Accumulator Page Viewer

2021-2022 CLAIM REPORT ORIENTATION -

Need Help?:
Contact the Help Desk by emailing healthplanhelpdesk@coalitionexchange.org

Please enter the information of the primary applicant/Employee below
Date of Birth(mm/dd/yyyy)
Last 4 digit of your SSN:

Householdmembers

Last NAME	first NAME	RElationship	Bday	Issued coverage start date	Issued coverage end date	health coverage

Overpayments:
The report may display Overpayment amounts in either plan year. Overpayments are sometimes created this year due to the extra layers of protection that the Plan Underwriter had to deploy in order to accommodate a deductible carryover credit and a short year deductible from May 1, 2022 to Dec 31, 2022. Any unintended Plan Overpayments will be used to offset future plan liabilities or settled at the end of the year.

Need Help?:
Contact the Help Desk by emailing healthplanhelpdesk@coalitionexchange.org

Click Here to View Calendar Year 2023

Calendar Year: [Plan Year 2021-2022]

The below report only display individuals who had claims this year. Any family members that is not displayed means that we have not received claims fro BCBS yet.

Plan Year	Name	Total Pay Your Provider	Possible Offset Provider Discount	Max Deductible	Max Coinsurance	Corrected Deductible	Corrected Coinsurance	Corrected Ded. + Coins.	HRA Plan Over (+) / Under (-) Credit Attribution

Plan year	Name	Total BCBS Billed	Total BCBS Allowed	Total BCBS Paid	Total Due Provider	Total BPA Owes	Total Employee Real Responsibility
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Claims Subject to Deductible and Coinsurance (Excludes QMG Clinic and Preventative Claims) for

Processed Date	Date of Service	Name	Claim Number	Provider	Pay Your Provider	Possible Offset Provider Discount	Total Billed	Penalty	Allowed Amount	Amount Due Provider	Plan Year	Correct Deductible	Correct Coinsurance	Correct Patient Owes	Correct Carrier Owes	BCBS Paid	HRA Plan Over (+) / Under (-) Credit Attribution	HRA Owes	HRA Responsibility

Detailed Break Down Of QMG 100% Free Employee Clinic Claims for

Processed Date	Date of Service	Name	Claim Number	Provider	Total Billed	Penalty	Allowed Amount	Amount Due Provider	Plan Year	Correct Deductible	Correct Coinsurance	Correct Patient Owes

Detailed Break Down Of Preventative Claims for

Processed Date	Date of Service	Name	Claim Number	Provider	Total Billed	Penalty	Allowed Amount	Amount Due Provider	Plan Year	Correct Deductible	Correct Coinsurance	Correct Patient Owes

Admin View

Plan year:

	Processed Date	Date of Service	Name	Claim Number	Provider	Pay Your Provider	Total Billed	Penalty	Allowed Amount	Amount Due Provider	Plan Year	Correct Deductible	Correct Coinsurance	Correct Patient Owes	Correct Carrier Owes	BCBS Paid	HRA Plan Over (+) / Under (-) Credit Attribution	HRA Credit payment	HRA Responsibility	Corrected Pay your provider	Sort order	HRACreditPayment	HRAPaymentDate	HRAPaymentCheckNo	TPAHRAOwes	TPAEmployeeOwes	preventativeexclusion	HRABudget	patientowesprovider	overpayment	hra_concession	[L2 Combined Pat Using Allowed]	[L2 Combined Pat Using Responsibility]	[L2 Combined HRA Using Allowed]	[L2 Combined HRA Using Responsibility]	hhid	empid	ScoringIDConcatL1	AuditorScoreConcatL1	[Allan Inclusion Marker]	PlaceOfService	[Diagnosis Code csv]	[Diagnosis Desc csv]	[CPT Code csv]	cpt_desc_csv	department	serviceprov	TotalLineItems2	total_match_dept	total_match_prov	total_match_cpt	total_match_bcbs_cpt	QMG ChargeID or BH ACCT/Voucher#	Initial Load Date	Count of Claim Match	Blessing_Notes

	Processed Date	Date of Service	Name	Claim Number	Provider	Pay Your Provider	Total Billed	Penalty	Allowed Amount	Amount Due Provider	Plan Year	Correct Deductible	Correct Coinsurance	Correct Patient Owes	Correct Carrier Owes	BCBS Paid	HRA Plan Over (+) / Under (-) Credit Attribution	HRA Credit payment	HRA Responsibility	Corrected Pay your provider	Sort order	HRACreditPayment	HRAPaymentDate	HRAPaymentCheckNo	TPAHRAOwes	TPAEmployeeOwes	preventativeexclusion	HRABudget	patientowesprovider	overpayment	hra_concession	[L2 Combined Pat Using Allowed]	[L2 Combined Pat Using Responsibility]	[L2 Combined HRA Using Allowed]	[L2 Combined HRA Using Responsibility]	hhid	empid	ScoringIDConcatL1	AuditorScoreConcatL1	[Allan Inclusion Marker]	PlaceOfService	[Diagnosis Code csv]	[Diagnosis Desc csv]	[CPT Code csv]	cpt_desc_csv	department	serviceprov	TotalLineItems2	total_match_dept	total_match_prov	total_match_cpt	total_match_bcbs_cpt	QMG ChargeID or BH ACCT/Voucher#	Initial Load Date	Count of Claim Match	Blessing_Notes

Date Of Service	Place Of Service	Billed Amount	Allowed Amount	Carrier Paid	Your Responsibility	Primary Diagnosis	Procedure Description	Procedure Code	Deductible	Coinsurance	Copay	Penalty	Medication Name	Medication QTY	Medication Supply	LineId	Department	Service Provider	Match Test Dept	Match Test Provider	Match Test CPT	100 Percent Marker	CPT CSV grouped