adjudication Outcome = LOOKUPVALUE(ClaimResponse[AdjudicationOutcome],ClaimResponse[NphiesClaimID],PreAuthorization[NphiesClaimID]," ")

    Parameters

    Parameter = {

    ("Payment Reconciliation", NAMEOF('All_Measures'[Total_payments_by_ins_company]), 0),


    ("Eligibility", NAMEOF('All_Measures'[Total_Eligibility_Requests_Sent]), 1),
    ("Claims", NAMEOF('All_Measures'[No_of_Claim_Requests sent]), 2)
    }

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