Post on 08-Dec-2021
DR.NTR VAIDYA SEVA TRUST
MIS MANUAL WITH
INDICATORS COMPENDIUM AND REPORT TABLES
VOLUME II
©2012 Dr.NTR Vaidya Seva Trust Road Number 46 Jubilee Hills Hyderabad 500033 Telephone: 040-23148000 Website: www.ntrvaidyaseva.ap.gov.in ail: feedback@ntrvaidyaseva.ap.gov.in
All rights reserved This book is produced by the staff of Dr.NTR Vaidya Seva Trust.
Rights and permissions Copy and reproduction of all or part of the material in this book without prior permission is allowed subject to the material being reproduced accurately and not being used in a derogatory or misleading context. Where the material is being published or issued to others, the source shall be prominently acknowledged.
ABBREVIATIONS
Sl.No Abbreviation Full Form
1 ~CA Cost of the Claims Approved
2 ~TD Cost of the Therapies Done
3 ~TDs Cost of the Therapies discharged
4 ~TP Cost of the Therapies Preauthorised
5 ACC Average Claim Case Waiting Time
6 ACN Average Categories per NWH
7 ACS Average Claim Size
8 AFR Adverse Feedback Rate
9 AI Autonomous Institutions
10 NVMCCO Dr.NTR Vaidya Seva Medical Camp Coordinator
11 AP Average Price
12 APC Average Preauth Case Waiting Time
13 APS Average Preauth Size
14 AS Dr.NTR Vaidya Seva
15 ATPCC Average therapies per covered card-year for a given therapy
16 ATPCP Average therapies per covered person-year for a given therapy
17 ATPUC Average therapies per utilised card-year for a given therapy
18 ATPUP Average therapies per utilised person-year for a given therapy
19 AVG. CAT Average Number of Categories
20 BC Backward Caste
21 BCR Bare Claim Ratio
22 BE Budget Estimate
23 BOR Dr.NTR Vaidya Seva Bed Occupancy Rate
24 BPAU Buffer case Preauthorisation
25 BPCD Bare Premium Claim Difference
26 CA Claims Approved
27 CAO Claims Authorization Officer
28 C-CC Chairman - Cochlear Committee
29 CDR Claim Deduction Ratio
30 CFR Case Fatality Rate
31 CH Claim Head
32 ClE Therapy Claims Eligible
33 CLMF Claims Afresh
34 CLMP Claims Pending
35 CLR Claim Rate
36 CMCO CM Camp Office
37 CMRF Chief Minister Relief Fund
38 CPD Claims Panel Doctor
39 CPP Claim Pendency Percentage
40 CR Claim Ratio
41 CRe Claims Rejected
42 Cr Crores
43 CTD Claims Trust Doctor
44 CUR Card Utilization Rate
45 CX / CEX Claims Executive
46 CY Cumulative Year
47
d Q[n] Q is the quarter of a year. The statistic is calculated from quarterly period amounts (Q[n] - Q[n-1]).
48 DFO Deputy Financial Officer
49 EAO Empanelment Authorization Officer
50 EEX Empanelment Executive
51 EH Empanelment head
52 EPD Empanelment Processing Doctor
53 EPO Empanelment Processing Officer
54 EPO (CMA) Empanelment Processing Officer
55 EW Empanelment Weight
56 EX Executive
57 EXPDR Expenditure
58 F Female
59 F/U Follow-up
60 FC Frequency Count
61 FY Financial Year
62 GH Government Hospital
63 Govt Government
64 GR Grievance Rate
65 HCAP HC Patient Referral Capture Rate
66 HCC Health Camps Conducted
67 HCON HC Patient Referral Conversion Rate
68 HCPR Patients Referred (through Health Camps)
69 HCPS Patients Screened (In Health Camp)
70 HD Hospital District
71 HD TP Hospital District Therapies Preauthorised
72 INS Insurance
73 IP Hospital In Patients
74 ITEX IT Executive
75 LCLM Live Claims
76 LP Therapy Claim Lapsed
77 LPAU Live Preauthorisation
78 LPAUC Live Preauthorisation Cancellation
79 M Male
80 MC-CC Member Convener - Cochlear Committee
81 MC-EDC Member Convener - Empanelment Disciplinary Committee
82 MIN Minority
83 NAM Network Vaidyamitra
84 NWH Network Hospital
85 OP Hospital Out Patients
86 PAO Preauth Authorization Officer
87 PAUC Preauthorisation Cancellation
88 PAUP Preauthorisation Pending
89 PCD Premium Claim Difference
90 PCLM Past Claims
91 PCR Preauth Cost Rate
92 PD Patient District
93 PD TP Patient District Therapies Preauthorised
94 PDR Preauth Disposal Rate
95 PEX-C Preauth Executive Cochlear
96 PFF Period Falling in the Financial Year
97 PID Preauth Insurance Doctor
98 PP Policy Period
99 PPAU Past Preauthorisation
100 PPAUC Past Preauthorisation Cancellation
101 PPD Preauth Panel Doctor
102 PPP Preauth Pendency Percentage
103 PTD Preauth Trust Doctor
104 PUR Person Utilization Rate
105 Pvt Private
106 R Rural
107 MEDCO Dr.NTR Vaidya Seva Medical Coordinator
108 REL Amount Released
109 SC Scheduled Caste
110 ST Scheduled Tribe
111 T Total
112
TAP/RAP/AA P/AP
Types of Cards
113 TCB Therapies Claim Pending at Bank
114 TCBC Therapies Claim Pending at Bank Cost
115 TCO Therapies Claim Outstanding
116 TCOC Therapies Claim Outstanding Cost
117 TD Therapies Done
118 TDs Therapies discharged
119 TP Therapies Preauthorised
120 U Urban
121 WAC Weighted Average Cases (WAC) per month for a NWH
122 WSD Weighted Standard Deviation (WSD)
123 Wt Weight
TABLE OF CONTENTS
VOLUME – I
1. Introduction ............................................................................. 1
2. Overview of MIS in AHCT .......................................................... 3
3. Overview of the scheme ........................................................... 7
4. Administration department .................................................... 10
5. Operations department ........................................................... 20
6. Empanelment, Disciplinary action and
Medical audit department ....................................................... 41
7. Field operations department .................................................... 50
8. Grievance department .............................................................. 54
9. Cochlear implant program ........................................................ 56
VOLUME -2
10. Indicators Organization Structure ............................................. 61
11. Data Types and Notations used ................................................ 69
12. Definition Dictionary ................................................................. 70
13. List of Indicators ......................................................................... 73
14. Indicator Bank ...........................................................................95
15. Appendix .................................................................................. 565
VOLUME-3
16. Report Tables .................................................................................. 569
1. Scheme Performance ............................................................... 570
1A. scheme utilization
1B. scheme experience
2. District Performance .............................................................. 585
2A.district wise tables
2B. government hospital performance
2C. utilisation rates
2E. migration pattern
2F.Grievances
2G.District specific tables
3. Category Performance .............................................................. 601
3A. Category wise tables
3B. Government hospital performance
3C. Utilisation rates
3D. Category specific tables
4. Therapy Performance ............................................................... 612
4A.Therapy wise tables
4B.Theray specific tables
5. Government Hospitals progress ................................................. 616
5A. Government hospital performance
5B. NWH wise tables
5C.NWH specific tables
6. Finance ...................................................................................... 626
6A.Finance and budget
6B Forecasts
7. Dash boards ............................................................................... 635
8 Field operations .......................................................................... 656
9. Periodic reports ......................................................................... 658
61
11. INDICATORS ORGANIZATION STRUCTURE
Sl.no Major Group
Minor Group
Sub Catego ry
Major Group Description
Minor Group Description
Sub Category Description
1 ADM SCO PCO Administration Scheme Population Coverage
2 ADM SCO BCO Administration Scheme Benefit Coverage
3 ADM SCO FCO Administration Scheme Financial Coverage
4 ADM SUT CUT Administration Scheme Utilization
Cards Utilization
5 ADM SUT PUT Administration Scheme Utilization
Persons Utilization
6 ADM SUT TUT Administration Scheme Utilization
Therapy Utilization Operations Wise Summary
7 ADM SUT UTR Administration Scheme Utilization
Utilization Rates
8 ADM SUT CLR Administration Scheme Utilization
Claim Rates
9 ADM SUT WGT Administration Scheme Utilization
Weights
10 ADM SEP CRT Administration Scheme Experience
Claim Ratios
11 ADM SEP CCO Administration Scheme Experience
Claims Commitment
12 ADM SEP FFO Administration Scheme Experience
Fund Forecast
14 FOP NWH *** Field Operations
Network Hospital NA
15 FOP HCA *** Field Operations
Health Camps NA
16 FOP FUC *** Field Operations
Follow-up Cases NA
17 FOP GHP *** Field Operations
Government Hospital Performance
NA
18 GRE GRE *** Grievances Grievances NA
19 EDM EMP *** Empanelment, Disciplinary Action And Medical Audit
Empanelment NA
62
Sl.no Major Group
Minor Group
Sub Catego ry
Major Group Description
Minor Group Description
Sub Category Description
20 EDM MAU *** Empanelment, Disciplinary Action And Medical Audit
Medical Audit NA
21 OPR PAU SUB Operations Preauthorisation Submitted
22 OPR PAU UPD Operations Preauthorisation Updated
23 OPR PAU FWD Operations Preauthorisation Forwarded
24 OPR PAU RAP Operations Preauthorisation Recommended for Approval
25 OPR PAU PEN Operations Preauthorisation Pending
26 OPR PAU RRJ Operations Preauthorisation Recommended for Rejection
27 OPR PAU APP Operations Preauthorisation Approved
28 OPR PAU REJ Operations Preauthorisation Rejected
29 OPR PAU TDP Operations Preauthorisation Total Disposed
30 OPR PAU AUC Operations Preauthorisation Auto Cancellation
31 OPR TRT UPD Operations Treatment Updated
32 OPR DSC UPD Operations Discharge Updated
33 OPR DEA UPD Operations Death Updated
34 OPR PAU WTC Operations Preauthorisation Waiting cases count
35 OPR PAU TWT Operations Preauthorisation Total Waiting
36 OPR TRT WTC Operations Treatment Waiting cases count
37 OPR DSC WTC Operations Discharge Waiting cases count
38 OPR PAU AWT Operations Preauthorisation Average Waiting Time
39 OPR TRT AWT Operations Treatment Average Waiting Time
40 OPR OBD AWT Operations On bed Average Waiting Time
41 OPR PAU HPA Operations Preauthorisation Hourly Preauth Arrival
42 OPR PAU ART Operations Preauthorisation Preauth Arrival Rate
43 OPR PAU HAP Operations Preauthorisation Hourly Preauth Approval
44 OPR PAU APR Operations Preauthorisation Preauth Approval Rate
45 OPR PAU DTO Operations Preauthorisation Daily Turnover
63
Sl.no Major Group
Minor Group
Sub Catego ry
Major Group Description
Minor Group Description
Sub Category Description
46 OPR PAU TOR Operations Preauthorisation Turn Over
47 OPR PAU CPT Operations Preauthorisation Case Processing Time
48 OPR PAU PPP Operations Preauthorisation Preauth Pendency Percentage
49 OPR PAU TIN Operations Preauthorisation Telephonic Intimations
50 OPR PAU BUF Operations Preauthorisation Buffer
51 OPR PAU ENH Operations Preauthorisation Enhancement
52 OPR PAU CCH Operations Preauthorisation Cochlear Cases
53 OPR CLM ELG Operations Claims Eligible
54 OPR CLM SUB Operations Claims Submitted
55 OPR CLM UPD Operations Claims Updated
56 OPR CLM WTC Operations Claims Waiting cases count
57 OPR CLM FWD Operations Claims Forwarded
58 OPR CLM RAP Operations Claims Recommended for Approval
59 OPR CLM RRJ Operations Claims Recommended for Rejection
60 OPR CLM PEN Operations Claims Pending
61 OPR CLM APP Operations Claims Approved
62 OPR CLM REJ Operations Claims Rejected
63 OPR CLM TDP Operations Claims Total Disposed
64 OPR CLM HAR Operations Claims Hourly Claims Arrival
65 OPR CLM CAR Operations Claims Claims Arrival Rate
66 OPR CLM HCD Operations Claims Hourly Claims Disposal
67 OPR CLM CDR Operations Claims Claims Disposal Rate
68 OPR CLM TWN Operations Claims Total Waiting
69 OPR CLM AWT Operations Claims Average Waiting Time
70 OPR CLM TOR Operations Claims Turn Over Rate
71 OPR CLM DTO Operations Claims Daily Turnover
72 OPR CLM CPP Operations Claims Claim Pendency Percentage
73 EMP EAP INT Empanelment Empanelment Application
Initiated
64
Sl.no Major Group
Minor Group
Sub Catego ry
Major Group Description
Minor Group Description
Sub Category Description
74 EMP EAP UPD Empanelment Empanelment Application
Updated
75 EMP ERE FWD Empanelment Empanelment Registration
Forwarded
76 EMP ERE APP Empanelment Empanelment Registration
Approved
77 EMP ERE PEN Empanelment Empanelment Registration
Pending
78 EMP ERE REJ Empanelment Empanelment Registration
Rejected
79 EMP EIP INT Empanelment Empanelment Inspection
Initiated
80 EMP EIP UPD Empanelment Empanelment Inspection
Updated
81 EMP EAU RAP Empanelment Empanelment Authorization
Recommended for Approval
82 EMP EAU RRE Empanelment Empanelment Authorization
Recommended for Rejection
83 EMP EAU REJ Empanelment Empanelment Authorization
Rejected
84 EMP EAU PEN Empanelment Empanelment Authorization
Pending
85 EMP EAU APP Empanelment Empanelment Authorization
Approved
86 EMP EAS INT Empanelment Empanelment Additional Specialities
Initiated
87 EMP EAS UPD Empanelment Empanelment Additional Specialities
Updated
88 EMP EAS RAP Empanelment Empanelment Additional Specialities
Recommended for Approval
89 EMP EAS RRE Empanelment Empanelment Additional Specialities
Recommended for Rejection
90 EMP EAS PEN Empanelment Empanelment Additional Specialities
Pending
91 EMP EAS IAP Empanelment Empanelment Additional Specialities
Inspection Approved
65
Sl.no Major Group
Minor Group
Sub Catego ry
Major Group Description
Minor Group Description
Sub Category Description
92 EMP EAS IRE Empanelment Empanelment Additional Specialities
Inspection Rejected
93 EMP EAS IUP Empanelment Empanelment Additional Specialities
Inspection Updated
94 EMP EAS APP Empanelment Empanelment Additional Specialities
Approved
95 EMP ECR INT Empanelment Empanelment Change Request of MEDCO
Initiated
96 EMP ECR UPD Empanelment Empanelment Change Request of MEDCO
Updated
97 EMP ECR RAP Empanelment Empanelment Change Request of MEDCO
Recommended for Approval
98 EMP ECR PEN Empanelment Empanelment Change Request of MEDCO
Pending
99 EMP ECR REJ Empanelment Empanelment Change Request of MEDCO
Rejected
100 EMP ECR APP Empanelment Empanelment Change Request of MEDCO
Approved
101 EMP ECA INT Empanelment Empanelment Change Request of NVMCCO
Initiated
102 EMP ECA UPD Empanelment Empanelment Change Request of NVMCCO
Updated
103 EMP ECA RAP Empanelment Empanelment Change Request of NVMCCO
Recommended for Approval
104 EMP ECA PEN Empanelment Empanelment Change Request of NVMCCO
Pending
105 EMP ECA REJ Empanelment Empanelment Change Request of NVMCCO
Rejected
66
Sl.no Major Group
Minor Group
Sub Catego ry
Major Group Description
Minor Group Description
Sub Category Description
106 EMP ECA APP Empanelment Empanelment Change Request of NVMCCO
Approved
107 EMP EAA INT Empanelment Empanelment Change Request of Additional NVMCCO
Initiated
108 EMP EAA UPD Empanelment Empanelment Change Request of Additional NVMCCO
Updated
109 EMP EAA RAP Empanelment Empanelment Change Request of Additional NVMCCO
Recommended for Approval
110 EMP EAA PEN Empanelment Empanelment Change Request of Additional NVMCCO
Pending
111 EMP EAA REJ Empanelment Empanelment Change Request of Additional NVMCCO
Rejected
112 EMP EAA APP Empanelment Empanelment Change Request of Additional NVMCCO
Approved
113 EMP EAR INT Empanelment Empanelment Change Request of Additional MEDCO
Initiated
114 EMP EAR UPD Empanelment Empanelment Change Request of Additional MEDCO
Updated
115 EMP EAR RAP Empanelment Empanelment Change Request of Additional MEDCO
Recommended for Approval
116 EMP EAR PEN Empanelment Empanelment Change Request of Additional MEDCO
Pending
67
Sl.no Major Group
Minor Group
Sub Catego ry
Major Group Description
Minor Group Description
Sub Category Description
117 EMP EAR REJ Empanelment Empanelment Change Request of Additional MEDCO
Rejected
118 EMP EAR APP Empanelment Empanelment Change Request of Additional MEDCO
Approved
119 EMP EBA INT Empanelment Empanelment Change of Bank Account Number
Initiated
120 EMP EBA UPD Empanelment Empanelment Change of Bank Account Number
Updated
121 EMP EBA RAP Empanelment Empanelment Change of Bank Account Number
Recommended for Approval
122 EMP EBA REJ Empanelment Empanelment Change of Bank Account Number
Rejected
123 EMP EBA PEN Empanelment Empanelment Change of Bank Account Number
Pending
124 EMP EBA APP Empanelment Empanelment Change of Bank Account Number
Approved
125 EMP EXD INT Empanelment Expertise Details Initiated
126 EMP EXD UPD Empanelment Expertise Details Updated
127 EMP EXD RAP Empanelment Expertise Details Recommended for Approval
128 EMP EXD REJ Empanelment Expertise Details Rejected
129 EMP EXD PEN Empanelment Expertise Details Pending
130 EMP EXD APP Empanelment Expertise Details Approved
131 OPR FOL SUB Operations Follow-up Cases Submitted
132 OPR FOL UPD Operations Follow-up Cases Updated
133 OPR FOL FWD Operations Follow-up Cases Forwarded
134 OPR FOL RAP Operations Follow-up Cases Recommended for Approval
135 OPR FOL RRJ Operations Follow-up Cases Recommended for Rejection
136 OPR FOL PEN Operations Follow-up Cases Pending
137 OPR FOL APP Operations Follow-up Cases Approved
68
Sl.no Major Group
Minor Group
Sub Catego ry
Major Group Description
Minor Group Description
Sub Category Description
138 OPR FOL REJ Operations Follow-up Cases Rejected
139 OPR FCH SUB Operations Follow-up Cochlear Cases
Submitted
140 OPR FCH UPD Operations Follow-up Cochlear Cases
Updated
141 OPR FCH FWD Operations Follow-up Cochlear Cases
Forwarded
142 OPR FCH RAP Operations Follow-up Cochlear Cases
Recommended for Approval
143 OPR FCH RRJ Operations Follow-up Cochlear Cases
Recommended for Rejection
144 OPR FCH PEN Operations Follow-up Cochlear Cases
Pending
145 OPR FCH APP Operations Follow-up Cochlear Cases
Approved
146 FOP NAM ATN Operations Network Vaidyamitra
Attendance
147 FOP NAM PCL Operations Network Vaidyamitra
Preauth Cleared
148 FOP NAM REG Operations Network Vaidyamitra
Registered
149 FOP NAM CON Operations Network Vaidyamitra
Conversions
150 FOP NAM FOL Operations Network Vaidyamitra
Follow-up
151 FOP NAM REF Operations Network Vaidyamitra
Referred Cases
152 FOP NAM BUP Operations Network Vaidyamitra
On-bed Updation
153 FOP PAM ATN Operations PHC Vaidyamitra
Attendance
154 FOP PAM REG Operations PHC Vaidyamitra
Registered
155 FOP PAM REF Operations PHC Vaidyamitra
Referred
156 FOP PAM CON Operations PHC Vaidyamitra
Conversions
157 FOP PAM FVS Operations PHC Vaidyamitra
Follow-up eligible case Visits
158 FOP PAM FOL Operations PHC Vaidyamitra
Follow-up
159 FOP PAM IEC Operations PHC Vaidyamitra
IEC
69
12. DATA TYPES AND NOTATIONS USED
Data Types for Indicators used
A Absolute Numbers
Re Real Numbers
P Percentage
R Rate
G Average
N Proportion
Rt Ratio
Notations used in the document
D Day W Week
M Month
Q Quarter
H Half Yearly
Y Yearly
Cum Cumulative
NA Not Any
Notations used for frequency of monitoring an indicator
Y Yes
N No
70
13. DEFINITION DICTIONARY
Id Definition name
Description
1
n' user card
A utilized card which is used by only n users of the family either one or more times, for one or more uses each time it is used. n <= number of members in the family card
2
Times of use of a card
Times of use of a card indicates the number of different times the card is used by a user, each time the card being used for one or more therapies. For ex: A hemodialysis patient would be using a card many times in a year
3
Uses of a card
Uses of a card indicates the number of therapies for which preauthorisation is given at one time for a user. For ex: an accident case may have three therapies preauthorised at the same time, in which case it is said the card is used once for three uses
4
Cards utilized or used for a given therapy
The frequency count of cards for which preauthorisation is given at least one time for at least one use of the therapy, during one or more specified periods (usually policy periods). A card for which preauthorisation is given more than once needs to be counted as a single card utilized.
5 Package Price Price per single performance of a therapy on a patient
6 Bed Unit (BU) 50 Beds (A NWH with 50 beds empanelled for one or more specialities)
7 From date The date from which the policy period started, in dd-mm-yyyy format.
8 To date The date on which the policy period ended, in dd-mm-yyyy format.
9
Policy Period (PP)
The time period between the start and end of an insurance contract during which a beneficiary unit will be eligible for a fixed financial cover.
10
Period Falling in FY (PFF)
The number of days which fall in the particular FY out of the total number of days in the PP. (= Latest date of PP falling in FY - Earliest date of PP falling in the same FY)
11
Major PP / Minor PP
Two policy periods fall in any financial year for the insurance scheme. The PP having the major share in the 365 days of FY is called major PP and the PP having the minor share in 365 days of FY is called minor PP.
71
12
Card Year
Card Year concept is a standardized measure of measuring the cards covered and their duration with exactness over a period of time. Even if the number of cards covered changes during the time period they will be considered using this measure. For example: 50 cards were covered in the first 6 months and later in the next 6 months 100 cards were covered (i.e. 50 cards were added during the middle of a year) and this is expressed as (25 cardyears+50 card years = 75 card years). 'x card years' represents that an equivalent to x number of cards were covered for one year during that period. We calculate card years at two levels. (1)For all the cards covered during a period and (2) the utilized cards during a period. There are a set of indicators which we want to calculate among the utilized cards. While calculating card years for utilized cards (only the utilized cards are taken into account and the duration for which they were covered). For example: we have a set of 700 cards covered for 1 year (i.e. 700 card years) and only 300 cards among these 700 cards were utilized. So while calculating indicators for utilized cards the denominator would be 300 card years. Interpretation of these indicators would be: Among the utilized cards, the average number of times a particular therapy has been performed per card year. These set of indicators are used to capture the change in the utility pattern of a particular therapy and so on (at card level).
13
Person Year
Person Year concept is a standardized measure of measuring the number of persons that were covered and their duration with exactness over a period of time. Even if the number of persons covered changes during the time period they will be considered using this measure. For example: 50 persons were covered in the first 6 months and later in the next 6 months 100 persons were covered (i.e. 50 persons were added during the middle of a year) and this is expressed as (25 personyears+50 person years = 75 person years). 'x person years' represents that an equivalent to x number of persons were covered for one year. We calculate person years at two levels. (1)For all the persons covered during a period and (2) for utilized persons covered during a period. There are a set of indicators which we want to calculate among the utilized persons. While calculating person years for utilized persons (only the utilized persons are taken into account and the duration for which they were covered). For example: we have covered 900 persons for 1 year (i.e. 900 person years) and only 300 persons among these 900 persons have utilized the services. So while calculating indicators for utilized persons the denominator would be 300 person years. Interpretation of these indicators would be: Among the utilized persons, the average number of times a particular therapy has been performed per person year. These set of indicators are used to capture the change in the utility pattern of a particular therapy and so on (at person level).
72
14 Procedure Basket
Procedure basket is a collection of specified procedures that are available in our scheme at a particular point of time.
15
Weights
We use two types of weights: Bare Weights and Weights. They are always calculated cumulatively (i.e. using data from the beginning of the scheme till the current date).
16
Defined Set of Therapies
A defined set of therapies is a specific set of therapies say (t1, t2, t3, t4) which are selected from the procedure basket. A defined set of therapies can also be all the therapies available in the procedure basket in some circumstances.
73
14. LIST OF INDICATORS
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
1
Number of Cards Covered ADM-SCO- PCO-001
CCO
95
2
Number of Persons covered ADM-SCO- PCO-002
PCO
96
3
Number of Therapies available ADM-SCO- BCO-001
THR_AV
97
4
Number of Therapies applicable ADM-SCO- BCO-002
THR_APP
98
5 Number of Medical Specialities Available
ADM-SCO- BCO-003
MCAT_AV
100
6 Number of Surgical Specialities Available
ADM-SCO- BCO-004
SCAT_AV
101
7
Premium Paid ADM-SCO- FCO-001
PR_PA
102
8
Bare Premium ADM-SCO- FCO-002
BR_PR
103
9
Proportionate Premium
ADM-SCO- FCO-003
PRO_PR
104
10
Premium paid per card
ADM-SCO- FCO-004
PR_PA_PCRD
105
11
Cards Utilized
ADM-SUT- CUT-001
CRD_UTI
107
12
Covered Card-years ADM-SUT- CUT-002
CCY
108
13
Utilised card-years ADM-SUT- CUT-003
UCY
110
14
Persons Utilized ADM-SUT- PUT-001
P_UTI
111
15
Covered Person-years ADM-SUT- PUT-002
CPY
113
16
Utilised person-years
ADM-SUT- PUT-003
UPY
114
17
Therapies done (TD=TrR_U) ADM-SUT- TUT-001
TD
116
18
Therapies discharged
ADM-SUT- TUT-002
TDIS
117
19
Therapies Claim raised ADM-SUT- TUT-003
CL_RS
118
20
Therapy Claim Approved ADM-SUT- TUT-004
CLA
120
21
Therapy Claim Rejected
ADM-SUT- TUT-005
CLR
121
74
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
22
Therapy Claim kept Pending ADM-SUT- TUT-006
CLPN
122
23
Therapy Claim Lapsed ADM-SUT- TUT-007
CL_LP
123
24
Therapies Claim paid
ADM-SUT- TUT-008
CLB_A
125
25
Claims amount paid for therapies preauthed during a specified period
ADM-SUT- TUT-009
CL_PCST_TP
126
26
Claim amount paid for therapies during a specified period
ADM-SUT- TUT-010
CL_PCST_D
127
27
Card Utilization Rate ADM-SUT- UTR-001
CUR
128
28
Person Utilization Rate ADM-SUT- UTR-002
PUR
130
29
Average number of times a Therapy was performed per 100 card-years among the covered cards
ADM-SUT- UTR-003
ATPCC
131
30
Average number of times a Therapy was performed per 100 card-years among the utilized cards
ADM-SUT- UTR-004
ATPUC
132
31
Average number of times a Therapy was performed per 100 person-years among covered persons
ADM-SUT- UTR-005
ATPCP
134
32
Average number of times a Therapy was performed per 100 person-years among utilized persons
ADM-SUT- UTR-006
ATPUP
135
33
Average number of cards utilized per 100 card years among the covered cards
ADM-SUT- UTR-007
ACPCC
136
34
Average number of Persons who Utilized a service per 100 card years among the covered cards
ADM-SUT- UTR-008
APPCC
138
35
Average number of Persons who Utilized a service per 100 card years among utilized cards
ADM-SUT- UTR-009
APPUC
139
36
Average number of times a card is used per 100 card years among the covered cards
ADM-SUT- UTR-010
ATIPCC
140
37 Average number of times a utilized card is used per 100 card years
ADM-SUT- UTR-011
ATIPUC
141
75
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
among the utilized cards
38 Average number of therapies used per one time usage of a card
ADM-SUT- UTR-012
AUPUC
143
39
Claim Rate for a [dimension] ADM-SUT- CLR-001
CLR
144
40
Claim Deduction Ratio ADM-SUT- CLR-002
CDR
145
41
Weight ADM-SUT- WGT-001
WT_DIM
146
42
Bare Weight ADM-SUT- WGT-002
BW_DIM
147
43
Claim Ratio ADM-SEP- CRT-001
CR
149
44
Bare Claim Ratio ADM-SEP- CRT-002
BCR
150
45
Premium Claim Difference ADM-SEP- CRT-003
PCD
151
46
Average Preauth Size ADM-SEP- CRT-004
APS
152
47
Average Claim Size ADM-SEP- CRT-005
ACS
154
48 Interest Earned by Insurer on Unspent Premium for a phase
ADM-SEP- CRT-006
INT_INS
155
49
Therapies Claim Outstanding for a specified period
ADM-SEP- CCO-001
TCO
156
50 Therapies Claim Outstanding Cost for a specified period
ADM-SEP- CCO-002
TCOC
157
51
Therapies Claim Pending at Bank for a specified period
ADM-SEP- CCO-003
TCB
158
52 Therapies Claim Pending at Bank Cost for a specified period
ADM-SEP- CCO-004
TCBC
160
53
Health Camp Claim Outstanding ADM-SEP- CCO-005
HC_CL_O
161
54 Health Camp Claim Outstanding Cost
ADM-SEP- CCO-006
HC_CLOC
162
55
Health Camp Claim pending ADM-SEP- CCO-007
HC_CLPN
163
56
Health Camp Claim Pending Cost ADM-SEP- CCO-008
HC_CLPNC
165
57
The R² value ADM-SEP- FFO-001
M_PA
166
58
The curve that is fitted ADM-SEP- FFO-002
M_CU
167
59
Error Plot
ADM-SEP- FFO-003
M_ERRPLT
168
76
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
60
Forecast data date ADM-SEP- FFO-004
M_FCST_DT
169
61 Weight of Specified Procedure Basket
ADM-SEP- FFO-005
FCST_RF_WT
170
62
Weight of month's Procedure Basket
ADM-SEP- FFO-006
FCST_MN_WT
172
63 Therapy Claim Paid-Total for a month
ADM-SEP- FFO-007
FCST_TH_CLM
173
64 Relative claim Paid for the month for RAS
ADM-SEP- FFO-008
FCST_RL_CLM
174
65
Relative Total Claim ADM-SEP- FFO-009
FCST_RL_TCLM
175
66
Cumulative relative Claim (Cr)
ADM-SEP- FFO-010
FCST_CL_RCLM
177
67
Hospital Beds
FOP-NWH- ***-001
HB
178
68
Reserved Beds in a NWH FOP-NWH- ***-002
RB
179
69
Occupied Beds in a NWH
FOP-NWH- ***-003
OB
180
70 Occupied Bed-days in a NWH, during a specified period
FOP-NWH- ***-004
OBD
181
71
Hospital OP in a NWH FOP-NWH- ***-005
OP
182
72
Hospital IP in a NWH FOP-NWH- ***-006
IP
183
73
Dr.NTR Vaidya Seva Bed Occupancy Rate, during a specified period
FOP-NWH- ***-007
BOR
184
74 Therapy-month for a given therapy, during a specified period
FOP-NWH- ***-008
THR_MTH
186
75
Bed Occupancy updation time FOP-NWH- ***-009
OB
187
76
Health Camps Conducted FOP-HCA- ***-001
HCC
188
77
Patients Screened FOP-HCA- ***-002
HCPS
189
78
Patients Referred FOP-HCA- ***-003
HCPR
190
79
Health Camp Rate
FOP-HCA- ***-004
HCR
192
80
Patients Screening Rate
FOP-HCA- ***-005
HCSR
193
81
HC patient referral capture rate
FOP-HCA- ***-006
HCAP
194
77
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
82
HC patient referral conversion rate FOP-HCA- ***-007
HCON
195
83
Follow-up eligible cases FOP-FUC-***- 001
FU_ECS
196
84
Follow-up availed cases
FOP-FUC-***- 002
FU_ACS
197
85
Follow-up claim submitted cases FOP-FUC-***- 003
FU_CSCS
199
86
Follow-up claim approved cases FOP-FUC-***- 004
FU_CACS
200
87 Percentage of therapies done in Government hospitals
FOP-GHP- ***-001
PCT_TDN_GH
201
88
Percentage of the cost for therapies done in Government hospitals
FOP-GHP- ***-002
PCT_CSTTDN_GH
202
89 Government Hospital Preauths through Health Camp Route
FOP-GHP- ***-003
HC_RT_GH
203
90 Private Hospital Preauths through Health Camp Route
FOP-GHP- ***-004
HC_RT_PH
205
91
Grievance Arrivals during a specified period
GRE-GRE- ***-001
GR_ARRV
206
92 Relative Frequency of Grievances during a specified period
GRE-GRE- ***-002
RFG
207
93
Grievance Rate during a specified period
GRE-GRE- ***-003
GR
208
94 Feedback letter Return Rate during a specified period
GRE-GRE- ***-004
FB_RR
210
95
Adverse Feedback Rate during a specified period
GRE-GRE- ***-005
AFR
211
96
Relative Bed Units for a NWH EDM-EMP- HUT-001
RBU
212
97
Empanelment Weight for a NWH EDM-EMP- HUT-002
EW
213
98
Weighted Average Cases per month for a NWH, for a specified period
EDM-EMP- HUT-003
WAC
215
99
Weighted Standard Deviation for a NWH
EDM-EMP- HUT-004
WSD
216
100 Average Categories per NWH during a specified period
EDM-EMP- HUT-005
ACN
218
101 Therapies preauthed per Category in a given NWH
EDM-EMP- HUT-006
THR_PA_CA
219
102
Percentage of therapies done by Government Doctors in Private hospitals during a specified period
EDM-EMP- HUT-007
PCT_THR_GVTDOC
220
78
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
103
Revolving Fund from the Preauthorisation's done during a specific period of time
EDM-EMP- HUT-008
RF
221
104
Case Fatality Rate EDM-MAU- ***-001
CFR
223
105
Therapies preauth submitted by MEDCO
OPR-PAU- SUB-001
PAU_S_R PAUC_S_R
224
106
Therapies Preauth Submitted by MEDCO and Live
OPR-PAU- SUB-002
LPAU_S_R LPAUC_S_R
225
107
Therapies Preauth Submitted by MEDCO in Past
OPR-PAU- SUB-003
PPAU_S_R PPAUC_S_R
227
108 Therapies Preauth Updated by MEDCO
OPR-PAU- UPD-001
PAU_U_R
PAUC_U_R
228
109 Therapies Preauth Updated by MEDCO and Live
OPR-PAU- UPD-002
LPAU_U_R LPAUC_U_R
229
110
Therapies Preauth Updated by MEDCO in Past
OPR-PAU- UPD-003
PPAU_U_R PPAUC_U_R
230
111
Therapies Preauth Updated by MEDCO and sent to Preauth operator
OPR-PAU- UPD-004
PAU_U_R_PPD PAU_U_R_PTD PAU_U_R_PAO
231
112
Therapies Preauth cancellation Updated by MEDCO and sent to Preauth operator
OPR-PAU- UPD-005
PAUC_U_R_PPD PAUC_U_R_PTD PAUC_U_R_PAO
233
113 Therapies Preauth Forwarded by NAM
OPR-PAU- FWD-001
PAU_F_N
234
114 Therapies Preauth Forwarded by NAM and Live
OPR-PAU- FWD-002
LPAU_F_N
235
115 Therapies Preauth Forwarded by NAM in Past
OPR-PAU- FWD-003
PPAU_F_N
236
116
Therapies Preauth Disposed by Preauth operator with Recommendation for Approval
OPR-PAU- RAP-001
PAU_RA_PPD PAU_RA_PID PAU_RA_PTD
237
117
Therapies Preauth Disposed by Preauth operator with Recommendation for Approval and Live
OPR-PAU- RAP-002
LPAU_RA_PPD LPAU_RA_PID LPAU_RA_PTD
239
118
Therapies Preauth Disposed by Preauth operator with Recommendation for Approval in the Past
OPR-PAU- RAP-003
PPAU_RA_PPD PPAU_RA_PID PPAU_RA_PTD
240
119
Therapies Preauth Disposed by Preauth operator with Recommendation for Approval without pendency
OPR-PAU- RAP-004
PAU_RA~NP_PPD PAU_RA~NP_PID PAU_RA~NP_PTD
241
79
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
120
Therapies Preauth Disposed by Preauth operator with Recommendation for Approval after pendency
OPR-PAU- RAP-005
PAU_RA~P_PPD PAU_RA~P_PID PAU_RA~P_PTD
243
121
Therapies Preauth Cancellation request Disposed by Preauth operator with Recommendation for Approval
OPR-PAU- RAP-006
PAUC_RA_PPD PAUC_RA_PID PAUC_RA_PTD
244
122
Therapies Preauth Cancellation request Disposed by Preauth operator with Recommendation for Approval (RA)and Live
OPR-PAU- RAP-007
LPAUC_RA_PPD LPAUC_RA_PID LPAUC_RA_PTD
245
123
Therapies Preauth Cancellation request Disposed by with Preauth operator with Recommendation for Approval (RA) in the Past
OPR-PAU- RAP-008
PPAUC_RA_PPD PPAUC_RA_PID PPAUC_RA_PTD
247
124
Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection(RR)
OPR-PAU- RRJ-001
PAU_RR_PPD PAU_RR_PID PAU_RR_PTD
248
125
Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection and live
OPR-PAU- RRJ-002
LPAU_RR_PPD
LPAU_RR_PID
LPAU_RR_PTD
249
126
Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection in the Past
OPR-PAU- RRJ-003
PPAU_RR_PPD
PPAU_RR_PID
PPAU_RR_PTD
251
127
Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection without pendency
OPR-PAU- RRJ-004
PAU_RR~NP_PPD PAU_RR~NP_PID PAU_RR~NP_PTD
252
128
Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection after pendency
OPR-PAU- RRJ-005
PAU_RR~P_PPD PAU_RR~P_PID PAU_RR~P_PTD
253
129 Therapies Preauth Disposed by Preauth operator with Pendency
OPR-PAU- PEN-001
PAU_P_PPD PAU_P_PID PAU_P_PTD
254
130
Therapies Preauth Disposed by Preauth operator with Pendency and Live
OPR-PAU- PEN-002
LPAU_P_PPD LPAU_P_PID LPAU_P_PTD
256
131
Therapies Preauth Disposed by Preauth operator with Pendency in the Past
OPR-PAU- PEN-003
PPAU_P_PPD PPAU_P_PID PPAU_P_PTD
257
80
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
132
Total number of therapies preauthorisation kept pending during specified period
OPR-PAU- PEN-004
PAU_P_T
258
133
Therapies Preauth cancellation request disposed by Preauth operator with Pendency
OPR-PAU- PEN-005
PAUC_P_PPD PAUC_P_PID PAUC_P_PTD
259
134
Therapies Preauth cancellation request Disposed by Preauth operator with Pendency and Live
OPR-PAU- PEN-006
LPAUC_P_PPD LPAUC_P_PID LPAUC_P_PTD
261
135
Therapies Preauth cancellation request disposed by Preauth operator with Pendency in the Past
OPR-PAU- PEN-007
PPAUC_P_PPD PPAUC_P_PID PPAUC_P_PTD
262
136 Therapies Preauth Disposed by Preauth operator with Approval
OPR-PAU- APP-001
PAU_A_PTD PAU_A_PAO
263
137
Total number of therapies preauthorisation approved during specified period
OPR-PAU- APP-002
PAU_A_T
264
138
Therapies Preauth Disposed by Preauth operator with Approval without pendency
OPR-PAU- APP-003
PAU_A~NP_PTD PAU_A~NP_PAO
266
139
Therapies Preauth Disposed by Preauth operator with Approval after pendency
OPR-PAU- APP-004
PAU_A~P_PTD PAU_A~P_PAO
267
140
Therapies Preauth cancellation request Disposed by Preauth operator with Approval
OPR-PAU- APP-005
PAUC_A_PTD PAUC_A_PAO
268
141
Total number of Therapies Preauth cancellation request disposed by Approval
OPR-PAU- APP-006
PAUC_A_T
269
142 Therapies Preauth Disposed by Preauth operator with Rejection
OPR-PAU- REJ-001
PAU_R_PTD PAU_R_PAO
270
143
Therapies Preauth Disposed by Preauth operator with Rejection without pendency
OPR-PAU- REJ-002
PAU_R~NP_PTD PAU_R~NP_PAO
272
144
Therapies Preauth Disposed by Preauth operator with Rejection after pendency
OPR-PAU- REJ-003
PAU_R~P_PTD PAU_R~P_PAO
273
145
Total number of therapies preauthorisation rejected during specified period
OPR-PAU- REJ-004
PAU_R_T
274
146
Total Therapies Preauth Disposed by PPD
OPR-PAU- TDP-001
PAU_D_PPD
275
147
Total Therapies Preauth Disposed by PTD
OPR-PAU- TDP-002
PAU_D_PTD
276
81
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
148 Total Therapies Preauth Disposed by PAO
OPR-PAU- TDP-003
PAU_D_PAO
277
149 Therapies Preauth disposed by auto cancellation
OPR-PAU- AUC-001
PAU_D_AUC
279
150
Therapies treatment Updated by MEDCO
OPR-TRT- UPD-001
TRT_U_R_SUR TRT_U_R_MTR
280
151 Therapies treatment Updated by MEDCO and Live
OPR-TRT- UPD-002
LTRT_U_R_SUR LTRT_U_R_MTR
281
152 Therapies treatment Updated by MEDCO in Past
OPR-TRT- UPD-003
PTRT_U_R_SUR PTRT_U_R_MTR
282
153 Total Therapies Treatment Updated by MEDCO
OPR-TRT- UPD-004
TRT_U_R_T
283
154
Total Therapies Treatment Updated by MEDCO and Live
OPR-TRT- UPD-005
LTRT_U_R_T
284
155
Total Therapies Treatment Updated by MEDCO in Past
OPR-TRT- UPD-006
PTRT_U_R_T
286
156 Therapies Discharge Updated by MEDCO
OPR-DSC- UPD-001
DSC_U_R
287
157
Therapies Death Updated by MEDCO/Executive
OPR-DEA- UPD-001
DEA_U_R DEA_U_X
288
158
Therapies Preauth Waiting for <12 hrs at preauth operator
OPR-PAU- WTC-001
PAU_W<12hrs-NAM PAU_W<12hrs-MEDCO PAU_W<12hrs-PPD PAU_W<12hrs-PTD PAU_W<12hrs-PAO
289
159
Therapies Preauth Waiting for >12 hrs at various levels
OPR-PAU- WTC-002
PAU_W>12hrs_NAM PAU_W>12hrs_MEDCO PAU_W>12hrs_PPD PAU_W>12hrs_PTD PAU_W>12hrs_PAO
290
160 Therapies Preauth Waiting at Preauth operator afresh
OPR-PAU- WTC-003
PAUF_W_PPD PAUF_W_PTD PAUF_W_PAO
292
161
Therapies Preauth Waiting at Preauth operator after updation of pendency
OPR-PAU- WTC-004
PAUP_W_PPD PAUP_W_PTD PAUP_W_PAO
293
162 Total Therapies Preauth Waiting at NAM
OPR-PAU- TWT-001
PAU_W_N
294
163 Therapies Preauth Waiting at MEDCO
OPR-PAU- TWT-002
PAU_W_R
295
164 Total Therapies Preauth Waiting at Preauth operator
OPR-PAU- TWT-003
PAU_W_PPD
296
165 Total Therapies Preauth Waiting at Preauth operator
OPR-PAU- TWT-004
PAU_W_PTD
297
166
Total Therapies Preauth Waiting at Preauth operator
OPR-PAU- TWT-005
PAU_W_PAO
299
82
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
167
Therapies Preauth Waiting at Trust OPR-PAU- TWT-006
PAU_W_TRU
300
168
Therapies Preauth Waiting at NWH OPR-PAU- TWT-007
PAU_W_NWH
301
169
Total Therapies Preauth Waiting
OPR-PAU- TWT-008
PAU_W_T
302
170 Therapies preauthed waiting for Treatment for >15 days
OPR-TRT- WTC-001
TRT_W>15days_R_SUR TRT_W>15days_R_MTR
303
171 Therapies preauthed waiting for Treatment for <15 days
OPR-TRT- WTC-002
TRT_W<15days_R SUR TRT_W<15days_R_MTR
304
172 Total Therapies waiting for Treatment for >15 days
OPR-TRT- WTC-003
TRT_W>15days_R_T
305
173
Total Therapies waiting for <15 days Treatment
OPR-TRT- WTC-004
TRT_W<15days_R_T
307
174
Total Therapies preauthed waiting for Treatment
OPR-TRT- WTC-005
TRT_W_R_T
308
175 Therapies waiting for discharge after Treatment for <15 days
OPR-DSC- WTC-001
DSC_W<15days_R_SUR DSC_W<15days_R_MTR
309
176
Therapies waiting for discharge after treatment for >15 days
OPR-DSC- WTC-002
DSC_W>15days_R_SUR DSC_W>15days_R_MTR
310
177 Total Therapies waiting for discharge after treatment
OPR-DSC- WTC-003
DSC_W_R_T
311
178
Average Case Waiting time for a therapy preauth case at NAM during a specified period
OPR-PAU- AWT-001
PAU_AWT N
312
179
Average case waiting time for a therapy preauth case at MEDCO during a specified period
OPR-PAU- AWT-002
PAU_AWT_R
314
180
Average case waiting time for a therapy preauth case at Preauth operator for a case during a specified period
OPR-PAU- AWT-003
PAU_AWT_PPD PAU_AWT_PTD PAU_AWT_PAO
315
181
Average case waiting time for a fresh therapy preauth case at Preauth operator during a specified period
OPR-PAU- AWT-004
PAUF_AWT_PPD PAUF_AWT_PTD PAUF_AWT_PAO
316
182
Average case waiting time at Preauth operator for a pending preauth updated case during a specified period
OPR-PAU- AWT-005
PAUP_AWT_PPD PAUP_AWT_PTD PAUP_AWT_PAO
317
183
Average waiting time at Trust for a preauth case during a specified period
OPR-PAU- AWT-006
PAU_AWT_TRU
319
184 Average waiting time at NWH for a preauth case during a specified
OPR-PAU- AWT-007
PAU_AWT_NWH
320
83
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
period
185 Average total waiting time for a preauth case
OPR-PAU- AWT-008
PAU_AWT_T
321
186
Average waiting time for treatment updation for a preauth approved case
OPR-TRT- AWT-001
TRT_AWT_SUR TRT_AWT_MTR
322
187
Average discharge updation waiting time for a preauth approved case during a specified period
OPR-DSC- AWT-001
DSC_AWT_SUR DSC_AWT_MTR
323
188
On-bed time for a case
OPR-OBD- AWT-001
OBD_AWT_SUR OBD_AWT_MTR
325
189
Hourly Preauth Arrival for each of the 24 hours in a day
OPR-PAU- HPA-001
PAU_HA
326
190
Preauth Arrival Rate OPR-PAU- ART-001
PAU_ART
327
191
Hourly Preauth approval for each of the 24 hours in a day
OPR-PAU- HAP-001
PAU_HAP
328
192
Preauth Approval rate OPR-PAU- APR-001
PAU_APR
329
193 Daily Turnover of preauth cases by Preauth operator
OPR-PAU- DTO-001
PAU_DTO_PPD PAU_DTO_PTD PAU_DTO_PAO
330
194 Preauth Turnover Rate for Preauth operator
OPR-PAU- TOR-001
PAU_TOR_PPD PAU_TOR_PTD PAU_TOR_PAO
332
195
Average Case Processing Time of Preauth Operator, during a specified period
OPR-PAU- CPT-001
PAU_ACPT
333
196
Preauth Pendency Percentage for Preauth Operator during a specified period
OPR-PAU- PPP-001
PAU_PPP_PPD PAU_PPP_PTD PAU_PPP_PAO
334
197 Telephonic Intimations PEX Approved
OPR-PAU- TIN-001
PAU_TIN_A_X
335
198
Preauthorisations-Regular-With buffer PTD Recommended Approval
OPR-PAU- BUF-001
BPAU_RA_PTD
336
199
Preauthorisations-Regular-With buffer PTD Recommended Rejection
OPR-PAU- BUF-002
BPAU_RR_PTD
338
200
Preauthorisations-Regular-With buffer PTD Pending
OPR-PAU- BUF-003
BPAU_P_PTD BPAU_P_PAO
339
201
Preauthorisations-Regular-With buffer PAO Approved
OPR-PAU- BUF-004
BPAU_A_PAO
340
202
Preauthorisations-Regular-With
OPR-PAU-
BPAU_R_PAO 341
84
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
buffer PAO Rejected BUF-005
203 Pre-authorisations - Enhancement MEDCO Initiated
OPR-PAU- ENH-001
PAU_ENH_I_R
342
204 Pre-authorisations - Enhancement MEDCO Updated
OPR-PAU- ENH-002
PAU_ENH_U_R
343
205 Pre-authorisations Enhancement updation waiting MEDCO
OPR-PAU- ENH-003
PAU_ENH_U_W_R
344
206
Pre-authorisations - Enhancement Preauth Operator Recommended Approval
OPR-PAU- ENH-004
PAU_ENH_RA_PTD PAU_ENH_RA_MC-ETC
345
207 Pre-authorisations - Enhancement Preauth Operator Rejected
OPR-PAU- ENH-005
PAU_ENH_R_PTD PAU_ENH_R_MC-ETC PAU_ENH_R_PAO
347
208 Pre-authorisations - Enhancement Preauth Operator Pending
OPR-PAU- ENH-006
PAU_ENH_P_PTD PAU_ENH_P_MC-ETC PAU_ENH_P_PAO
348
209 Pre-authorisations - Enhancement PAO Approved
OPR-PAU- ENH-007
PAU_ENH_A_PAO
349
210 Pre-authorisations Enhancement cases waiting at Preauth Operator
OPR-PAU- ENH-008
PAU_ENH_W_PTD PAU_ENH_W_MC-ETC PAU_ENH_W_PAO
350
211 Pre-Authorisations-Cochlear Cases Initiated by MEDCO
OPR-PAU- CCH-001
PAU_CCH_I_R
351
212 Pre-Authorisations-Cochlear Cases Updated by MEDCO
OPR-PAU- CCH-002
PAU_CCH_U_R
353
213 Pre-authorisations Cochlear cases updation waiting at MEDCO
OPR-PAU- CCH-003
PAU_CCH_W_R
354
214
Pre-Authorisations-Cochlear Cases forwarded by Preauth Operator
OPR-PAU- CCH-004
PAU_CCH_F_N PAU_CCH_F_X
355
215
Pre-authorisations Cochlear cases waiting at Preauth Operator
OPR-PAU- CCH-005
PAU_CCH_W_N PAU_CCH_W_X
356
216
Pre-Authorisations-Cochlear Cases Recommended Approval by Preauth Operator
OPR-PAU- CCH-006
PAU_CCH_RA_MC-CC PAU_CCH_RA_C-CC
357
217
Pre-Authorisations-Cochlear Cases Recommended Rejection by Preauth Operator
OPR-PAU- CCH-007
PAU_CCH_RR_MC-CC PAU_CCH_RR_C-CC
358
218 Pre-Authorisations-Cochlear Cases Pending with Preauth Operator
OPR-PAU- CCH-008
PAU_CCH_P_MC-CC PAU_CCH_P_C-CC PAU_CCH_P_PAO
360
219 Pre-authorisations Cochlear cases waiting with Preauth Operator
OPR-PAU- CCH-009
PAU_CCH_W_MC-CC PAU_CCH_W_C-CC PAU_CCH_W_PAO
361
220 Pre-Authorisations-Cochlear Cases C-CC Rejected by Preauth Operator
OPR-PAU- CCH-010
PAU_CCH_R_C-CC PAU_CCH_R_PAO
362
85
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
221 Pre-Authorisations-Cochlear Cases PAO Approved
OPR-PAU- CCH-011
PAU_CCH_A_C-CC PAU_CCH_A_PAO
363
222 Pre-auth Cochlear Cancel Requests MEDCO Initiated
OPR-PAU- CCH-012
PAUC _CCH_I_R
365
223
Pre-auth Cochlear cases Cancel Requests MEDCO Updated
OPR-PAU- CCH-013
PAUC_CCH_U_R
366
224 Pre-auth Cochlear cases Cancel Requests waiting with MEDCO
OPR-PAU- CCH-014
PAUC_CCH_W_R
367
225
Pre-Authorisations-Cochlear Cases Cancel Requests Recommended Approval by preauth operator
OPR-PAU- CCH-015
PAUC_CCH_RA_MC-CC PAUC_CCH_RA_C-CC
368
226
Pre-Authorisations-Cochlear Cases Cancel Requests Recommended Rejection by preauth operator
OPR-PAU- CCH-016
PAUC_CCH_RR_MC-CC PAUC_CCH_RR_C-CC
369
227
Pre-Authorisations-Cochlear Cases Cancel Requests Pending by preauth operator
OPR-PAU- CCH-017
PAUC_CCH_P_MC-CC PAUC_CCH_P_C-CC
370
228
Pre-auth Cochlear cases Cancel Requests waiting with preauth operator
OPR-PAU- CCH-018
PAUC_CCH_W_MC-CC PAUC_CCH_W_C-CC
372
229
Pre-Authorisations-Cochlear Cases Cancel Requests Rejected by preauth operator
OPR-PAU- CCH-019
PAUC_CCH_R_C-CC
373
230
Therapy Claims Eligible
OPR-CLM- ELG-001
CLM_ELG
374
231
Therapy Claims submitted OPR-CLM- SUB-001
CLM_S_R
375
232
Therapy Claims submitted and Live
OPR-CLM- SUB-002
LCLM_S_R
376
233
Therapy Claims submitted in Past OPR-CLM- SUB-003
PCLM_S_R
377
234 Therapy Claims Updated by MEDCO
OPR-CLM- UPD-001
CLM_U_R
378
235 Therapy Claims Updated by MEDCO and Live
OPR-CLM- UPD-002
LCLM_U_R
379
236 Therapy Claims Updated by MEDCO in Past
OPR-CLM- UPD-003
PCLM_U_R
381
237
Therapy Claims Updated by MEDCO and sent to Claims operator
OPR-CLM- WTC-001
CLM_W_CPD CLM_W_CTD CLM_W_CH CLM_W_CAO
382
238
Therapy Claims Forwarded by CEX OPR-CLM- FWD-001
CLM_F_X
383
239
Therapy Claims Forwarded by CEX and Live
OPR-CLM- FWD-002
LCLM_F_X
384
86
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
240 Therapy Claims Forwarded by CEX in Past
OPR-CLM- FWD-003
PCLM_F_X
385
241
Therapy Claims Disposed by Claims operator with Recommended for Approval
OPR-CLM- RAP-001
CLM_RA_CPD CLM_RA_CTD CLM_RA_CH
386
242
Therapy Claims Disposed by Claims operator with Recommended for Approval and Live
OPR-CLM- RAP-002
LCLM_RA_CPD LCLM_RA_CTD LCLM_RA_CH
388
243
Therapy Claims Disposed by Claims operator with Recommended for Approval in the Past
OPR-CLM- RAP-003
PCLM_RA_CPD PCLM_RA_CTD PCLM_RA_CH
389
244
Therapy Claims Disposed by Claims operator with Recommended for Approval without pendency
OPR-CLM- RAP-004
CLM_RA~NP_CTD CLM_RA~NP_CH
390
245
Therapy Claims Disposed by Claims operator with Recommended for Approval after pendency
OPR-CLM- RAP-005
CLM_RA~P_CTD CLM_RA~P_CH
391
246 Therapy Claims Disposed by Claims operator with RR
OPR-CLM- RRJ-001
CLM_RR_CPD CLM_RR_CTD CLM_RR_CH
393
247
Therapy Claims Disposed by Claims operator with Recommendation for Rejection and Live
OPR-CLM- RRJ-002
LCLM_RR_CPD LCLM_RR_CTD LCLM_RR_CH
394
248
Therapy Claims Disposed by Claims operator with Recommendation for Rejection in the Past
OPR-CLM- RRJ-003
PCLM_RR_CPD PCLM_RR_CTD PCLM_RR_CH
395
249
Therapy Claims Disposed by Claims operator with Recommendation for Rejection without pendency
OPR-CLM- RRJ-004
CLM_RR~NP_CTD CLM_RR~NP_CH
396
250
Therapy Claims Disposed by Claims operator with Recommendation for Rejection after pendency
OPR-CLM- RRJ-005
CLM_RR~P_CTD CLM_RR~P_CH
398
251
Therapy Claims Disposed by Claims operator with Pendency
OPR-CLM- PEN-001
CLM_P_CPD CLM_P_CTD CLM_P_CH CLM_P_CAO
399
252
Therapy Claims Disposed by Claims operator with Pendency and Live
OPR-CLM- PEN-002
LCLM_P_CPD LCLM_P_CTD LCLM_P_CH LCLM_P_CAO
400
253
Therapy Claims Disposed by Claims operator with Pendency in the Past
OPR-CLM- PEN-003
PCLM_P_CPD PCLM_P_CTD PCLM_P_CH PCLM_P_CAO
401
254
Therapy Claims Disposed by Claims operator with Approval
OPR-CLM- APP-001
CLM_A_CH CLM_A_CAO
403
87
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
255
Therapy Claims Disposed by Claims operator with Approval without pendency
OPR-CLM- APP-002
CLM_A~NP_CH CLM_A~NP_CAO
404
256
Therapy Claims Disposed by Claims operator with Approval after pendency
OPR-CLM- APP-003
CLM_A~P_CH CLM_A~P_CAO
405
257
Therapy Claims Disposed by Claims operator with Rejection
OPR-CLM- REJ-001
CLM_R_CH CLM_R_CAO
406
258
Therapy Claims Disposed by Claims operator with Rejection without pendency
OPR-CLM- REJ-002
CLM_R~NP_CH CLM_R~NP_CAO
407
259
Therapy Claims Disposed by Claims operator with Rejection after pendency
OPR-CLM- REJ-003
CLM_R~P_CH CLM_R~P_CAO
408
260
Total Therapy claims Disposed by CPD
OPR-CLM- TDP-001
CLM_D_CPD
409
261 Total Therapy claims Disposed by CTD
OPR-CLM- TDP-002
CLM_D_CTD
410
262 Total Therapy claims Disposed by CH
OPR-CLM- TDP-003
CLM_D_CH
412
263 Therapy claims Disposed by CH (for insurance)
OPR-CLM- TDP-004
CLM_D_ICH
413
264
Therapy claims Disposed by CAO
OPR-CLM- TDP-005
CLM_D_CAO
414
265 Therapy Claims Disposed by A/C with Approval
OPR-CLM- TDP-006
CLM_A_AC
415
266
Therapy Claims Paid by Bank
OPR-CLM- TDP-007
CLM_A_B
416
267 Average Hourly Claims Arrival for each of the 24 hours in a day
OPR-CLM- HAR-001
CLM_HA
417
268
Claims Arrival Rate
OPR-CLM- CAR-001
CLM_ART
418
269 Average Hourly Claims Disposal for each of the 24 hours in a day
OPR-CLM- HCD-001
CLM_HD
419
270
Claims Disposal Rate OPR-CLM- CDR-001
CLM_DR
420
271
Therapy Claims Waiting at MEDCO OPR-CLM- WTC-001
CLM_W>7days_R CLM_W<7days_R
421
272
Therapy Claims Waiting at CEX OPR-CLM- WTC-002
CLM_W>7days_CX CLM_W<7days_CX
423
273
Therapy Claims Waiting at Claims operator afresh
OPR-CLM- WTC-003
CLMF_W_CPD CLMF_W_CTD CLMF_W_CH CLMF_W_CAO
424
88
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
274
Therapy Claims Waiting at Claims operator after updation of pendency
OPR-CLM- WTC-004
CLMP_W_CPD CLMP_W_CTD CLMP_W_CH CLMP_W_CAO
425
275
Therapy Claims Waiting at CPD for <7 days
OPR-CLM- WTC-005
CLM_W<7_CPD CLM_W<7_CTD CLM_W<7_CH CLM_W<7_CAO
426
276
Therapy Claims Waiting at Claims operator for >7 days
OPR-CLM- WTC-006
CLM_W>7_CPD CLM_W>7_CTD CLM_W>7_CH CLM_W>7_CAO
428
277
Therapy Claims Waiting at A/C OPR-CLM- WTC-007
CLM_W<7days_AC CLM_W>7days_AC
429
278
Therapy Claims Waiting at Bank OPR-CLM- WTC-008
CLM_W<7days_B CLM_W>7days_B
430
279 Total Therapy Claims Waiting at MEDCO
OPR-CLM- TWN-001
CLM_W_R_T
431
280 Total Therapy Claims Waiting at CEX
OPR-CLM- TWN-002
CLM_W_CX_T
432
281 Total Therapy Claims Waiting at CPD
OPR-CLM- TWN-003
CLM_W_CPD_T
433
282 Total Therapy Claims Waiting at CTD
OPR-CLM- TWN-004
CLM_W_CTD_T
434
283
Total Therapy Claims Waiting at CH
OPR-CLM- TWN-005
CLM_W_CH_T
436
284 Total Therapy Claims Waiting at CAO
OPR-CLM- TWN-006
CLM_W_CAO_T
437
285
Total Therapy Claims Waiting at A/C
OPR-CLM- TWN-007
CLM_W_AC
438
286 Total Therapy Claims Waiting at Bank
OPR-CLM- TWN-008
CLM_W_B
439
287
Total Therapy Claims Waiting for approval at Trust
OPR-CLM- TWN-009
CLM_W_TRU
440
288
Total Therapy Claims Waiting for approval at NWH
OPR-CLM- TWN-010
CLM_W_NWH
441
289
Total Therapy Claims Waiting for Approval
OPR-CLM- TWN-011
CLM_W_T
442
290
Average CWT for disposal of fresh claim cases at MEDCO during a specified period
OPR-CLM- AWT-001
CLMF_AWT_R
443
291
Average CWT for updation of pending claim cases at MEDCO during a specified period
OPR-CLM- AWT-002
CLMP_AWT_R
444
292 Average CWT at CEX for a fresh Claim case during a specified
OPR-CLM- AWT-003
CLM_AWT_CX
446
89
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
period
293
Average CWT at Claims operator for a fresh Claim case during a specified period
OPR-CLM- AWT-004
CLMF_AWT_CPD CLMF_AWT_CTD CLMF_AWT_CH CLMF_AWT_CAO
447
294
Average CWT at claims operator for a pending updated Claim case during a specified period
OPR-CLM- AWT-005
CLMP_AWT_CPD CLMP_AWT_CTD CLMP_AWT_CH CLMP_AWT_CAO
448
295
Average CWT at claims operator for a Claim case during a specified period
OPR-CLM- AWT-006
CLM_AWT_CPD CLM_AWT_CTD CLM_AWT_CH CLM_AWT_CAO
449
296
Average CWT at A/C for a Claim case during a specified period
OPR-CLM- AWT-007
CLM_AWT_AC
451
297 Average CWT at Bank for a Claim case during a specified period
OPR-CLM- AWT-008
CLM_AWT_B
452
298 Average CWT at Trust for a Claim case
OPR-CLM- AWT-009
CLM_AWT_TRU
453
299
Average CWT at NWH for a Claim case
OPR-CLM- AWT-010
CLM_AWT_NWH
454
300 Average CWT for approval of a claim case
OPR-CLM- AWT-011
CLM_AWT_TO
455
301
Average CWT for payment of a claim case during a specified period
OPR-CLM- AWT-012
CLM_AWT_P
456
302
Turnover Rate for claims, of claims operator for a specified period
OPR-CLM- TOR-001
CLM_TOR_CX CLM_TOR_CPD CLM_TOR_CTD CLM_TOR_CH CLM_TOR_CAO
457
303 TOR for a role during a specified period
OPR-CLM- TOR-002
CLM_TOR_RO
459
304
Daily Turnover of claims operator
OPR-CLM- DTO-001
CLM_DTO_CX CLM_DTO_CPD CLM_DTO_CTD CLM_DTO_CH CLM_DTO_CAO
460
305
Claim Pendency Percentage for claims operator during a specified period
OPR-CLM- CPP-001
CLM_CPP_CPD CLM_CPP_CTD CLM_CPP_CH CLM_CPP_CAO
461
306 Empanelment Application Hospital User Initiated
EMP-EAP- INT-001
EAP_I_R
463
307 Empanelment Application Hospital User Updated
EMP-EAP- UPD-001
EAP_U_R
464
90
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
308
Empanelment Application Registration Forwarded by empanelment operator
EMP-ERE- FWD-001
EAP_RE_F_EEX EAP_RE_F_EPO EAP_RE_F_EPD
465
309 Empanelment Application- Registration approved by EH
EMP-ERE- APP-002
EAP_RE_A_EH
466
310
Empanelment Application- Registration kept pending by EH
EMP-ERE- PEN-003
EAP_RE_P_EH
467
311
Empanelment Application- Registration rejected by EH
EMP-ERE-REJ- 004
EAP_RE_R_EH
468
312
Empanelment -Inspection EPO Initiated
EMP-EIP-INT- 001
EMP_IP_I_EPO
469
313 Empanelment -Inspection MC-EDC Updated
EMP-EIP- UPD-002
EMP_IP_U_MC-EDC
470
314
Empanelment Authorisation Recommended Approval by empanelment operator
EMP-EAU- RAP-001
EMP_AU_RA_MC-EDC EMP_AU_RA_EAO
471
315
Empanelment Authorisation Recommended Rejection by empanelment operator
EMP-EAU- RRE-002
EMP_AU_RR_MC-EDC EMP_AU_RR_EAO
472
316
Empanelment Authorisation Rejected by empanelment operator
EMP-EAU- REJ-003
EMP_AU_R_MC-EDC EMP_AU_R_EAO EMP_AU_R_EH
474
317 Empanelment Authorisation Pending by empanelment operator
EMP-EAU- PEN-004
EMP_AU_P_MC-EDC EMP_AU_P_EAO EMP_AU_P_EH
475
318 Empanelment Authorisation- EH Approved
EMP-EAU- APP-005
EMP_AU_A_EH
476
319 Additional Specialities Empanelment MEDCO Initiated
EMP-EAS-INT- 001
EAS_I_R
477
320 Additional Specialities Empanelment MEDCO Updated
EMP-EAS- UPD-001
EAS_U_R
478
321
Additional Specialities Empanelment Recommended Approval Empanelment Operator
EMP-EAS- RAP-001
EAS_RA_EEX EAS_RA_EPO
479
322
Additional Specialities Empanelment Recommended Rejection Empanelment Operator
EMP-EAS- RRE-001
EAS_RR_EEX EAS_RR_EPO
480
323
Additional Specialities Empanelment Pending Empanelment Operator
EMP-EAS- PEN-001
EAS_P_EEX EAS_P_EPO EAS_P_MC-EDC
482
324
Additional Specialities Empanelment inspection Approved Empanelment Operator
EMP-EAS-IAP- 001
EAS_IP_A_MC-EDC EAS_IP_A_EPO
483
325 Additional Specialities Empanelment Inspection MC-EDC
EMP-EAS-IRE- 001
EAS_IP_R_MC-EDC EAS_IP_R_EH
484
91
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
Rejected
326
Additional Specialities Empanelment-Inspection MC-EDC Updated
EMP-EAS- IUP-001
EAS_IP_U_MC-EDC
485
327 Additional Specialities Empanelment EH Approved
EMP-EAS- APP-001
EAS_A_EH
486
328 Change Requests of MEDCO Initiated by MEDCO
EMP-ECR- INT-001
ECR_I_R
487
329 Change Requests of MEDCO Updated by MEDCO
EMP-ECR- UPD-001
ECR_U_R
488
330
Change Requests of MEDCO- Recommended Approval by Empanelment Operator
EMP-ECR- RAP-001
ECR_RA_ITEX ECR_RA_EEX ECR_RA_MD-EDC
489
331
Change Requests of MEDCO Pending by Empanelment Operator
EMP-ECR- PEN-001
ECR_P_ITEX ECR_P_EEX ECR_P_MD-EDC ECR_P_EH
491
332
Change Requests of MEDCO Rejected by Empanelment Operator
EMP-ECR-REJ- 001
ECR_R_EEX ECR_R_MD-EDC ECR_R_EH
492
333 Change Requests of MEDCO Approved
EMP-ECR- APP-001
ECR_A_EH
493
334 Change Requests of NVMCCO Initiated by MEDCO
EMP-ECA- INT-001
ECA_I_R
494
335
Change Requests of NVMCCO Updated by MEDCO
EMP-ECA- UPD-001
ECA_U_R
495
336
Change Requests of NVMCCO Recommended Approval by Empanelment Operator
EMP-ECA- RAP-001
ECA_RA_ITEX ECA_RA_EEX ECA_RA_MD-EDC
496
337
Change Requests of NVMCCO Pending by Empanelment Operator
EMP-ECA- PEN-001
ECA_P_ITEX ECA_P_EEX ECA_P_MD-EDC ECA_P_EH
498
338
Change Requests of NVMCCO Rejected by Empanelment Operator
EMP-ECA- REJ-001
ECA_R_EEX ECA_R_MD-EDC ECA_R_EH
499
339
Change Requests of NVMCCO Approved by Empanelment Operator
EMP-ECA- APP-001
ECA_A_EH
500
340
Change Requests of Additional NVMCCO Initiated by MEDCO
EMP-EAA- INT-001
EAA_I_R
501
341 Change Requests of Additional NVMCCO Updated by MEDCO
EMP-EAA- UPD-001
EAA_U_R
502
342
Change Requests of Additional NVMCCO Recommended Approval by Empanelment Operator
EMP-EAA- RAP-001
EAA_RA_ITEX EAA_RA_EEX EAA_RA_MD-EDC
504
92
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
343
Change Requests of Additional NVMCCO Pending by Empanelment Operator
EMP-EAA- PEN-001
EAA_P_ITEX EAA_P_EEX EAA_P_MD-EDC EAA_P_EH
505
344
Change Requests of Additional NVMCCO Rejected by Empanelment Operator
EMP-EAA- REJ-001
EAA_R_EEX EAA_R_MD-EDC EAA_R_EH
506
345 Change Requests of Additional NVMCCO Approved by EH
EMP-EAA- APP-001
EAA_A_EH
508
346
Change Requests of Additional MEDCO Initiated by MEDCO
EMP-EAR- INT-001
EAR_I_R
509
347 Change Requests of Additional MEDCO Updated by MEDCO
EMP-EAR- UPD-001
EAR_U_R
510
348
Change Requests of Additional MEDCO Recommended Approval by Empanelment Operator
EMP-EAR- RAP-001
EAR_RA_ITEX EAR_RA_EEX EAR_RA_MD-EDC
511
349
Change Requests of Additional MEDCO Pending by Empanelment Operator
EMP-EAR- PEN-001
EAR_P_ITEX EAR_P_EEX EAR_P_MD-EDC EAR_P_EH
512
350
Change Requests of Additional MEDCO Rejected by Empanelment Operator
EMP-EAR- REJ-001
EAR_R_EEX EAR_R_MD-EDC EAR_R_EH
513
351
Change Requests of Additional MEDCO Approved by Empanelment Operator
EMP-EAR- APP-001
EAR_A
515
352 Change of Bank Account Number Initiated by MEDCO
EMP-EBA- INT-001
EBA_I_R
516
353
Change of Bank Account Number Updated by MEDCO
EMP-EBA- UPD-001
EBA_U_R
517
354
Change of Bank Account Number Recommended Approval by Empanelment Operator
EMP-EBA- RAP-001
EBA_RA_EEX EBA_RA_DFO
518
355
Change of Bank Account Number Rejected by Empanelment Operator
EMP-EBA- REJ-001
EBA_R_EEX EBA_R_DFO EBA_R_CH
519
356
Change of Bank Account Number Pending by Empanelment Operator
EMP-EBA- PEN-001
EBA_P_EEX EBA_P_DFO EBA_P_CH
520
357 Change of Bank Account Number Approved by CH
EMP-EBA- APP-001
EBA_A_CH
522
358 Expertise Details Initiated by MEDCO
EMP-EXD- INT-001
EXD_I_R
523
359 Expertise Details Updated by MEDCO
EMP-EXD- UPD-001
EXD_U_R
524
93
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
360
Expertise Details Recommended Approval by Empanelment Operator
EMP-EXD- RAP-001
EXD_RA_EEX EXD_RA_EPD EXD_RA_MD-EDC
525
361
Expertise Details Rejected Empanelment Operator
EMP-EXD- REJ-001
EXD_R_EEX EXD_R_EPD EXD_R_MD-EDC EXD_R_EH
526
362
Expertise Details Pending Empanelment Operator
EMP-EXD- PEN-001
EXD_P_EEX EXD_P_EPD EXD_P_MD-EDC EXD_P_EH
527
363
Expertise Details Approved EH
EMP-EXD- APP-001
EXD_A_EH 529
364 Therapies Follow-up cases submitted by MEDCO
OPR-FOL- SUB-001
FOL_S_R 530
365 Therapies Follow-up cases updated by MEDCO
OPR-FOL- UPD-001
FOL_U_R 531
366 Therapies Follow-up cases forwarded by CEX
OPR-FOL- FWD-001
FOL_U_R 532
367
Therapies Follow-up cases Recommended Approval
OPR-FOL- RAP-001
FOL_RA_CTD 533
368 Therapies Follow-up cases Recommended Rejection
OPR-FOL-RRJ- 001
FOL_RR_CTD 534
369
Therapies Follow-up cases kept pending
OPR-FOL- PEN-001
FOL_P_CTD FOL_P_CAO
535
370
Therapies Follow-up cases approved
OPR-FOL- APP-001
FOL_A_CTD FOL_A_CAO FOL_A_AC
537
371
Therapies Follow-up cases rejected OPR-FOL-REJ- 001
FOL_R_CTD FOL_R_CAO
538
372 Cochlear Therapies Follow-up cases submitted by MEDCO
OPR-FCH- SUB-001
FCH_S_R 539
373 Cochlear Therapies Follow-up cases updated by MEDCO
OPR-FCH- UPD-001
FCH_U_R 540
374
Cochlear Therapies Follow-up cases forwarded by CEX
OPR-FCH- FWD-001
FCH_F_CEX 541
375 Cochlear Therapies Follow-up cases Recommended Approval
OPR-FCH- RAP-001
FCH_RA_MC-CC FCH_RA_C-CC
542
376
Cochlear Therapies Follow-up cases Recommended Rejection
OPR-FCH-RRJ- 001
FCH_RR_MC-CC FCH_RR_C-CC
544
377 Cochlear Therapies Follow-up cases kept pending
OPR-FCH- PEN-001
FCH_P_MC-CC FCH_P_C-CC
545
378 Cochlear Therapies Follow-up cases approved
OPR-FCH- APP-001
FCH_A_CAO FCH_A_AC
546
379 Attendance of NAM FOP-NAM-
ATN-001
ATN_N 547
94
Gsl n
Indicator Name Indicator Code
Indicator Acronym Pg No.
380 Regular preauth cases cleared by NAM
FOP-NAM- PCL-001
PAU_F_N 549
381 Patient registrations done by NAM FOP-NAM-
REG-001
REG_N 550
382
OP/IP Conversions done by NAM FOP-NAM- CON-001
CON_N 551
383 Follow-up cases cleared by NAM FOP-NAM-
FOL-001
FOL_F_N 552
384 133 reserved procedure Cases referred by NAM
FOP-NAM- REF-001
REF_N 553
385 On bed updation by NAM FOP-NAM-
BUP-001
BUP_N 555
386
Attendance of PAM FOP-PAM- ATN-001
ATN_PAM 556
387
Patient registrations done by PAM FOP-PAM- REG-001
REG_PAM 557
388 Referral Capture count by PAM FOP-PAM-
REF-001
REF_PAM 558
389
Referral Conversion Count by PAM FOP-PAM- CON-001
CON_PAM 560
390 Dr.NTR Vaidya Seva discharged patients visited by PAM
FOP-PAM- FVS-001
FVS_PAM 561
391 Dr.NTR Vaidya Seva patients mobilised for follow-up treatment by PAM
FOP-PAM- FOL-001
FOL_PAM 562
392 IEC Conducted by PAM FOP-PAM-
IEC-001
IEC_PAM 563
95
15. INDICATOR BANK
1. ADM-SCO-PCO-001
# KPI Properties Description
1 Gsln: 1
2 Major Group: ADM
3 Minor Group: SCO
4 Sub Category: PCO
5 Indicator Code: ADM-SCO-PCO-001
6 Indicator Name: Number of Cards Covered
7 Indicator Acronym:
CCO
8 Indicator Description:
The number of cards which were covered as per the agreement with Insurer during that policy period (or) the number of cards eligible under a Scheme during a specified period
9 Dimensions: Policy Period and Phase, District
10 Role & Action: NA
11 Formula: Count of the cards covered
12 Data required: Number of cards covered during a specified period
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N N N N N Policy Period
14 Data source: Bid dcouments of RAS
15 Indicator Monitors:
Input
16 Indicator use: Summary measure to see how many cards are being covered during a particular period
96
17 Unit of measure for the Indicator:
Number of cards
18 Type: A
19 Remarks: Note: Categorised as program administration indicator, that is the reason the indicators are coded by adm-***- ***-*** format (in reports referred as 'Cards')
********************************************************************
2. ADM-SCO-PCO-002
# KPI Properties Description
1 Gsln: 2
2 Major Group: ADM
3 Minor Group: SCO
4 Sub Category: PCO
5 Indicator Code: ADM-SCO-PCO-002
6 Indicator Name: Number of Persons covered
7 Indicator Acronym:
PCO
8 Indicator Description:
The number of people in the cards that were covered as per the agreement with the insurer during the policy period (or) the number of persons eligible under a scheme during a specified period
9 Dimensions: Policy Period and Phase, District
10 Role & Action: NA
11 Formula: Count of the people covered
12 Data required: The population covered is obtained from civil supplies and other relevant data sources (such as Journalist Cards etc.)
97
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N N N N N Policy Period
14 Data source: Bid documents of RAS
15 Indicator Monitors:
Input
16 Indicator use: Summary measure to see how many people are being covered during a particular period
17 Unit of measure for the Indicator:
Number of persons
18 Type: A
19 Remarks: (in reports referred as 'Population')
********************************************************************
3. ADM-SCO-BCO-001
# KPI Properties Description
1 Gsln: 3
2 Major Group: ADM
3 Minor Group: SCO
4 Sub Category: BCO
5 Indicator Code: ADM-SCO-BCO-001
6 Indicator Name: Number of Therapies available
7 Indicator Acronym:
THR_AV
8 Indicator Description:
The number of therapies available as a whole for the Trust
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
98
11 Formula: Count of the number of therapies
12 Data required: Number of therapies or procedures available during a specified period (generally policy period)
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N N N N N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: Summary measure to see how many therapies are covered during a particular period
17 Unit of measure for the Indicator:
Number of therapies
18 Type: A
19 Remarks: (in reports referred as 'Therapies Available')
********************************************************************
4. ADM-SCO-BCO-002
# KPI Properties Description
1 Gsln: 4
2 Major Group: ADM
3 Minor Group: SCO
4 Sub Category: BCO
5 Indicator Code: ADM-SCO-BCO-002
6 Indicator Name: Number of Therapies applicable
7 Indicator Acronym:
THR_APP
99
8 Indicator Description:
The number of therapies applicable in a particular scheme for a specified period. This number differs for insurance scheme, for trust mode, CMCO, Journalist scheme etc
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Count of the number of therapies
12 Data required: Number of therapies or procedures available under different schemes during a specified period (generally policy period)
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N N N N N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: Summary measure to see how many therapies are covered under different schemes present in our business model during a particular period
17 Unit of measure for the Indicator:
Number of therapies
18 Type: A
19 Remarks: (in reports referred as 'Therapies applicable')
********************************************************************
100
5. ADM-SCO-BCO-003
# KPI Properties Description
1 Gsln: 5
2 Major Group: ADM
3 Minor Group: SCO
4 Sub Category: BCO
5 Indicator Code: ADM-SCO-BCO-003
6 Indicator Name: Number of Medical Specialities Available
7 Indicator Acronym:
MCAT_AV
8 Indicator Description:
The number of medical specialities which are available
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Count of the number of medical specialities
12 Data required: Number of medical specialities available during a specified period (generally policy period)
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N N N N N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: Summary measure to see how many medical specialities are covered during a particular period
17 Unit of measure for the Indicator:
Number of medical specialities
18 Type: A
101
19 Remarks: NA
*****************************************************************
6.ADM-SCO-BCO-004
# KPI Properties Description
1 Gsln: 6
2 Major Group: ADM
3 Minor Group: SCO
4 Sub Category: BCO
5 Indicator Code: ADM-SCO-BCO-004
6 Indicator Name: Number of Surgical Specialities Avaialable
7 Indicator Acronym:
SCAT_AV
8 Indicator Description:
The number of surgical specialities which are available
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Count of the number of surgical specialities
12 Data required: Number of surgical specialities available during a specified period (generally policy period)
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N N N N N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: Summary measure to see how many surgical specialities are covered during a particular period
102
17 Unit of measure for the Indicator:
Number of surgical specialities
18 Type: A
19 Remarks: NA
********************************************************************
7.ADM-SCO-FCO-001
# KPI Properties Description
1 Gsln: 7
2 Major Group: ADM
3 Minor Group: SCO
4 Sub Category: FCO
5 Indicator Code: ADM-SCO-FCO-001
6 Indicator Name: Premium Paid
7 Indicator Acronym:
PR_PA
8 Indicator Description:
Total Amount prepaid to the insurer during the policy period including taxes, including payments for any additional cards
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Sum of the amounts paid to the insurer including service tax
12 Data required: Amount paid to the insurer including service tax
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N N N N N Policy Period
14 Data source: RAS Database
103
15 Indicator Monitors:
Input
16 Indicator use: Summary measure to monitor the amount paid to the insurer
17 Unit of measure for the Indicator:
Rupees
18 Type: A
19 Remarks: NA
********************************************************************
8.ADM-SCO-FCO-002
# KPI Properties Description
1 Gsln: 8
2 Major Group: ADM
3 Minor Group: SCO
4 Sub Category: FCO
5 Indicator Code: ADM-SCO-FCO-002
6 Indicator Name: Bare Premium
7 Indicator Acronym:
BR_PR
8 Indicator Description:
Premium paid without including taxes
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Amount paid to the insurer including service tax - Amount covered under service tax
12 Data required: Amount paid to the insurer including service tax and Amount covered under service tax
104
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N N N N N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: Summary measure to monitor the amount paid to the insurer devoid of service taxes. Service taxes could be changed by the government and if it happens we want to exclude the service taxes amount and monitor the premium amount paid to the insurer
17 Unit of measure for the Indicator:
Rupees
18 Type: A
19 Remarks: NA
********************************************************************
9.ADM-SCO-FCO-003
# KPI Properties Description
1 Gsln: 9
2 Major Group: ADM
3 Minor Group: SCO
4 Sub Category: FCO
5 Indicator Code: ADM-SCO-FCO-003
6 Indicator Name: Proportionate Premium
7 Indicator Acronym:
PRO_PR
8 Indicator Description:
The amount of money paid to the insurers as per the policy periods (i.e. Major Policy period and Minor Policy period)
105
9 Dimensions: Financial Year
10 Role & Action: NA
11 Formula: The premium paid for the Policy Period x (Period Falling in the Financial year / total number of days in the Policy Period)
12 Data required: Premium paid for the Policy Period, Policy Period duration details
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N N N Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: It is useful for caculating the premium amount paid to the insurer as per financial years. (Premium amount paid to the insurer = Proportionate premium paid to the insurer for the Major and Minor policy periods falling in that year).
17 Unit of measure for the Indicator:
Rupees
18 Type: Re
19 Remarks: NA
******************************************************************** 10.ADM-SCO-FCO-004
# KPI Properties Description
1 Gsln: 10
2 Major Group: ADM
3 Minor Group: SCO
4 Sub Category: FCO
106
5 Indicator Code:
ADM-SCO-FCO-004
6 Indicator Name:
Premium paid per card
7 Indicator Acronym:
PR_PA_PCRD
8 Indicator Description:
Actuals
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Premium Amount / Number of cards covered (during the specified period)
12 Data required: Premium amount paid to the insurer and number of cards covered
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N N N N Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: Summary measure to monitor the amount paid for a card and also the change in premium per card over a course of time
17 Unit of measure for the Indicator:
Rupees per card
18 Type: R
19 Remarks: NA
********************************************************************
107
11.ADM-SUT-CUT-001
# KPI Properties Description
1 Gsln: 11
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: CUT
5 Indicator Code: ADM-SUT-CUT-001
6 Indicator Name: Cards Utilized
7 Indicator Acronym:
CRD_UTI
8 Indicator Description:
The frequency count of cards for which a preauthorisation is given atleast one time for atleast one use of any therapy during one or more specified periods (usually policy periods). A card for which preauthorisation is given more than once needs to be counted as a single card utilised.
9 Dimensions: Policy Period and Phase, District
10 Role & Action: NA
11 Formula: Count of cards as per the indicator description
12 Data required: Cards Utilization Profile (i.e. how many cards have been utilized and for what purposes)
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Outcome
16 Indicator use: Summary measure to see the cards utilized as a whole and also in dimensions of categories etc.
108
17 Unit of measure for the Indicator:
Number of cards (In Thousands)
18 Type: A
19 Remarks: Note1: While breaking down the utilization of cards per category: a card for which preauthorisation is given more than once, for the category, needs to be counted as a single card utilised for that category. Note2: This number can be taken for the whole scheme, for insurance mode, and for trust modes separately.
********************************************************************
12.ADM-SUT-CUT-002
# KPI Properties Description
1 Gsln: 12
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: CUT
5 Indicator Code: ADM-SUT-CUT-002
6 Indicator Name: Covered Card-years
7 Indicator Acronym:
CCY
8 Indicator Description:
The number of cards which were covered and the time duration they were covered when expressed in card years (is termed as coverd card years)
9 Dimensions: Policy Period and Phase, District
10 Role & Action: NA
11 Formula: (Cards covered x {(To date - From date)/365} for a specified period (usually policy period))/100000
12 Data required: Number of cards covered and the time period for which they were covered
109
13 Frequency of
Monitoring:
14 Data source: Bid Documents of RAS
15 Indicator Monitors:
Output
16 Indicator use: Standardized measure of expressing number of cards covered in a given period in card years (accouting for the changes that take place in a year). Example: During a financial year 100 therapies were done for 100 cards (who were covered for 4 months (minor policy period) in present financial year) and later 500 cards were added during the next policy period and thus for the next 8 months 600 cards were covered and 200 therapies were performed in the next 8 months(major policy period) of the financial year. So the number of therapies performed during a financial year needs to take into account the changes in the number of cards covered during that period. Similarly all measures are calculated per card year. In the consideredfinancial year the first 4 months consists of 121 days and the remaining 8 months consists of 245 days. The card year during this financial year is (100*121/366 + 600*245/366) 435.8904 card years. Number of therapies performed per one card year during this financial year is (100+200 / 435.8904) = 0.688. The number of therapies per 100 card years in this financial year is 68.8
17 Unit of measure for the Indicator:
lakh card-years
18 Type: Re
19 Remarks: If the report is for successive periods then ‘Sum of Covered Card-years’ is used. It is calculated using the formula: Sum of [ [Cards Covered x {(To date - From date)/365}] for each specified period(usually policy period)].
********************************************************************
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
110
13.ADM-SUT-CUT-003
# KPI Properties Description
1 Gsln: 13
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: CUT
5 Indicator Code: ADM-SUT-CUT-003
6 Indicator Name: Utilised card-years
7 Indicator Acronym:
UCY
8 Indicator Description:
The number of cards used for a particular [dimension] if one lakh cards are covered over one year period.
9 Dimensions: Policy Period and Phase, Therapy, Category
10 Role & Action: NA
11 Formula: (Frequency Count of utilised cards x {(To date - From date)/365} for a specified period (usually policy period))/100000
12 Data required: The number of cards that have been utilized during a specified period of time and the associated [dimension] data.
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It represents the number of cards that have been used for a [dimension of interest] in one year (if one lakh cards were covered). It could be used for breakdown analysis/ profiling of usage of cards by [dimension of interest].
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
111
17 Unit of measure for the Indicator:
lakh card-years
18 Type: Re
19 Remarks: When a defined set of therapies dimension is used all the cards which were utilized for one or more therapies from that basket are considered in the formula
********************************************************************
14.ADM-SUT-PUT-001
# KPI Properties Description
1 Gsln: 14
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: PUT
5 Indicator Code: ADM-SUT-PUT-001
6 Indicator Name: Persons Utilized
7 Indicator Acronym:
P_UTI
8 Indicator Description:
The frequency count of persons for which preauthorisation is given for one or more procedures either one or more times during one or more specified periods (usually policy periods) . A person for which preauthorisation is given more than once needs to be counted as a single person utilised.
9 Dimensions: Policy Period and Phase, Therapy, Category
10 Role & Action: NA
11 Formula: Count of persons (as per the indicator description)/100000
12 Data required: Persons Utilization Profile (i.e. how many persons have utilized our services and what procedures have been used)
112
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Outcome
16 Indicator use: Summary measure to see the utilization of our services by persons as a whole and also in [dimensions of interest].
17 Unit of measure for the Indicator:
Number of persons (In lakhs)
18 Type: Re
19 Remarks: Note1: While breaking down the utilization of persons per [dimension]: a person for which preauthorisation is given more than once, for the [dimension], needs to be counted as a single person who utilised the particular dimension.
Note2: This number can be taken for the whole scheme, for insurance mode, and for trust modes separately.
********************************************************************
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
113
15.ADM-SUT-PUT-002
# KPI Properties Description
1 Gsln: 15
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: PUT
5 Indicator Code: ADM-SUT-PUT-002
6 Indicator Name: Covered Person-years
7 Indicator Acronym:
CPY
8 Indicator Description:
The number of persons who were covered and the time duration they were covered when expressed in person years (is termed as coverd person years)
9 Dimensions: Policy Period and Phase, District (to compare districts in terms of population during the particular time period)
10 Role & Action: NA
11 Formula: (Population x {(To date - From date)/365} for that period(usually a policy period))/100000
12 Data required: Population covered and the time period during which they are covered
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: Bid Documents of RAS
15 Indicator Monitors:
Output
114
16 Indicator use: Standardized measure of expressing number of persons covered in a given period in person years (accouting for the changes that take place in a year). Example: During a financial year 100 therapies were done for 100 persons (who were covered for 4 months (minor policy period) in present financial year) and later 500 persons were added during the next policy period and thus for the next 8 months 600 persons were covered and 200 therapies were performed for them in the next 8 months(major policy period) of the financial year. So the number of therapies performed during a financial year needs to take into accountthe changes that took place in the number of persons covered during that period. Similarly all other measures are calculated per person year. In theconsideredfinancial year the first 4 months consists of 121 days and the remaining 8 months consists of 245 days. The person year during this financial year is (100*121/366 + 600*245/366) 435.8904 person years. Number of therapies performed per one person year during this financial year is (100+200 / 435.8904) = 0.688. The number of therapies per 100 person years in this financial year is 68.8
17 Unit of measure for the Indicator:
lakh person-years
18 Type: Re
19 Remarks: If the report is for successive periods then ‘Sum of Covered Person-years’ is used. It is calculated using the formula: Sum of [ [Persons Covered x {(To date - From date)/365}] for each specified period(usually policy period)]
********************************************************************
16.ADM-SUT-PUT-003
# KPI Properties Description
1 Gsln: 16
2 Major Group: ADM
115
3 Minor Group: SUT
4 Sub Category: PUT
5 Indicator Code: ADM-SUT-PUT-003
6 Indicator Name: Utilised person-years
7 Indicator Acronym:
UPY
8 Indicator Description:
The number of persons who used a particular [dimension] if one lakh persons are covered over one year period.
9 Dimensions: Policy Period and Phase, Therapy, Category
10 Role & Action: NA
11 Formula: (Number of persons who utilized a [dimension] x {(To date - From date)/365} for a specified period (usually policy period))/100000
12 Data required: The number of persons that have utilized a [dimension] during a specified period of time if one lakh persons are covered over one year period.
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It represents the number of persons that have utilized a [dimension of interest] in one year (if one lakh persons were covered). It could be used for breakdown analysis/ profiling of utilization of [dimension of interest ] by persons.
17 Unit of measure for the Indicator:
lakh person-years
116
18 Type: Re
19 Remarks: When a defined set of therapies dimension is used all the cards which were utilized for one or more therapies from that basket are considered in the formula
********************************************************************
17.ADM-SUT-TUT-001
# KPI Properties Description
1 Gsln: 17
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: TUT
5 Indicator Code: ADM-SUT-TUT-001
6 Indicator Name: Therapies done (TD=TrR_U)
7 Indicator Acronym:
TD
8 Indicator Description:
The frequency count of surgeries/therapies done for the pre-authorisations given during a specified period.
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Count of surgeries/therapies as per indicator description
12 Data required: Data of individual case processing from patient registration to claims paid for every patient registered in RAS database during a particular time period.
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
117
15 Indicator Monitors:
Output
16 Indicator use: These are summary operational indicators which give us a picture of how many cases are processed during a particular period and how many of them are present at every level/exit point.
17 Unit of measure for the Indicator:
Number of therapies
18 Type: A
19 Remarks: This can be calculated for the whole scheme, for insurance mode, and for trust modes separately.
********************************************************************
18.ADM-SUT-TUT-002
# KPI Properties Description
1 Gsln: 18
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: TUT
5 Indicator Code: ADM-SUT-TUT-002
6 Indicator Name: Therapies discharged
7 Indicator Acronym:
TDIS
8 Indicator Description:
The frequency count of surgeries/therapies discharged out of the pre-authorisations given during a specified period.
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Count of surgeries/therapies as per indicator description
118
12 Data required: Data of individual case processing from patient registration to claims paid for every patient registered in RAS database during a particular time period.
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: These are summary operational indicators which give us a picture of how many cases are processed during a particular period and how many of them are present at every level/exit point.
17 Unit of measure for the Indicator:
Number of therapies
18 Type: A
19 Remarks: This can be calculated for the whole scheme, for insurance mode, and for trust modes separately.
********************************************************************
19.ADM-SUT-TUT-003
# KPI Properties Description
1 Gsln: 19
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: TUT
5 Indicator Code: ADM-SUT-TUT-003
6 Indicator Name: Therapies Claim raised
7 Indicator Acronym:
CL_RS
119
8 Indicator Description:
The frequency count of surgeries/therapies for which claim is raised out of the preauths given during a specified period.
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Count of surgeries/therapies as per indicator description
12 Data required: Data of individual case processing from patient registration to claims paid for every patient registered in RAS database during a particular time period.
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: These are summary operational indicators which give us a picture of how many cases are processed during a particular period and how many of them are present at every level/exit point.
17 Unit of measure for the Indicator:
Number of claims
18 Type: A
19 Remarks: This can be calculated for the whole scheme, for insurance mode, and for trust modes separately.
********************************************************************
120
20. ADM-SUT-TUT-004
# KPI Properties Description
1 Gsln: 20
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: TUT
5 Indicator Code: ADM-SUT-TUT-004
6 Indicator Name: Therapy Claim Approved
7 Indicator Acronym:
CLA
8 Indicator Description:
The number of therapies approved for payment out of 'therapies claim raised'. Approved means those approved by Claim Head in case of insurance or CAO in case of Trust.
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Sum of the Number of therapies approved by Insurance Claim Head and the Number of therapies approved by Trust CAO
12 Data required: Data of individual case processing from patient registration to claims paid for every patient registered in RAS database during a particular time period.
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
121
16 Indicator use: These are summary operational indicators which give us a picture of how many cases are processed during a particular period and how many of them are present at every level/exit point.
17 Unit of measure for the Indicator:
Number of claims
18 Type: A
19 Remarks: NA
********************************************************************
21.ADM-SUT-TUT-005
# KPI Properties Description
1 Gsln: 21
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: TUT
5 Indicator Code: ADM-SUT-TUT-005
6 Indicator Name: Therapy Claim Rejected
7 Indicator Acronym:
CLR
8 Indicator Description:
The number of therapies rejected for payment out of 'therapies claim raised'. Rejected means those rejected by Claim Head in case of insurance or CAO in case of Trust.
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Sum of the Number of therapies rejected by Insurance Claim Head and the Number of therapies approved by Trust CAO 'out of the 'therapies claim raised'.
122
12 Data required: Data of individual case processing from patient registration to claims paid for every patient registered in RAS database during a particular time period.
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: These are summary operational indicators which give us a picture of how many cases are processed during a particular period and how many of them are present at every level/exit point.
17 Unit of measure for the Indicator:
Number of claims
18 Type: A
19 Remarks: NA
********************************************************************
22.ADM-SUT-TUT-006
# KPI Properties Description
1 Gsln: 22
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: TUT
5 Indicator Code: ADM-SUT-TUT-006
6 Indicator Name: Therapy Claim kept Pending
7 Indicator Acronym:
CLPN
123
8 Indicator Description:
The number of therapies pending approval out of 'therapies claim raised'.
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Sum of the cases pending at panel doctor, trust doctor, claims head and claims authorization officer.
12 Data required: Data of individual case processing from patient registration to claims paid for every patient registered in RAS database during a particular time period.
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: These are summary operational indicators which give us a picture of how many cases are processed during a particular period and how many of them are present at every level/exit point.
17 Unit of measure for the Indicator:
Number of claims
18 Type: A
19 Remarks: NA
********************************************************************
23.ADM-SUT-TUT-007
# KPI Properties Description
1 Gsln: 23
2 Major Group: ADM
3 Minor Group: SUT
124
4 Sub Category: TUT
5 Indicator Code: ADM-SUT-TUT-007
6 Indicator Name: Therapy Claim Lapsed
7 Indicator Acronym:
CL_LP
8 Indicator Description:
The number of therapies waiting approval out of 'therapies claim raised' which have lapsed due to time barring or cancellation + the number of therapies discharged out of those preauthed which remain not submitted after 90 day period.
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Count of surgeries/therapies as per indicator description
12 Data required: Data of individual case processing from patient registration to claims paid for every patient registered in RAS database during a particular time period.
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: These are summary operational indicators which give us a picture of how many cases are processed during a particular period and how many of them are present at every level/exit point.
17 Unit of measure for the Indicator:
Number of claims
18 Type: A
125
19 Remarks: NA
********************************************************************
24. ADM-SUT-TUT-008
# KPI Properties Description
1 Gsln: 24
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: TUT
5 Indicator Code: ADM-SUT-TUT-008
6 Indicator Name: Therapies Claim paid
7 Indicator Acronym:
CLB_A
8 Indicator Description:
The frequency count of therapies for which claim is paid for therapies preauthed during a specified period
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Count of therapies as per the indicator description
12 Data required: Data of individual case processing from patient registration to claims paid for every patient registered in RAS database during a particular time period.
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
126
16 Indicator use: These are summary operational indicators which give us a picture of how many cases are processed during a particular period and how many of them are present at every level/exit point.
17 Unit of measure for the Indicator:
Number of claims
18 Type: A
19 Remarks: NA
********************************************************************
25. ADM-SUT-TUT-009
# KPI Properties Description
1 Gsln: 25
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: TUT
5 Indicator Code: ADM-SUT-TUT-009
6 Indicator Name: Claims amount paid for therapies preauthed during a specified period
7 Indicator Acronym:
CL_PCST_TP
8 Indicator Description:
Claim paid amount till date for all therapies preauthed during the period.
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Sum of all amounts as per the indicator description
12 Data required: Claims paid data during a specified period
127
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To see the amount of claims paid for a specified period and compare them across time-periods.
17 Unit of measure for the Indicator:
Rupees
18 Type: A
19 Remarks: Note: Generally claim paid term used would represent the amount paid till date for the therapies preauthed during a specified period. (unless specified otherwise) (in reports referred as 'Therapies Claim Paid Cost for a specified period ')
********************************************************************
26. ADM-SUT-TUT-010
# KPI Properties Description
1 Gsln: 26
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: TUT
5 Indicator Code: ADM-SUT-TUT-010
6 Indicator Name: Claim amount paid for therapies during a specified period
7 Indicator
Acronym:
CL_PCST_D
128
8 Indicator
Description:
The claim paid cost of therapies during a month for all therapies preauthed during the past.
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Sum of all amounts as per the indicator description
12 Data required: Claims paid data during a specified period
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It records the amount that the institute is paying during a period in the form of claims and the moment of funds from our company periodically.
17 Unit of measure or the Indicator:
Rupees
18 Type: A
19 Remarks: (in reports referred as 'Therapies Claim Paid Cost during a specified period ')
********************************************************************
27.ADM-SUT-UTR-001
# KPI Properties Description
1 Gsln: 27
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: UTR
5 Indicator Code: ADM-SUT-UTR-001
129
6 Indicator Name: Card Utilization Rate
7 Indicator Acronym:
CUR
8 Indicator Description:
The number of cards utilized if one lakh cards are covered over one year period
9 Dimensions: Policy Period and Phase, District, Therapy, Category, Age, Sex, Community (caste), Region (Urban/Rural), Defined set of therapies
10 Role & Action: NA
11 Formula: (Number of cards utilized during the specified period/Card years during the specified period)*100000
12 Data required: The number of cards covered during a specific period (in card years) and the number of cards utilized for the [associated dimension].
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Profiling the utilization of cards [at dimensions of interest]
17 Unit of measure for the Indicator:
Number per lakh card-years
18 Type: R
19 Remarks: When a defined set of therapies dimension is used the cards which were utilized for one or more therapies from that basket are considered in the formula
********************************************************************
130
28.ADM-SUT-UTR-002
# KPI Properties Description
1 Gsln: 28
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: UTR
5 Indicator Code: ADM-SUT-UTR-002
6 Indicator Name: Person Utilization Rate
7 Indicator Acronym:
PUR
8 Indicator Description:
The number of persons who utilized a particular [dimension] if one lakh persons are covered over one year period.
9 Dimensions: Policy Period and Phase, District, Therapy, Category, Age, Sex, Community (caste), Region (Urban/Rural), Defined set of therapies
10 Role & Action: NA
11 Formula: (Number of persons who utilized a particular [dimension] during the specified period/ Person years during the specified period)*100000
12 Data required: The number of persons covered during a specific period (in person years) and the number of persons who utilized a particular [dimension].
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: RAS Database
131
15 Indicator Monitors:
Output
16 Indicator use: Profiling the utilization of various therapies at person level
17 Unit of measure for the Indicator:
Number per lakh person-years
18 Type: R
19 Remarks: When a defined set of therapies dimension is used all the persons who utilized one or more therapies from that basket are considered in the formula
********************************************************************
29.ADM-SUT-UTR-003
# KPI Properties Description
1 Gsln: 29
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: UTR
5 Indicator Code: ADM-SUT-UTR-003
6 Indicator Name: Average number of times a Therapy was performed per 100 card-years among the covered cards
7 Indicator Acronym:
ATPCC
8 Indicator Description:
Average number of therapies performed per one hundred card years among the covered cards.
9 Dimensions: Therapy, category, PD, HD, NWH
10 Role & Action: NA
11 Formula: (Frequency count of performance of the therapy during successive periods / Card-years)
132
12 Data required: The number of cards that have been covered for given period of time (in card years) and the frequency count of the therapy done during the specified period (each time used is accounted as one count).
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Profiling the therapies (taking into account the number of times a person has used a particular therapy and the number of covered person years) during a particular period at person level. It gives us the picture of which therapies are being utilized most number of times. (A person can use haemodialysis procedure twice and this information is not being recorded in person utilization rate indicator.) It is profiling the load of the therapies among the covered cards during a specific period of time.
17 Unit of measure for the Indicator:
Number of therapies per 100 card years
18 Type: G
19 Remarks: ATPCC for all therapies: Sum of ATPCC for individual therapies.
*****************************************************************
30.ADM-SUT-UTR-004
# KPI Properties Description
1 Gsln: 30
2 Major Group: ADM
3 Minor Group: SUT
133
4 Sub Category: UTR
5 Indicator Code: ADM-SUT-UTR-004
6 Indicator Name: Average number of times a Therapy was performed per 100 card-years among the utilized cards
7 Indicator Acronym:
ATPUC
8 Indicator Description:
Average number of therapies performed per one hundred card years among the utilised cards
9 Dimensions: Therapy, category, PD, HD, NWH
10 Role & Action: NA
11 Formula: Frequency count of performance of a given therapy during successive periods / Card-years
12 Data required: Number of times a particular therapy has been used and the number of cards that have been covered for a given period of time (card years) for the cards which were utilized for that therapy
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To identify/profile the pattern of change in utility of therapies among the utilized cards/families during specific period of time. It is also used for profiling the load of the therapies among the utilized cards during a specific period of time.
17 Unit of measure for the Indicator:
Number of therapies per 100 card years
18 Type: G
134
19 Remarks: For all therapies it is calculated as: Sum of frequency count of performance of all therapies during successive periods / Total number of Card-years (for utilized cards.)
********************************************************************
31.ADM-SUT-UTR-005
# KPI Properties Description
1 Gsln: 31
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: UTR
5 Indicator Code: ADM-SUT-UTR-005
6 Indicator Name: Average number of times a Therapy was performed per 100 person-years among covered persons
7 Indicator Acronym:
ATPCP
8 Indicator Description:
Average number of therapies performed per one hundred person years among the covered persons.
9 Dimensions: Therapy, category, PD, HD, NWH
10 Role & Action: NA
11 Formula: Frequency count of performance of a given therapy during successive periods / Person-years
12 Data required: The number of persons that have been covered during a specified period (in person years) and the frequency count of the therapy done during the specified period (each time used is accounted as one count).
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y Y Policy Period
14 Data source: RAS Database
135
15 Indicator Monitors:
Output
16 Indicator use: Profiling the therapies (taking into account the number of times a person has used a particular therapy and the number of covered person years) during a particular period at person level. It gives us the picture of which therapies are being utilized most number of times. (A person can use haemodialysis procedure twice and this information is not being recorded in person utilization rate indicator.) It is profiling the load of the therapies among the covered persons during a specific period of time.
17 Unit of measure for the Indicator:
Number of therapies per 100 person years
18 Type: G
19 Remarks: ATPCP for all therapies: Sum of ATPCP for individual therapies.
********************************************************************
32.ADM-SUT-UTR-006
# KPI Properties Description
1 Gsln: 32
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: UTR
5 Indicator Code: ADM-SUT-UTR-006
6 Indicator Name: Average number of times a Therapy was performed per 100 person-years among utilized persons
7 Indicator Acronym:
ATPUP
8 Indicator Description:
Average number of therapies performed per one hundred person years among the utilized persons.
136
9 Dimensions: Therapy, category, PD, HD, NWH
10 Role & Action: NA
11 Formula: Frequency count of performance of a given therapy during successive periods / Person-years
12 Data required: Number of times a particular therapy has been used and the number of persons who utilized that therapy (in person years)
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To identify/profile the pattern of change in the number of therapies among the utilized persons during specific period of time
17 Unit of measure for the Indicator:
Number of therapies per 100 person years
18 Type: G
19 Remarks: For all therapies it is calculated as: Sum of frequency count of performance of all therapies during successive periods / Total number of person-years (for utilized persons)
********************************************************************
33.ADM-SUT-UTR-007
# KPI Properties Description
1 Gsln: 33
2 Major Group: ADM
3 Minor Group: SUT
137
4 Sub Category: UTR
5 Indicator Code: ADM-SUT-UTR-007
6 Indicator Name: Average number of cards utilized per 100 card years among the covered cards
7 Indicator Acronym:
ACPCC
8 Indicator Description:
Average number of cards utilized per one hundred card years among the covered cards
9 Dimensions: Therapy, category, PD, HD, NWH
10 Role & Action: NA
11 Formula: Frequecy count of the number of cards which are preauthed atleast once / Card Years
12 Data required: The cards which were preauthed atleast once and the number of cards that were covered for a specified period of time (in card years)
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It captures the change in utility pattern of cards (Card Utilization Pattern)
17 Unit of measure for the Indicator:
Number of cards per 100 card years
18 Type: G
19 Remarks: NA
********************************************************************
D W M Q H Y Cum Other
N N N Y Y Y Y Policy Period
138
34. ADM-SUT-UTR-008
# KPI Properties Description
1 Gsln: 34
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: UTR
5 Indicator Code: ADM-SUT-UTR-008
6 Indicator Name: Average number of Persons who Utilized a service per 100 card years among the covered cards
7 Indicator Acronym:
APPCC
8 Indicator Description:
Average number of persons who have utilized the services per one hundred card years among the covered cards
9 Dimensions: Therapy, category, PD, HD, NWH
10 Role & Action: NA
11 Formula: Frequency count of the number of people who were given preauth atleast once / Card years
12 Data required: The persons who were given preauth atleast once and the number of cards that were covered for a specified period of time (in card years)
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It captures the change in the utility pattern of people/ persons (People Utilization Pattern)
D W M Q H Y Cum Other
N N N Y Y Y Y Policy Period
139
17 Unit of measure for the Indicator:
Number of persons per 100 card years
18 Type: G
19 Remarks: NA
********************************************************************
35. ADM-SUT-UTR-009
# KPI Properties Description
1 Gsln: 35
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: UTR
5 Indicator Code: ADM-SUT-UTR-009
6 Indicator Name: Average number of Persons who Utilized a service per 100 card years among utilized cards
7 Indicator Acronym:
APPUC
8 Indicator Description:
Average number of persons who have utilized the services per one hundred card years among the utilized cards
9 Dimensions: Therapy, category, PD, HD, NWH
10 Role & Action: NA
11 Formula: Frequency count of the number of people who were given preauth atleast once / Card years
12 Data required: The persons who were given preauth and the number of utilized cards that are covered for a specified period of time (in card years)
140
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: This is a measure to capture the change in the utility pattern of people/persons among the utilized cards (People Utilization Pattern).
17 Unit of measure for the Indicator:
Number of persons per 100 card years
18 Type: G
19 Remarks: NA
********************************************************************
36.ADM-SUT-UTR-010
D W M Q H Y Cum Other
N N N Y Y Y Y Policy Period
# KPI Properties Description
1 Gsln: 36
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: UTR
5 Indicator Code: ADM-SUT-UTR-010
6 Indicator Name: Average number of times a card is used per 100 card years among the covered cards
7 Indicator Acronym:
ATIPCC
8 Indicator Description:
Average number of times a card is used per one hundred card years among the covered cards
9 Dimensions: Therapy, category, PD, HD, NWH
141
10 Role & Action: NA
11 Formula: Sum(Frequency count of the number of times a card is used) for all the cards which were atleast preauthed once / Card years
12 Data required: The number of times a card is used, the details of every card transaction and the number of cards that were covered for a specified period of time (in card years)
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It is a summary measure which shows the average number of times a card is used per one covered card year
17 Unit of measure for the Indicator:
Number of times a card is used per 100 card years
18 Type: G
19 Remarks: NA
********************************************************************
37. ADM-SUT-UTR-011
# KPI Properties Description
1 Gsln: 37
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: UTR
5 Indicator Code: ADM-SUT-UTR-011
D W M Q H Y Cum Other
N N N Y Y Y Y Policy Period
142
6 Indicator Name: Average number of times a utilized card is used per 100 card years among the utilized cards
7 Indicator Acronym:
ATIPUC
8 Indicator Description:
Average number of times a card is used per one hundred card years among the utilized cards
9 Dimensions: Therapy, category, PD, HD, NWH
10 Role & Action: NA
11 Formula: Sum(Frequency count of the number of times a card is used) for all the cards which were atleast preauthed once / Card years
12 Data required: The number of times a card is used, the details of every card transaction and the number of utilized cards that are covered for a specified period of time (in card years)
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It captures the change in the utility of the number of times a card is used. (Times usage utilization pattern). i.e. load within the utilized cards
17 Unit of measure for the Indicator:
Number of times a card is used per 100 card years
18 Type: G
19 Remarks: Number of times a card is used is another parameter of interest among the utilization.
********************************************************************
D W M Q H Y Cum Other
N N N Y Y Y Y Policy Period
143
38. ADM-SUT-UTR-012
# KPI Properties Description
1 Gsln: 38
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: UTR
5 Indicator Code: ADM-SUT-UTR-012
6 Indicator Name: Average number of therapies used per one time usage of a card
7 Indicator Acronym:
AUPUC
8 Indicator Description:
Average number of therapies that are performed during a single instance of card utilization
9 Dimensions: Therapy
10 Role & Action: NA
11 Formula: Sum(Frequency count of number of therapy uses for one time utilization of a card) for all the cards which were preauthed atleast once / Sum(Frequency count of the number of times each card is used) for all the cards which were preauthed atleast once
12 Data required: Card usage data and the associated therapy uses
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It captures the load of usage of therapies per a single utilization of a card
D W M Q H Y Cum Other
N N N Y Y Y Y Policy Period
144
17 Unit of measure for the Indicator:
Number of uses per one time utilization of the card
18 Type: G
19 Remarks: Note: It is always calculated from the utilized cards only
********************************************************************
39. ADM-SUT-CLR-001
# KPI Properties Description
1 Gsln: 39
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: CLR
5 Indicator Code: ADM-SUT-CLR-001
6 Indicator Name: Claim Rate for a [dimension]
7 Indicator Acronym:
CLR
8 Indicator Description:
The amount of money that is being spent on a particular therapy (or a set of therapies, as per the dimension) during a specific period per covered card year
9 Dimensions: Category, Reserved Therapies, Tertiary Care Therapies, All Therapies
10 Role & Action: NA
11 Formula: For one therapy: (Package price x number of therapies done claim paid) for the specified period/Covered card- years (in that duration)
12 Data required: Therapies done for which claim has been paid, specified time duration, package price and covered card years
145
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To profile and compare which therapies (or set of therapies)are costing maximum during a specified period
17 Unit of measure for the Indicator:
Rupees per covered card-year
18 Type: R
19 Remarks: Hint for caculating CLR for a set of therapies: For a set of therapies claim rate is calculated individually and summed up
********************************************************************
40.ADM-SUT-CLR-002
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
# KPI Properties Description
1 Gsln: 40
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: CLR
5 Indicator Code: ADM-SUT-CLR-002
6 Indicator Name: Claim Deduction Ratio
7 Indicator Acronym:
CDR
8 Indicator Description:
It is a ratio which indicates about the claim amount that has been reduced from the preauth estimate during a specified period.
146
9 Dimensions: Policy Period and Phase, Therapy, Category
10 Role & Action: NA
11 Formula: 100 x (Therapies done Cost - Therapies Claim Paid Cost) / Therapies Done Cost
12 Data required: Therapies preauth cost and Therapies claim paid cost
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To see how much of deduction has taken place for a period of time between preauths and claims
17 Unit of measure for the Indicator:
Number (without any specific unit)
18 Type: Rt
19 Remarks: NA
********************************************************************
41.ADM-SUT-WGT-001
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
# KPI Properties Description
1 Gsln: 41
2 Major Group: ADM
3 Minor Group: SUT
4 Sub Category: WGT
5 Indicator Code: ADM-SUT-WGT-001
6 Indicator Name: Weight
147
7 Indicator Acronym:
WT_DIM
8 Indicator Description:
Weight of a [dimension]
9 Dimensions: Therapy basket, Category Basket, Reserved Therapies, Tertiary care Therapies
10 Role & Action: NA
11 Formula: Sum of Wts of therapies (as per the dimension) from the procedure basket
12 Data required: Weight of each individual therapy available in the therapy basket
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It gives the proportion of cost bagged by a set of therapies (defined by the dimension)
17 Unit of measure for the Indicator:
Number (without any specific unit)
18 Type: Rt
19 Remarks: Weight of any set of procedures will always be less than 1 and the weight of all the procedures will always be equal to 1.
******************************************************************** 42.ADM-SUT-WGT-002
# KPI Properties Description
1 Gsln: 42
2 Major Group: ADM
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
148
3 Minor Group: SUT
4 Sub Category: WGT
5 Indicator Code: ADM-SUT-WGT-002
6 Indicator Name: Bare Weight
7 Indicator Acronym:
BW_DIM
8 Indicator Description:
Bare Weight of a [dimension]
9 Dimensions: Therapy basket, Category Basket, Reserved Therapies, Tertiary care Therapies
10 Role & Action: NA
11 Formula: Sum of BWs of therapies (as per the dimension) from the procedure basket
12 Data required: Bare Weight of each individual therapy available in the therapy basket
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It gives the proportion of utilization for a set of therapies (defined by the dimension)
17 Unit of measure for the Indicator:
Number (without any specific unit)
18 Type: Rt
19 Remarks: Bare Weight of any set of procedures will always be less than 1 and the weight of all the procedures will always be equal to 1.
********************************************************************
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
149
43.ADM-SEP-CRT-001
# KPI Properties Description
1 Gsln: 43
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CRT
5 Indicator Code: ADM-SEP-CRT-001
6 Indicator Name: Claim Ratio
7 Indicator Acronym:
CR
8 Indicator Description:
Ratio of the amount spent on claims and the amount invested as premium during a specified period
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Therapies Claim paid Cost for the period/Premium paid for the period
12 Data required: Therapies Claims paid amount and premium paid amount
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Outcome
16 Indicator use: To look at a glance what has happened in the previous years in terms of the input amount(premium paid) and the spent amount(claims paid).
17 Unit of measure for the Indicator:
Number (without any specific unit)
D W M Q H Y Cum Other
N N N N N N N Policy Period
150
18 Type: Rt
19 Remarks: It is interpreted depending upon the value greater than 1 or lesser than 1 (or) by comparing with other values over different time periods.
********************************************************************
44.ADM-SEP-CRT-002
D W M Q H Y Cum Other
N N N N N N N Policy Period
# KPI Properties Description
1 Gsln: 44
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CRT
5 Indicator Code:
ADM-SEP-CRT-002
6 Indicator Name:
Bare Claim Ratio
7 Indicator Acronym:
BCR
8 Indicator Description:
Ratio of the amount spent on claims and the amount invested as bare premium (void of service taxes) during a specified period.
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Therapies Claim paid Cost for the period/ Bare Premium
12 Data required: Therapies Claim paid cost, premium paid, service tax during a specific period
13 Frequency of
Monitoring:
14 Data source: RAS Database
151
15 Indicator Monitors:
Outcome
16 Indicator use: To look at a glance what has happened in the previous years in terms of the input amount(premium paid) and the spent amount(claims paid). This a finer measure compared to the claim ratio and will be useful when there is variation in service taxes levied by the government.
17 Unit of measure for the Indicator:
Number (without any specific unit)
18 Type: Rt
19 Remarks: It is interpreted depending upon the value greater than 1 or lesser than 1 (or) by comparing with other values over different time periods.
********************************************************************* 45.ADM-SEP-CRT-003
# KPI Properties Description
1 Gsln: 45
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CRT
5 Indicator Code:
ADM-SEP-CRT-003
6 Indicator Name:
Premium Claim Difference
7 Indicator Acronym:
PCD
8
Indicator Description:
Difference of the amount invested as premium during a policy period and the amount incurred as expenditure (Therapies Claim Paid Cost) during a Policy Period
9 Dimensions: Policy Period and Phase
152
10 Role & Action: NA
11 Formula: Premium Paid for the Policy Period - Therapies Claim
Paid Cost for the Policy Period
12 Data required: Therapies Claims paid amount and premium paid
amount
13
Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N N N N N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Outcome
16
Indicator use: This indicators too conveys the same information as above indicators i.e. to look at a glance what has happened in the previous years in terms of the input amount(premium paid) and the spent amount(claims paid). However this indicator specifies the exact amount that differs between the investment and expenditure amounts.
17
Unit of measure for the Indicator:
Rupees
18 Type: A
19 Remarks: NA
*****************************************************************
46.ADM-SEP-CRT-004
# KPI Properties Description
1 Gsln: 46
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CRT
153
5 Indicator Code:
ADM-SEP-CRT-004
6 Indicator Name:
Average Preauth Size
7 Indicator Acronym:
APS
8
Indicator Description:
Mean Preauth Size, It is a central tendency measure which represents the preauth cost during a specified period.
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Therapy Preauth Cost / Number of Therapies
Preauthed
12 Data required: Therapies Preauth Cost and Number of therapies
which have been preauthed
13
Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It would be useful to monitor if the preauth cost is
decreasing or increasing over various time periods.
17
Unit of measure for the Indicator:
Rupees
18 Type: G
19 Remarks: NA
*****************************************************************
154
47. ADM-SEP-CRT-005
# KPI Properties Description
1 Gsln: 47
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CRT
5 Indicator Code: ADM-SEP-CRT-005
6 Indicator Name: Average Claim Size
7 Indicator Acronym: ACS
8 Indicator Description: Mean Claim Size, It is a central tendency measure which represents the claim cost during a specified period.
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11 Formula: Therapies Claim Paid Cost / Number of Therapies Claim Paid
12 Data required: Therapies claim paid cost and number of therapies claim paid
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors: Output
16 Indicator use: It would be useful to monitor if the claim cost is decreasing or increasing over various time periods.
17 Unit of measure for the Indicator:
Rupees
155
18 Type: G
19 Remarks: NA
*****************************************************************
48. ADM-SEP-CRT-006
# KPI Properties Description
1 Gsln: 48
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CRT
5 Indicator Code: ADM-SEP-CRT-006
6 Indicator Name: Interest Earned by Insurer on Unspent Premium
for a phase
7 Indicator Acronym: INT_INS
8 Indicator Description:
Interest earned by the insurer on unspent premium for a particular phase
9 Dimensions: Policy Period and Phase
10 Role & Action: NA
11
Formula: Sum of [ {(0.94 x bare premium available with insurer at the beginning of the day) - claim payment for the day} x 0.75/30.5] for all the days in the specified period. This assumes that 0.06 percent of premium is spent for admin expenses on the day of premium payment; that month has 30.5 days; that rate of bank interest is 9% per annum.
12
Data required: Day wise bare premium available with the insurer and the claim payments made by the insurer per day
156
13
Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Outcome
16 Indicator use: It conveys how much profit the insurer is making
on the unspent premium for a particular phase.
17 Unit of measure for the Indicator:
Crore Rupees
18 Type: Re
19 Remarks: NA
*****************************************************************
49.ADM-SEP-CCO-001
# KPI Properties Description
1 Gsln: 49
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CCO
5 Indicator Code:
ADM-SEP-CCO-001
6 Indicator Name:
Therapies Claim Outstanding for a specified period
7 Indicator Acronym:
TCO
8 Indicator Description:
Number of therapy claims which are yet to be processed (or) are in 'in process' state
9 Dimensions: Overall Scheme, Policy period and Phase
157
10 Role & Action: NA
11 Formula: Count of therapy claims as per indicator description
12 Data required: Number of therapy claims which are 'in process'
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To look at the number of cases which are 'in process' at a particular point of time duration
17 Unit of measure for the Indicator:
Number of claims
18 Type: A
19 Remarks: NA
*****************************************************************
50.ADM-SEP-CCO-002
# KPI Properties Description
1 Gsln: 50
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CCO
5 Indicator Code:
ADM-SEP-CCO-002
6 Indicator Name:
Therapies Claim Outstanding Cost for a specified period
158
7 Indicator Acronym:
TCOC
8 Indicator Description:
The cost that incurs for the 'in process' therapy claims
9 Dimensions: Overall Scheme, Policy period and Phase
10 Role & Action: NA
11 Formula: Sum of the amount
12 Data required: Cost of the claims which are 'in process'
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To get an idea of the amount that we are thought to be liable for as these cases are not yet processed
17 Unit of measure for the Indicator:
Rupees
18 Type: A
19 Remarks: NA
*****************************************************************
51.ADM-SEP-CCO-003
# KPI Properties Description
1 Gsln: 51
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CCO
159
5 Indicator Code:
ADM-SEP-CCO-003
6 Indicator Name:
Therapies Claim Pending at Bank for a specified period
7 Indicator Acronym:
TCB
8 Indicator Description:
Number of therapy claims which have got approved but weren't yet paid by the bank (to the NWH)
9 Dimensions: Overall Scheme, Policy period and Phase
10 Role & Action: NA
11 Formula: Count of therapy claims as per indicator description
12 Data required: Case process data and bank payment data
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the rate of movement of funds at bank level after processing this indicator is used. It gives the number of cases which are yet to be paid at the bank level.
17 Unit of measure for the Indicator:
Number of claims
18 Type: A
19 Remarks: NA
*****************************************************************
160
52. ADM-SEP-CCO-004
# KPI Properties Description
1 Gsln: 52
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CCO
5 Indicator Code:
ADM-SEP-CCO-004
6 Indicator Name:
Therapies Claim Pending at Bank Cost for a specified period
7 Indicator Acronym:
TCBC
8 Indicator Description:
The cost that incurs for the therapy claims which have got approved but weren't yet paid by the bank
9 Dimensions: Overall Scheme, Policy period and Phase
10 Role & Action: NA
11 Formula: Sum of the amount
12 Data required: Cost of the claims which were approved but weren't yet paid by the bank
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To calculate the actual liquid amount we have we need to subtract this amount as well as the health camps claim pending amount from our liquid assets. (It helps us in calculating the exact liquid amount which we have at a particular point of time.)
161
17 Unit of measure for the Indicator:
Rupees
18 Type: A
19 Remarks: NA
*****************************************************************
53. ADM-SEP-CCO-005
# KPI Properties
Description
1 Gsln: 53
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category:
CCO
5 Indicator Code:
ADM-SEP-CCO-005
6 Indicator Name:
Health Camp Claim Outstanding
7 Indicator Acronym:
HC_CL_O
8 Indicator Description:
Number of health camp claims which are yet to be processed (or) are in 'in process' state
9 Dimensions: Overall Scheme, Policy period and Phase
10 Role & Action:
NA
11 Formula: Count of health camps as per indicator description
12 Data required:
Number of health camp claims which are 'in process'
162
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To look at the number of cases which are 'in process' at a particular point of time duration
17 Unit of measure for the Indicator:
Number of claims
18 Type: A
19 Remarks: NA
*****************************************************************
54. ADM-SEP-CCO-006
# KPI Properties Description
1 Gsln: 54
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CCO
5 Indicator Code:
ADM-SEP-CCO-006
6 Indicator Name:
Health Camp Claim Outstanding Cost
7 Indicator Acronym:
HC_CLOC
8 Indicator Description:
The cost that incurs for the 'in process' health camp claims
163
9 Dimensions: Overall Scheme, Policy period and Phase
10 Role & Action: NA
11 Formula: Sum of the amount
12 Data required: Cost of the health camp claims which are 'in process'
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To get an idea of the amount that we are thought to be liable for as these cases are not yet processed
17 Unit of measure for the Indicator:
Rupees
18 Type: A
19 Remarks: NA
*****************************************************************
55. ADM-SEP-CCO-007
# KPI Properties Description
1 Gsln: 55
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CCO
5 Indicator Code:
ADM-SEP-CCO-007
164
6 Indicator Name:
Health Camp Claim pending
7 Indicator Acronym:
HC_CLPN
8 Indicator Description:
Number of health camp claims which have got approved but weren't yet paid by the bank (to the NWH)
9 Dimensions: Overall Scheme, Policy period and Phase
10 Role & Action: NA
11 Formula: Count of health camps as per indicator description
12 Data required: Health camp claim process data and bank payment data
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the rate of movement of funds at bank level after processing this indicator is used. It gives the number of cases which are yet to be paid at the bank level.
17 Unit of measure for the Indicator:
Number of claims
18 Type: A
19 Remarks: NA
*****************************************************************
165
56. ADM-SEP-CCO-008
# KPI Properties Description
1 Gsln: 56
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: CCO
5 Indicator Code:
ADM-SEP-CCO-008
6 Indicator Name:
Health Camp Claim Pending Cost
7 Indicator Acronym:
HC_CLPNC
8 Indicator Description:
The cost that incurs for the health camp claims which have got approved but weren't yet paid by the bank
9 Dimensions: Overall Scheme, Policy period and Phase
10 Role & Action: NA
11 Formula: Sum of the amount
12 Data required: Cost of the health camp claims which were approved but weren't yet paid by the bank
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To calculate the actual liquid amount we have we need to subtract this amount as well as the therapies claim pending amount from our liquid assets. (It helps us in calculating the exact liquid amount which we have at a particular point of time.)
166
17 Unit of measure for the Indicator:
Rupees
18 Type: A
19 Remarks: NA
*****************************************************************
57.ADM-SEP-FFO-001
# KPI Properties Description
1 Gsln: 57
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: FFO
5 Indicator Code:
ADM-SEP-FFO-001
6 Indicator Name:
The R² value (also known as Coefficient of Determination)
7 Indicator Acronym:
M_PA
8 Indicator Description:
Forecast Model Diagnostics measure
9 Dimensions: NA
10 Role & Action: NA
11 Formula: It is provided by the software
12 Data required: Forecast dataset prepared for analysis
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N Policy Period
14 Data source: RAS Database
167
15 Indicator Monitors:
None
16 Indicator use: Goodness of model fit parameter
17 Unit of measure for the Indicator:
Number (without any specific unit)
18 Type: NA
19 Remarks: Model Diagnostic Measures
*****************************************************************
58.ADM-SEP-FFO-002
# KPI Properties Description
1 Gsln: 58
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: FFO
5 Indicator Code:
ADM-SEP-FFO-002
6 Indicator Name:
The curve that is fitted
7 Indicator Acronym:
M_CU
8 Indicator Description:
Forecast Model Description
9 Dimensions: NA
10 Role & Action: NA
11 Formula: None
12 Data required: Forecast dataset prepared for analysis
168
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
None
16 Indicator use: Type of curve that is fitted to the data
17 Unit of measure for the Indicator:
Descriptive Field (no units present)
18 Type: NA
19 Remarks: Model Diagnostic Measures
*****************************************************************
59.ADM-SEP-FFO-003
# KPI Properties Description
1 Gsln: 59
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: FFO
5 Indicator Code: ADM-SEP-FFO-003
6 Indicator Name:
Error Plot
7 Indicator Acronym:
M_ERRPLT
8 Indicator Description:
Forecast Model Diagnostics measure
9 Dimensions: NA
10 Role & Action: NA
169
11 Formula: None
12 Data required: Forecast dataset prepared for analysis
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
None
16 Indicator use: Shows the variations from the actual data and the values obtained from the prediction model. It is useful for residual analysis and outlier analysis.
17 Unit of measure for the Indicator:
Plot Diagram (no units present)
18 Type: NA
19 Remarks: Model Diagnostic Measures
********************************************************************
60.ADM-SEP-FFO-004
# KPI Properties Description
1 Gsln: 60
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: FFO
5 Indicator Code: ADM-SEP-FFO-004
6 Indicator Name: Forecast data date
7 Indicator Acronym:
M_FCST_DT
170
8 Indicator Description:
Forecast data description in terms of time period
9 Dimensions: NA
10 Role & Action: NA
11 Formula: None
12 Data required: Forecast dataset prepared for analysis
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
None
16 Indicator use: The time period of the data that has been used for building the prediction model. (From date and end date of the data used for forecasting)
17 Unit of measure for the Indicator:
Date Description (Date format)
18 Type: NA
19 Remarks: Model Diagnostic Measures
********************************************************************
61.ADM-SEP-FFO-005
# KPI Properties Description
1 Gsln: 61
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: FFO
5 Indicator Code: ADM-SEP-FFO-005
171
6 Indicator Name: Weight of Specified Procedure Basket
7 Indicator Acronym:
FCST_RF_WT
8 Indicator Description:
Weights calculated as on 1st Jan/1st July of current year (whichever is latest). They can also be considered as reference weights.
9 Dimensions: NA
10 Role & Action: NA
11 Formula: Weights calculated as on 1st Jan/1st July of current year (from the cumulative data)
12 Data required: Claim Rate of every therapy available in the procedure basket during the "fully loaded state" year
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
None
16 Indicator use: This set of weights are used as reference weights which we apply for preparing forecast analysis dataset assuming that the same utility rates would be present at any given point of time in the past.(Note: this is done for a particular method of forecasting which is in use at present only)
17 Unit of measure for the Indicator:
Number (without any specific unit)
18 Type: A
19 Remarks: Defintion of "Reference Weights"
********************************************************************
172
62. ADM-SEP-FFO-006
# KPI Properties Description
1 Gsln: 62
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: FFO
5 Indicator Code: ADM-SEP-FFO-006
6 Indicator Name: Weight of month's Procedure Basket
7 Indicator Acronym:
FCST_MN_WT
8 Indicator Description:
The reference weights are applied to the retrospective (or) partially loaded set of procedures data during a time period of one month to calculate the weight of the month's procedure basket
9 Dimensions: NA
10 Role & Action: NA
11 Formula: Sum of [Wts for therapies available for the month for Insurance mode + Wts for therapies available for the month under Trust mode]
12 Data required: Claim Rate of every therapy available in the procedure basket during the "fully loaded state" year
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
None
173
16 Indicator use: These weights indicate the percentage of cost the partially loaded set of procedures would account for if the fully loaded set of procedures were made available at that point of time
17 Unit of measure for the Indicator:
Number (without any specific unit)
18 Type: A
19 Remarks: This is an intermediate variable
********************************************************************
63. ADM-SEP-FFO-007
# KPI Properties Description
1 Gsln: 63
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: FFO
5 Indicator Code: ADM-SEP-FFO-007
6 Indicator Name: Therapy Claim Paid-Total for a month
7 Indicator Acronym:
FCST_TH_CLM
8 Indicator Description:
The total claim amount for a particular month (usually the previous years data (of 'partially loaded state' years).
9 Dimensions: NA
10 Role & Action: NA
11 Formula: Sum of [Claim paid for the month for Insurance mode + Claim paid for the same month for Trust mode]
12 Data required: Claims paid amount during the specified time period (usually month-wise)
174
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
None
16 Indicator use: This is an intermediate variable which is used for preparing the forecasting dataset.
17 Unit of measure for the Indicator:
Crore Rupees
18 Type: A
19 Remarks: Intermediate variable
********************************************************************
64.ADM-SEP-FFO-008
# KPI Properties Description
1 Gsln: 64
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: FFO
5 Indicator Code: ADM-SEP-FFO-008
6 Indicator Name: Relative claim Paid for the month for RAS
7 Indicator Acronym:
FCST_RL_CLM
8 Indicator Description:
This is a derived variable which is used for calculating the amount that would have costed us in previous years(partially loaded state) if we were fully loaded.
9 Dimensions: NA
175
10 Role & Action: NA
11 Formula: Total Claim paid for a month/ Month's Procedure Basket Wt. This gives the proportionate claim for given basket of procedures
12 Data required: Indicator coded (Therapy Claim paid - Total for a month) and the reference weights
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
None
16 Indicator use: This is used for calculating the amount that we would incur if we were "fully loaded" in the past time periods
17 Unit of measure for the Indicator:
Crore Rupees
18 Type: A
19 Remarks: Final variable of interest (when we consider all the procedures available in the procedure basket during forcasting)
********************************************************************
65.ADM-SEP-FFO-009
# KPI Properties Description
1 Gsln: 65
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: FFO
5 Indicator Code: ADM-SEP-FFO-009
176
6 Indicator Name: Relative Total Claim
7 Indicator Acronym:
FCST_RL_TCLM
8 Indicator Description:
This is a derived variable which is used for calculating the amount that would have costed us in previous years (partially loaded state) for a specific set of procedures (say a set of procedures in AS-II and AS_I etc.).
9 Dimensions: NA
10 Role & Action: NA
11 Formula: (Therapy claim paid for period/Wt of month's procedure basket) x Specified Procedure Basket Wt
12 Data required: Intermediate variables: Therapy Claim paid for the month (past data), reference weights, therapies available in the specified duration (past)
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
None
16 Indicator use: This is used for calculating the amount for a specific set of procedures that we would incur if we were "fully loaded" in the past time periods
17 Unit of measure for the Indicator:
Crore Rupees
18 Type: A
19 Remarks: Final variable of interest (when we consider a subset of procedures and the cost it incurs to us during forecasting)
********************************************************************
177
66. ADM-SEP-FFO-010
# KPI Properties Description
1 Gsln: 66
2 Major Group: ADM
3 Minor Group: SEP
4 Sub Category: FFO
5 Indicator Code: ADM-SEP-FFO-010
6 Indicator Name: Cumulative relative Claim (Cr)
7 Indicator Acronym:
FCST_CL_RCLM
8 Indicator Description:
Sum of previous months relative claim and present months claim
9 Dimensions: NA
10 Role & Action: NA
11 Formula: Relative claim Paid for the month + cumulative relative claim for the previous months
12 Data required: "Relative Total Claim" variable
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
None
16 Indicator use: This is a running sum of the estimated amount used in forecasting report
17 Unit of measure for the Indicator:
Crore Rupees
18 Type: A
178
19 Remarks: Variable of interest defined for forecasting report
********************************************************************
67. FOP-NWH-***-001
# KPI Properties Description
1 Gsln: 67
2 Major Group: FOP
3 Minor Group: NWH
4 Sub Category: ***
5 Indicator Code: FOP-NWH-***-001
6 Indicator Name: Hospital Beds
7 Indicator Acronym:
HB
8 Indicator Description:
Total number of beds available in a NWH
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: No formula (fixed quantity)
12 Data required: Hospital capacity in terms of beds
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N N
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: Indicator set to capture the capacity and utilization pattern of the NWH in the scheme
179
17 Unit of measure for the Indicator:
Number of beds
18 Type: A
19 Remarks: NA
********************************************************************
68.FOP-NWH-***-002
# KPI Properties Description
1 Gsln: 68
2 Major Group: FOP
3 Minor Group: NWH
4 Sub Category: ***
5 Indicator Code: FOP-NWH-***-002
6 Indicator Name: Reserved Beds in a NWH
7 Indicator Acronym:
RB
8 Indicator Description:
Number of beds reserved for Dr.NTR Vaidya Seva out of total Hospital beds
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: No formula (fixed quantity)
12 Data required: Reserved number of beds for Dr.NTR Vaidya Seva
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N N
14 Data source: RAS Database
15 Indicator Monitors:
Input
180
16 Indicator use: Indicator set to capture the capacity and utilization pattern of the NWH in the scheme
17 Unit of measure for the Indicator:
Number of beds
18 Type: A
19 Remarks: NA
********************************************************************
69.FOP-NWH-***-003
D W M Q H Y Cum Other
Y N N N N N N N
# KPI Properties Description
1 Gsln: 69
2 Major Group: FOP
3 Minor Group: NWH
4 Sub Category: ***
5 Indicator Code: FOP-NWH-***-003
6 Indicator Name: Occupied Beds in a NWH
7 Indicator Acronym:
OB
8 Indicator Description:
Number of beds occupied by Dr.NTR Vaidya Seva patients out of total Hospital beds
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: Count of beds occupied by Dr.NTR Vaidya Seva patients in a hospital
12 Data required: Number of beds occupied in a hospital by Dr.NTR Vaidya Seva
13 Frequency of
Monitoring:
181
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Indicator set to capture the capacity and utilization pattern of the NWH in the scheme
17 Unit of measure for the Indicator:
Number of beds
18 Type: A
19 Remarks: NA
********************************************************************
70.FOP-NWH-***-004
# KPI Properties Description
1 Gsln: 70
2 Major Group: FOP
3 Minor Group: NWH
4 Sub Category: ***
5 Indicator Code: FOP-NWH-***-004
6 Indicator Name: Occupied Bed-days in a NWH, during a specified period
7 Indicator Acronym:
OBD
8 Indicator Description:
Occupied bed days represents the duration a NWH has been utilized by patients during a specific period of time
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: Sum of occupied beds in days for all cases
12 Data required: Number of beds occupied during a specific time period
182
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Indicator set to capture the capacity and utilization pattern of the NWH in the scheme
17 Unit of measure for the Indicator:
Number of occupied bed-days
18 Type: A
19 Remarks: NA
********************************************************************
71.FOP-NWH-***-005
# KPI Properties Description
1 Gsln: 71
2 Major Group: FOP
3 Minor Group: NWH
4 Sub Category: ***
5 Indicator Code: FOP-NWH-***-005
6 Indicator Name: Hospital OP in a NWH
7 Indicator Acronym:
OP
8 Indicator Description:
Frequency count of OP cases registered
9 Dimensions: NWH, HD
10 Role & Action: NA
183
11 Formula: Same as indicator description
12 Data required: OP case registration details
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Indicator set to capture the capacity and utilization pattern of the NWH in the scheme
17 Unit of measure for the Indicator:
Number of cases
18 Type: A
19 Remarks: NA
********************************************************************
72.FOP-NWH-***-006
# KPI Properties Description
1 Gsln: 72
2 Major Group: FOP
3 Minor Group: NWH
4 Sub Category: ***
5 Indicator Code: FOP-NWH-***-006
6 Indicator Name: Hospital IP in a NWH
7 Indicator Acronym:
IP
8 Indicator Description:
Frequency count of IP cases registered
184
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: Same as indicator description
12 Data required: IP case registration details
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Indicator set to capture the capacity and utilization pattern of the NWH in the scheme
17 Unit of measure for the Indicator:
Number of cases
18 Type: A
19 Remarks: NA
********************************************************************
73.FOP-NWH-***-007
# KPI Properties Description
1 Gsln: 73
2 Major Group: FOP
3 Minor Group: NWH
4 Sub Category: ***
5 Indicator Code: FOP-NWH-***-007
6 Indicator Name: Dr.NTR Vaidya Seva Bed Occupancy Rate, during a specified period
185
7 Indicator Acronym:
BOR
8 Indicator Description:
The occupancy rate is a calculation used to show the actual utilization of an inpatient health facility for a given time period.
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: Occupied Bed-days in a NWH / Reserved Beds in the NWH x number of days in the period
12 Data required: Occupied Beds in a hospital, Reserved beds in a hospital, time period
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Indicator set to capture the capacity and utilization pattern of the NWH in the scheme
17 Unit of measure for the Indicator:
Percent (like x% etc.)
18 Type: R
19 Remarks: NA
********************************************************************
186
74. FOP-NWH-***-008
# KPI Properties Description
1 Gsln: 74
2 Major Group: FOP
3 Minor Group: NWH
4 Sub Category: ***
5 Indicator Code: FOP-NWH-***-008
6 Indicator Name: Therapy-month for a given therapy, during a specified period
7 Indicator Acronym:
THR_MTH
8 Indicator Description:
1 therapy month denotes that one particular therapy has been provided by the NWH for a period equivalent to that of 1 month. Therapy month is a standard used to see which therapies are utilized mostly in a NWH. (In other words, it shows which therapies are being provided mostly by a particular network hospital).
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: 1 x (number of days in the specified period/30.5)Ex: One therapy made available in a NWH for patients to utilise as and when required for one month will mean 1 therapy-month
12 Data required: Therapies done by a NWH
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
187
16 Indicator use: Indicator set to capture the capacity and utilization pattern of the NWH in the scheme
17 Unit of measure for the Indicator:
Number of Therapy Months
18 Type: Re
19 Remarks: NA
********************************************************************
75. FOP-NWH-***-009
# KPI Properties Description
1 Gsln: 75
2 Major Group: FOP
3 Minor Group: NWH
4 Sub Category: ***
5 Indicator Code: FOP-NWH-***-009
6 Indicator Name: Bed Occupancy updation time
7 Indicator Acronym:
OB
8 Indicator Description:
Average time at which the bed occupancy updation was done by the NWH
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: (Sum(Time taken by the NWH to update bed occupancy in each case))/Number of cases
12 Data required: Time taken by the NWH to update bed occupancy and the number of cases
188
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: Indicator set to capture the capacity and utilization pattern of the NWH in the scheme
17 Unit of measure for the Indicator:
Units of time (Ex: mins, hrs etc.)
18 Type: G
19 Remarks: NA
********************************************************************
76.FOP-HCA-***-001
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 76
2 Major Group: FOP
3 Minor Group: HCA
4 Sub Category: ***
5 Indicator Code: FOP-HCA-***-001
6 Indicator Name: Health Camps Conducted
7 Indicator Acronym:
HCC
8 Indicator Description:
Number of health camps conducted during a specified period
9 Dimensions: Policy Period and Phase, PD, NWH
10 Role & Action: NA
189
11 Formula: Count Of health camps
12 Data required: Data of the health camps conducted during a particular period
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: Indicator set to monitor the efficiency of health camps referral system
17 Unit of measure for the Indicator:
Number of health camps
18 Type: A
19 Remarks: NA
********************************************************************
77.FOP-HCA-***-002
# KPI Properties Description
1 Gsln: 77
2 Major Group: FOP
3 Minor Group: HCA
4 Sub Category: ***
5 Indicator Code: FOP-HCA-***-002
6 Indicator Name: Patients Screened
7 Indicator Acronym:
HCPS
190
8 Indicator Description:
Number of patients screened in all the health camps conducted during a specified period
9 Dimensions: Policy Period and Phase, PD, NWH
10 Role & Action: NA
11 Formula: Count of patients
12 Data required: Number of patients screened in a health camp and the time period
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: Indicator set to monitor the efficiency of health camps referral system
17 Unit of measure for the Indicator:
Number of patients screened
18 Type: A
19 Remarks: NA
********************************************************************
78.FOP-HCA-***-003
# KPI Properties Description
1 Gsln: 78
2 Major Group: FOP
3 Minor Group: HCA
4 Sub Category: ***
5 Indicator Code: FOP-HCA-***-003
191
6 Indicator Name: Patients Referred
7 Indicator Acronym:
HCPR
8 Indicator Description:
Number of patients referred to Network Hospitals from all the health camps conducted during a specified period
9 Dimensions: Policy Period and Phase, PD
10 Role & Action: NA
11 Formula: Count of patients
12 Data required: Number of patients referred to Network Hospitals during a health camp and the time period
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Indicator set to monitor the efficiency of health camps referral system
17 Unit of measure for the Indicator:
Number of patients referred
18 Type: A
19 Remarks: NA
********************************************************************
192
79.FOP-HCA-***-004
# KPI Properties Description
1 Gsln: 79
2 Major Group: FOP
3 Minor Group: HCA
4 Sub Category: ***
5 Indicator Code: FOP-HCA-***-004
6 Indicator Name: Health Camp Rate
7 Indicator Acronym:
HCR
8 Indicator Description:
Number of health camps conducted per week (during a specific period of time)
9 Dimensions: Policy Period and Phase, PD, HD
10 Role & Action: NA
11 Formula: Number of health camps conducted during a specified period / Number of weeks in the period
12 Data required: Number of health camps conducted and the time duration in which they were conducted
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: Indicator set to monitor the efficiency of health camps referral system
193
17 Unit of measure for the Indicator:
Number of health camps conducted per one week
18 Type: A
19 Remarks: NA
********************************************************************
80.FOP-HCA-***-005
# KPI Properties Description
1 Gsln: 80
2 Major Group: FOP
3 Minor Group: HCA
4 Sub Category: ***
5 Indicator Code: FOP-HCA-***-005
6 Indicator Name: Patients Screening Rate
7 Indicator Acronym:
HCSR
8 Indicator Description:
Number of patients screened (in all the health camps conducted during a specified period) per week
9 Dimensions: Policy Period and Phase, PD
10 Role & Action: NA
11 Formula: Number of patients screened in all the health camps conducted during a specified period / Number of weeks in the period
12 Data required: Number of health camps, number of patients screened and the time duration
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N Y Y Y Y Y Y Policy Period
194
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: Indicator set to monitor the efficiency of health camps referral system
17 Unit of measure for the Indicator:
Number of patients screened per one week
18 Type: R
19 Remarks: NA
********************************************************************
81.FOP-HCA-***-006
# KPI Properties Description
1 Gsln: 81
2 Major Group: FOP
3 Minor Group: HCA
4 Sub Category: ***
5 Indicator Code: FOP-HCA-***-006
6 Indicator Name: HC patient referral capture rate
7 Indicator Acronym:
HCAP
8 Indicator Description:
One patient out of every 'n patients' who were screened get referred to a hospital, this is calculated as HCAP
9 Dimensions: Policy Period and Phase, PD
10 Role & Action: NA
11 Formula: Number of patients referred to NWH / Number of patients screened in health camps
195
12 Data required: Number of patients screened in a health camp and the number of patients referred to a hospital
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Indicator set to monitor the efficiency of health camps referral system
17 Unit of measure for the Indicator:
One patient referred per every 'n' number of patients screened
18 Type: R
19 Remarks: NA
********************************************************************
82.FOP-HCA-***-007
# KPI Properties Description
1 Gsln: 82
2 Major Group: FOP
3 Minor Group: HCA
4 Sub Category: ***
5 Indicator Code: FOP-HCA-***-007
6 Indicator Name: HC patient referral conversion rate
7 Indicator Acronym:
HCON
8 Indicator Description:
One patient out of every 'n patients' who were referred get registered in a hospital, this is calculated as HCON
196
9 Dimensions: Policy Period and Phase, PD
10 Role & Action: NA
11 Formula: Number of patients registered in NWH / Number of patients referred to NWH
12 Data required: Number of patients referred in a health camp and the number of patients registered to a hospital
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Outcome
16 Indicator use: Indicator set to monitor the efficiency of health camps referral system
17 Unit of measure for the Indicator:
One patient registered per every 'n' number of patients referred
18 Type: R
19 Remarks: NA
********************************************************************
83.FOP-FUC-***-001
# KPI Properties Description
1 Gsln: 83
2 Major Group: FOP
3 Minor Group: FUC
4 Sub Category: ***
5 Indicator Code: FOP-FUC-***-001
6 Indicator Name: Follow-up eligible cases
197
7 Indicator Acronym:
FU_ECS
8 Indicator Description:
Number of follow-up eligible cases at any specified point of time
9 Dimensions: Policy Period and Phase, PD, HD
10 Role & Action: NA
11 Formula: Count of cases
12 Data required: Cases which are eligible for follow-up
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: Summary indicators for follow-up at each level of process flow
17 Unit of measure for the Indicator:
Number of cases
18 Type: A
19 Remarks: NA
********************************************************************
84.FOP-FUC-***-002
# KPI Properties Description
1 Gsln: 84
2 Major Group: FOP
3 Minor Group: FUC
4 Sub Category: ***
198
5 Indicator Code: FOP-FUC-***-002
6 Indicator Name: Follow-up availed cases
7 Indicator Acronym:
FU_ACS
8 Indicator Description:
Number of follow-up availed cases at any specified point of time
9 Dimensions: Policy Period and Phase, PD, HD
10 Role & Action: NA
11 Formula: Count of cases
12 Data required: Cases which availed follow-up
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: Summary indicators for follow-up at each level of process flow
17 Unit of measure for the Indicator:
Number of cases
18 Type: A
19 Remarks: NA
********************************************************************
199
85. FOP-FUC-***-003
# KPI Properties Description
1 Gsln: 85
2 Major Group: FOP
3 Minor Group: FUC
4 Sub Category: ***
5 Indicator Code: FOP-FUC-***-003
6 Indicator Name: Follow-up claim submitted cases
7 Indicator Acronym:
FU_CSCS
8 Indicator Description:
Number of follow-up availed cases for which claim has been submitted
9 Dimensions: Policy Period and Phase, PD, HD
10 Role & Action: NA
11 Formula: Count of cases
12 Data required: Claim data for follow-up availed cases with their status
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: Summary indicators for follow-up at each level of process flow
17 Unit of measure for the Indicator:
Number of cases
18 Type: A
200
19 Remarks: NA
********************************************************************
86. OP-FUC-***-004
# KPI Properties Description
1 Gsln: 86
2 Major Group: FOP
3 Minor Group: FUC
4 Sub Category: ***
5 Indicator Code: FOP-FUC-***-004
6 Indicator Name: Follow-up claim approved cases
7 Indicator Acronym:
FU_CACS
8 Indicator Description:
Number of follow-up availed cases for which claim has been approved
9 Dimensions: Policy Period and Phase, PD, HD
10 Role & Action: NA
11 Formula: Count of cases
12 Data required: Claim data for follow-up availed cases with their status
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Summary indicators for follow-up at each level of process flow
201
17 Unit of measure for the Indicator:
Number of cases
18 Type: A
19 Remarks: NA
********************************************************************
87.FOP-GHP-***-001
# KPI Properties Description
1 Gsln: 87
2 Major Group: FOP
3 Minor Group: GHP
4 Sub Category: ***
5 Indicator Code: FOP-GHP-***-001
6 Indicator Name: Percentage of therapies done in Government hospitals
7 Indicator Acronym:
PCT_TDN_GH
8 Indicator Description:
(Indicator Name is self descriptive)
9 Dimensions: Policy Period and Phase, HD, Category
10 Role & Action: NA
11 Formula: (Therapies done by Government Hospitals during a specified period / Therapies done in all NWHs for the period)*100
12 Data required: Number of therapies done and the type of the hospital where the therapy has been done
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
202
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor the percentage of therapies done by government hospitals during a specific period
17 Unit of measure for the Indicator:
Percentage of therapies
18 Type: P
19 Remarks: NA
********************************************************************
88.FOP-GHP-***-002
# KPI Properties Description
1 Gsln: 88
2 Major Group: FOP
3 Minor Group: GHP
4 Sub Category: ***
5 Indicator Code: FOP-GHP-***-002
6 Indicator Name: Percentage of the cost for therapies done in Government hospitals
7 Indicator Acronym:
PCT_CSTTDN_GH
8 Indicator Description:
(Indicator Name is self descriptive)
9 Dimensions: Policy Period and Phase, HD, Category
10 Role & Action: NA
11 Formula: (Cost of Therapies done for Government Hospitals during a specified period / Cost of all Therapies done in all NWHs during the period)*100
203
12 Data required: Cost of the therapies and the type of the hospital where the therapy has been done
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor the percentage of cost of the therapies that are being done by government hospitals
17 Unit of measure for the Indicator:
Percentage of cost
18 Type: P
19 Remarks: NA
********************************************************************
89. FOP-GHP-***-003
# KPI Properties Description
1 Gsln: 89
2 Major Group: FOP
3 Minor Group: GHP
4 Sub Category: ***
5 Indicator Code: FOP-GHP-***-003
6 Indicator Name: Government Hospital Preauths through Health Camp Route
7 Indicator Acronym:
HC_RT_GH)
204
8 Indicator Description:
Number of therapies preauthed (PaPAO_A + PaT_A) in Government Hospitals, from the patients referred from Health Camps during a specified period
9 Dimensions: Policy Period and Phase, HD, Therapy, Category
10 Role & Action: NA
11 Formula: Number of Preauths from preauth authorization officer (PaPAO_A)+ Number of Preauths from preauth trust doctor(PaT_A)
12 Data required: Patient referral route data and the Number of therapies preauthed by government hospitals
(Note: Records whose source of Referral is healthcamp are used)
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To compare the share of preauths routed to the government and private hospitals during a specific period of time. We want to see if there is any uneven distribution between the number of preauths that are routed to government and private hospitals
17 Unit of measure for the Indicator:
Number of preauths
18 Type: A
19 Remarks: NA
********************************************************************
205
90. FOP-GHP-***-004
# KPI Properties Description
1 Gsln: 90
2 Major Group: FOP
3 Minor Group: GHP
4 Sub Category: ***
5 Indicator Code: FOP-GHP-***-004
6 Indicator Name: Private Hospital Preauths through Health Camp Route
7 Indicator Acronym:
HC_RT_PH
8 Indicator Description:
Number of therapies preauthed (PaPAO_A + PaT_A) in Private Hospitals, from the patients referred from Health Camps during a specified period
9 Dimensions: Policy Period and Phase, HD, Therapy, Category
10 Role & Action: NA
11 Formula: Number of Preauths from preauth authorization officer (PaPAO_A)+ Number of Preauths from preauth trust doctor(PaT_A)
12 Data required: Patient referral route data and the Number of therapies preauthed by private hospitals
(Note: Records whose source of Referral is healthcamp are used)
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
206
16 Indicator use: To compare the share of preauths routed to the government and private hospitals during a specific period of time. We want to see if there is any uneven distribution between the number of preauths that are routed to government and private hospitals
17 Unit of measure for the Indicator:
Number of preauths
18 Type: A
19 Remarks: NA
********************************************************************
91. GRE-GRE-***-001
# KPI Properties Description
1 Gsln: 91
2 Major Group: GRE
3 Minor Group: GRE
4 Sub Category: ***
5 Indicator Code: GRE-GRE-***-001
6 Indicator Name: Grievance Arrivals during a specified period
7 Indicator Acronym:
GR_ARRV
8 Indicator Description:
Frequency count of Grievances received during the specified period
9 Dimensions: Policy Period and Phase, HD, NWH
10 Role & Action: NA
11 Formula: Count Of Grievances
12 Data required: Number of grievances during a specific period
207
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Summary measure to see the number of grievances received during a period
17 Unit of measure for the Indicator:
Number of grievances
18 Type: A
19 Remarks: NA
********************************************************************
92.GRE-GRE-***-002
# KPI Properties Description
1 Gsln: 92
2 Major Group: GRE
3 Minor Group: GRE
4 Sub Category: ***
5 Indicator Code: GRE-GRE-***-002
6 Indicator Name: Relative Frequency of Grievances during a specified period
7 Indicator Acronym:
RFG
8 Indicator Description:
Number of grievances arrived relating to the disaggregation variable during the period / total number of grievances received during the period
9 Dimensions: Policy Period and Phase, HD, NWH
208
10 Role & Action: NA
11 Formula: Same as the indicator description
12 Data required: Number of grievances and data related to the disaggregation variable (category)
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Breakdown analysis of the number of grievances received by category. The category could be either a hospital/therapy etc depending on the analysis.
17 Unit of measure for the Indicator:
Number of grievances related to the category of interest
18 Type: N
19 Remarks: NA
********************************************************************
93. GRE-GRE-***-003
# KPI Properties Description
1 Gsln: 93
2 Major Group: GRE
3 Minor Group: GRE
4 Sub Category: ***
5 Indicator Code: GRE-GRE-***-003
6 Indicator Name: Grievance Rate during a specified period
209
7 Indicator Acronym:
GR
8 Indicator Description:
Grievance arrivals per 100 therapies preauthed during the specified period
9 Dimensions: Policy Period and Phase, HD, NWH
10 Role & Action: NA
11 Formula: (Number of grievances / Number of preauths during a specified period)*100
12 Data required: Number of grievances and the number of therapies preauthed
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Outcome
16 Indicator use: To see the number of grievances per 100 preauths during a specific period of time and compare across various time periods.
17 Unit of measure for the Indicator:
Number of grievances per 100 preauths
18 Type: R
19 Remarks: NA
********************************************************************
210
94. GRE-GRE-***-004
# KPI Properties Description
1 Gsln: 94
2 Major Group: GRE
3 Minor Group: GRE
4 Sub Category: ***
5 Indicator Code: GRE-GRE-***-004
6 Indicator Name: Feedback letter Return Rate during a specified period
7 Indicator Acronym:
FB_RR
8 Indicator Description:
Feed back response rate is the percentage of people who responded to our feed back letters.
9 Dimensions: Policy Period and Phase, HD, NWH
10 Role & Action: NA
11 Formula: (Number of letters returned / Number of letters dispatched during the period)*100
12 Data required: Number of feedback letters returned to us and the number of feedback letters sent by us
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: The response rate tells us how many have given feedback to us and if the given feedback is a representative of the current situation or not. For example, people who encountered adverse events might be more prone to give a feedback which will introduce bias into what we are measuring.
211
17 Unit of measure for the Indicator:
Percentage of people who responded to feedback letters
18 Type: R
19 Remarks: NA
********************************************************************
95.GRE-GRE-***-005
# KPI Properties Description
1 Gsln: 95
2 Major Group: GRE
3 Minor Group: GRE
4 Sub Category: ***
5 Indicator Code: GRE-GRE-***-005
6 Indicator Name: Adverse Feedback Rate during a specified period
7 Indicator Acronym:
AFR
8 Indicator Description:
Number of adverse feedback letters received per 100 feedback letters received during the specified period
9 Dimensions: Policy Period and Phase, HD, NWH
10 Role & Action: NA
11 Formula: (Number of adverse feed back letters received/ Number of feed back letters received)*100
12 Data required: Number of adverse feedback letters and total number of feedback letters received
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y Y Policy Period
14 Data source: RAS Database
212
15 Indicator Monitors:
Outcome
16 Indicator use: To see the proportion of adverse feedback letters among the feed back letters which we received during a specified period of time and compare them over various time periods.
17 Unit of measure for the Indicator:
Number of adverse feedback letters received per 100 feedback letters received
18 Type: R
19 Remarks: NA
********************************************************************
96.EDM-EMP-HUT-001
# KPI Properties Description
1 Gsln: 96
2 Major Group: EDM
3 Minor Group: EMP
4 Sub Category: HUT
5 Indicator Code: EDM-EMP-HUT-001
6 Indicator Name: Relative Bed Units for a NWH
7 Indicator Acronym:
RBU
8 Indicator Description:
Relative bed units is a measure used for describing the capacity of the hospitals in a standard form (Bed Units).
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: Number of Hospital Beds in the NWH/ Bed Unit
12 Data required: Hospital Bed capacity and the time period during which they were empanelled
213
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y N N
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: This indicator is used for comparing hospitals with different capacity and the quantity of services they offer. For ex: a 50 bedded NWH providing 50 therapies and a 100 bedded NWH providing 50 therapies performance can be compared using this indicator. (Hypothetical example)
17 Unit of measure for the Indicator:
Number of Relative Bed Units
18 Type: Rt
19 Remarks: NA
********************************************************************
97. EDM-EMP-HUT-002
# KPI Properties Description
1 Gsln: 97
2 Major Group: EDM
3 Minor Group: EMP
4 Sub Category: HUT
5 Indicator Code: EDM-EMP-HUT-002
6 Indicator Name: Empanelment Weight for a NWH
7 Indicator Acronym:
EW
214
8 Indicator Description:
Empanelment weight denotes the capacity of an hospital in terms of what services it can provide for Dr.NTR Vaidya Seva (and how much demand/utilization is there for those NWH services (captured by bare weights) over a period of time
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: Sum of (BWs for all therapies in the category) for all categories/specialities empanelled in the NWH
12 Data required: All the categories a NWH has empanelled for during a specific period of time and the bare weights (for all the therapies which are covered under those categories)
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It is useful to compare various hospitals in terms of their capacity.
17 Unit of measure for the Indicator:
Number (without any specific unit)
18 Type: Re
19 Remarks: NA
********************************************************************
215
98. EDM-EMP-HUT-003
# KPI Properties Description
1 Gsln: 98
2 Major Group: EDM
3 Minor Group: EMP
4 Sub Category: HUT
5 Indicator Code: EDM-EMP-HUT-003
6 Indicator Name: Weighted Average Cases per month for a NWH, for a specified period
7 Indicator Acronym:
WAC
8 Indicator Description:
It is the average number of cases per empanelled category/therapy which a hospital is providing services to.
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: (1/RBU) x Sum of (Frequency count of a therapy preauthed during the period x BW of the therapy) for all therapies in the specialities empanelled in the NWH / (30.5 x Total BWs of all Categories for which the NWH is empanelled) (Using Software: (1/RBU) x (1/30.5) x (weighted mean), where weight = BW and variable = frequency of therapy preauth count)
12 Data required: Hospital capacity in terms of Relative Bed Units, Therapies preauthed during the specific period from the NWH, Categories empanelled in a NWH and therapies present in those categories, Bare weights for all the therapies
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y N N
216
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It is used to monitor how a hospital is performing as per the Dr.NTR Vaidya Seva Scheme. If a hospital doesn't provide sufficient services to Dr.NTR Vaidya Seva patients then it's average goes below the normal range
17 Unit of measure for the Indicator:
Number of cases per empanelled category/therapy
18 Type: G
19 Remarks: Hospitals empanel by specialities and not by therapies. Thus category can be considered as level 1 and therapy can be considered as level 2 (level 2 is bottom or finer level of measurement)
********************************************************************
99.EDM-EMP-HUT-004
# KPI Properties Description
1 Gsln: 99
2 Major Group: EDM
3 Minor Group: EMP
4 Sub Category: HUT
5 Indicator Code: EDM-EMP-HUT-004
6 Indicator Name: Weighted Standard Deviation for a NWH
7 Indicator Acronym:
WSD
8 Indicator Description:
It is the weighted standard deviation for the above indicator. (i.e. Weighted Average Cases per month for a NWH, for a specified period)
9 Dimensions: NWH, HD
217
10 Role & Action: NA
11 Formula: (1/RBU) x (1/30.5) x (weighted standard deviation formula), where weight = BW (Using Software: (1/RBU) x (1/30.5) x (weighted standard deviation), where weight = BW and variable = frequency of therapy preauth count)
12 Data required: Hospital capacity in terms of Relative Bed Units, Therapies preauthed during the specific period from the NWH, Categories empanelled in a NWH and therapies present in those categories, Bare weights for all the therapies
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: When the averages of two hospitals or the average of a particular hospital during two time points is same, then we look at the standard deviations to see which hospital is more reliable/consistent in providing the services to Dr.NTR Vaidya Seva patients.
17 Unit of measure for the Indicator:
Number (without any specific unit)
18 Type: Re
19 Remarks: Weighted Standard Deviation can be calculated by SAS / other statistical softwares and excel
********************************************************************
218
100.EDM-EMP-HUT-005
# KPI Properties Description
1 Gsln: 100
2 Major Group: EDM
3 Minor Group: EMP
4 Sub Category: HUT
5 Indicator Code: EDM-EMP-HUT-005
6 Indicator Name: Average Categories per NWH during a specified period
7 Indicator Acronym:
ACN
8 Indicator Description:
In a particular time period on average how many categories have been empanelled per a NWH.
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: sum of (categories for a given NWH) for all NWHs / total NWHs empanelled during the period
12 Data required: Number of categories empanelled for all the NWH during a specific period of time
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N N Y Y Y N N
14 Data source: RAS Database
15 Indicator Monitors:
Input
16 Indicator use: To monitor the change in the supply of services from the NWH's
219
17 Unit of measure for the Indicator:
Number of categories per one NWH
18 Type: G
19 Remarks: NA
********************************************************************
101.EDM-EMP-HUT-006
# KPI Properties Description
1 Gsln: 101
2 Major Group: EDM
3 Minor Group: EMP
4 Sub Category: HUT
5 Indicator Code: EDM-EMP-HUT-006
6 Indicator Name: Therapies preauthed per Category in a given NWH
7 Indicator Acronym:
THR_PA_CA
8 Indicator Description:
Indicator name is self descriptive
9 Dimensions: NWH, HD
10 Role & Action: NA
11 Formula: Frequency count of therapies preauthed for a category available with the specified NWH
12 Data required: Therapies Preauthed from a particular NWH and the category to which this therapy belongs to. (Category code, Surgery Code, NWH_CD))
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
220
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: Profiling of the therapies preauthed for a particular category during a specific period of time and analyse the patterns.
17 Unit of measure for the Indicator:
Number of therapies preauthed
18 Type: A
19 Remarks: NA
********************************************************************
102.EDM-EMP-HUT-007
# KPI Properties Description
1 Gsln: 102
2 Major Group: EDM
3 Minor Group: EMP
4 Sub Category: HUT
5 Indicator Code:
EDM-EMP-HUT-007
6 Indicator Name:
Percentage of therapies done by Government Doctors in Private hospitals during a specified period
7 Indicator Acronym:
PCT_THR_GVTDOC
8 Indicator Description:
Indicator name is self descriptive
9 Dimensions: NWH, HD
10 Role & Action:
NA
221
11 Formula: (Number of therapies done by Government doctors in Private hospitals during the specified period/ Total number of therapies done out of preauths given during the specified period)*100
12 Data required:
Records of surgeries done by doctors in private hospitals along with their medical registration number and the doctors registered with government hospitals along with their medical registration number
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: It is done to see if the government doctors are practising mostly in the private hospitals
17 Unit of measure for the Indicator:
Percent of therapies
18 Type: P
19 Remarks: NA
*******************************************************************
103.EDM-EMP-HUT-008
# KPI Properties Description
1 Gsln: 103
2 Major Group: EDM
3 Minor Group: EMP
4 Sub Category: HUT
5 Indicator Code:
EDM-EMP-HUT-008
222
6 Indicator Name:
Revolving Fund from the Preauthorisation's done during a specific period of time
7 Indicator Acronym:
RF
8 Indicator Description:
Indicator name is self descriptive
9 Dimensions: NWH, HD
10 Role & Action:
NA
11 Formula: Amount deducted from the payment to a Government NWH from amount of claims approved
12 Data required:
Therapies preauthed by government hospitals, the amount that it incurs and the amount deducted as revolving fund
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor the amount that has been deducted from the amount of claims approved for government hospitals in the form of revolving fund. We can define a time period and see how much amount is being collected as revolving fund periodically.
17 Unit of measure for the Indicator:
Rupees
18 Type: A
19 Remarks: NA
*******************************************************************
223
104.EDM-MAU-***-001
# KPI Properties
Description
1 Gsln: 104
2 Major Group: EDM
3 Minor Group: MAU
4 Sub Category:
***
5 Indicator Code:
EDM-MAU-***-001
6 Indicator Name:
Case Fatality Rate
7 Indicator Acronym:
CFR
8 Indicator Description:
1000 x Number of deaths/Number of therapies done
9 Dimensions: NWH, HD, Hospitalwise Category
10 Role & Action:
NA
11 Formula: 1000 x Number of deaths/Number of therapies done
12 Data required:
Number of deaths occurred and number of surgeries done out of preauths during the particular period
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
N N Y Y Y Y N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
224
16 Indicator use:
To monitor whether the quality of care is proper or not in a NWH. If the quality diminishes then the 'Case Fatality Rate' increases.
17 Unit of measure for the Indicator:
Number of deaths per number of therapies done
18 Type: R
19 Remarks: NA
*******************************************************************
105.OPR-PAU-SUB-001
# KPI Properties
Description
1 Gsln: 105
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category:
SUB
5 Indicator Code:
OPR-PAU-SUB-001
6 Indicator Name:
Therapies preauth submitted by MEDCO
7 Indicator Acronym:
PAU_S_R
PAUC_S_R
8 Indicator Description:
The number of therapies Preauth(Fresh preauth, Preauth cancellation) have been submitted by MEDCO to NAM.
9 Dimensions: Fresh preauth Cases
Preauth cancellation Cases
10 Role & Action:
MEDCO&
Preauth Submitted
225
11 Formula: NA
12 Data required:
NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use:
To monitor performance of MEDCO in disposal of preauth cases
17 Unit of measure for the Indicator:
Fresh preauth Cases
Preauth cancellation Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
*******************************************************************
106. OPR-PAU-SUB-002
# KPI Properties
Description
1 Gsln: 106
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category:
SUB
5 Indicator Code:
OPR-PAU-SUB-002
226
6 Indicator Name:
Therapies Preauth Submitted by MEDCO and Live
7 Indicator Acronym:
LPAU_S_R
LPAUC_S_R
8 Indicator Description:
The number of therapies for which Preauths(Fresh preauth,Preauth cancellation) have been submitted by MEDCO and awaiting final disposal at various levels of Trust at this moment.
9 Dimensions: Fresh preauth Cases
Preauth cancellation Cases
10 Role & Action:
MEDCO&
Preauth Submitted
11 Formula: NA
12 Data required:
NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of MEDCO in disposal of preauth cases
17 Unit of measure for the Indicator:
Fresh preauth Cases
Preauth cancellation Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
*******************************************************************
227
107. OPR-PAU-SUB-003
# KPI Properties Description
1 Gsln: 107
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: SUB
5 Indicator Code:
OPR-PAU-SUB-003
6 Indicator Name:
Therapies Preauth Submitted by MEDCO in Past
7 Indicator Acronym:
PPAU_S_R
PPAUC_S_R
8 Indicator Description:
The number of therapies for which Preauths(Fresh preauth,Preauth cancellation) have been submitted by MEDCO in the past
9 Dimensions: Fresh preauth Cases
Preauth cancellation Cases
10 Role & Action: MEDCO&Preauth Submitted
11 Formula: PAU_S_R (-)LPAU_S_R
PAUC_S_R(-)LPAUC_S_R
12 Data required: PAU_S_R; LPAU_S_R; PAUC_S_R; LPAUC_S_R
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of MEDCO in disposal of preauth cases
228
17 Unit of measure for the Indicator:
Fresh preauth Cases
Preauth cancellation Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
108.OPR-PAU-UPD-001
# KPI Properties Description
1 Gsln: 108
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: UPD
5 Indicator Code: OPR-PAU-UPD-001
6 Indicator Name: Therapies Preauth Updated by MEDCO
7 Indicator Acronym:
PAU_U_R
PAUC_U_R
8 Indicator Description:
The number of therapies for which Preauths (Preauth,Preauth cancellation) have been updated by MEDCO after pendency and returned to Trust
9 Dimensions: Fresh preauth Cases
Preauth cancellation Cases
10 Role & Action: MEDCO&Preauth Updated
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
229
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of MEDCO in disposal of preauth pendency cases
17 Unit of measure for the Indicator:
Preauth pendency Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
109.OPR-PAU-UPD-002
# KPI Properties Description
1 Gsln: 109
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: UPD
5 Indicator Code: OPR-PAU-UPD-002
6 Indicator Name: Therapies Preauth Updated by MEDCO and Live
7 Indicator Acronym:
LPAU_U_R
LPAUC_U_R
8 Indicator Description:
The number of therapies for which Preauths(Fresh preauth,Preauth cancellation) have been updated by MEDCO after pendency and awaiting final disposal at various levels of Trust at this moment
9 Dimensions: Fresh preauth Cases
Preauth cancellation Cases
10 Role & Action: MEDCO&Preauth Updated
230
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of MEDCO in disposal of preauth pendency cases
17 Unit of measure for the Indicator:
Preauth pendency Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
110.PR-PAU-UPD-003
# KPI Properties Description
1 Gsln: 110
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: UPD
5 Indicator Code: OPR-PAU-UPD-003
6 Indicator Name: Therapies Preauth Updated by MEDCO in Past
7 Indicator Acronym:
PPAU_U_R
PPAUC_U_R
231
8 Indicator Description:
The number of therapies for which Preauths(Fresh preauth,Preauth cancellation) have been updated by MEDCO after pendency in the past and returned to Trust
9 Dimensions: Fresh preauth Cases
Preauth cancellation Cases
10 Role & Action: MEDCO&Preauth Updated
11 Formula: PAU_U_R (-)LPAU_U_R
PAUC_U_R(-)LPAUC_U_R
12 Data required: PAU_U_R; LPAU_U_R; PAUC_U_R; LPAUC_U_R
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of MEDCO in disposal of preauth pendency cases
17 Unit of measure for the Indicator:
Preauth pendency Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
111.OPR-PAU-UPD-004
# KPI Properties Description
1 Gsln: 111
2 Major Group: OPR
3 Minor Group: PAU
232
4 Sub Category: UPD
5 Indicator Code:
OPR-PAU-UPD-004
6 Indicator Name:
Therapies Preauth Updated by MEDCO and sent to Preauth operator
7 Indicator Acronym:
PAU_U_R_PPD
PAU_U_R_PTD
PAU_U_R_PAO
8 Indicator Description:
The number of Therapies Preauth updated by MEDCO for therapies Preauths kept pendency and returned to preauth operator
9 Dimensions: PPD
PTD
PAO
10 Role & Action: MEDCO&Preauth Updated
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of MEDCO in disposal of preauth pendency cases
17 Unit of measure for the Indicator:
Preauth pendency Cases
18 Type: A
233
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
112.OPR-PAU-UPD-005
# KPI Properties Description
1 Gsln: 112
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: UPD
5 Indicator Code: OPR-PAU-UPD-005
6 Indicator Name: Therapies Preauth cancellation Updated by MEDCO and sent to Preauth operator
7 Indicator Acronym:
PAUC_U_R_PPD
PAUC_U_R_PTD
PAUC_U_R_PAO
8 Indicator Description:
The number of Therapies Preauth cancellation updated by MEDCO for therapies Preauths kept pendency and returned to preauth operator
9 Dimensions: PPD
PTD
PAO
10 Role & Action: MEDCO&Preauth Updated
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
234
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of MEDCO in disposal of preauth pendency cases
17 Unit of measure for the Indicator:
Preauth Cancellation pendency Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
113.OPR-PAU-FWD-001
# KPI Properties Description
1 Gsln: 113
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: FWD
5 Indicator Code: OPR-PAU-FWD-001
6 Indicator Name: Therapies Preauth Forwarded by NAM
7 Indicator Acronym:
PAU_F_N
8 Indicator Description:
The number of therapies for which Preauths have been forwarded by NAM after being raised for the first time by MEDCO
9 Dimensions: NA
10 Role & Action: NAM&Preauth Forwarded
11 Formula: NA
12 Data required: NA
235
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of NAM in disposal of preauth cases
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: NA
********************************************************************
114.OPR-PAU-FWD-002
# KPI Properties Description
1 Gsln: 114
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: FWD
5 Indicator Code: OPR-PAU-FWD-002
6 Indicator Name: Therapies Preauth Forwarded by NAM and Live
7 Indicator Acronym:
LPAU_F_N
8 Indicator Description:
The number of therapies for which Preauths have been forwarded by NAM after being raised for the first time by MEDCO and awaiting final disposal at various levels of Trust at this moment
9 Dimensions: NA
236
10 Role & Action: NAM &Preauth Forwarded
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of NAM in disposal of preauth cases
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: NA
********************************************************************
115.OPR-PAU-FWD-003
# KPI Properties Description
1 Gsln: 115
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: FWD
5 Indicator Code: OPR-PAU-FWD-003
6 Indicator Name: Therapies Preauth Forwarded by NAM in Past
7 Indicator Acronym:
PPAU_F_N
237
8 Indicator Description:
The number of therapies for which Preauths have been forwarded by NAM in Past
9 Dimensions: NA
10 Role & Action: NAM &Preauth Forwarded
11 Formula: PAU_F_N ( -) LPAU_F_N
12 Data required: PAU_F_N; LPAU_F_N
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of NAM in disposal of preauth cases
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: NA
********************************************************************
116.OPR-PAU-RAP-001
# KPI Properties Description
1 Gsln: 116
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: RAP
5 Indicator Code: OPR-PAU-RAP-001
238
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Approval
7 Indicator Acronym:
PAU_RA_PPD
PAU_RA_PID
PAU_RA_PTD
8 Indicator Description:
The number of therapies Preauth which have been disposed with a Recommendation for Approval by preauth operator
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator &Recommended approval
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
239
117.OPR-PAU-RAP-002
# KPI Properties Description
1 Gsln: 117
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: RAP
5 Indicator Code: OPR-PAU-RAP-002
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Approval and Live
7 Indicator Acronym:
LPAU_RA_PPD
LPAU_RA_PID
LPAU_RA_PTD
8 Indicator Description:
The number of therapies Preauth which have been disposed with a Recommendation for Approval by the preauth operator and awaiting final disposal at various levels of Trust at this moment
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator&Recommended approval
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
240
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
118.OPR-PAU-RAP-003
# KPI Properties Description
1 Gsln: 118
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: RAP
5 Indicator Code: OPR-PAU-RAP-003
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Approval in the Past
7 Indicator Acronym:
PPAU_RA_PPD
PPAU_RA_PID
PPAU_RA_PTD
8 Indicator Description:
The number of therapies Preauth which have been disposed with a Recommendation for Approval by the preauth operator in the Past
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator&
Recommended approval
241
11 Formula: PAU_RA_PPD (-)LPAU_RA_PPD
PAU_RA_PID (-)LPAU_RA_PID
PAU_RA_PTD (-)LPAU_RA_PTD
12 Data required: PAU_RA_PPD; LPAU_RA_PPD; PAU_RA_PID; LPAU_RA_PID; PAU_RA_PTD; LPAU_RA_PTD
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
119. OPR-PAU-RAP-004
# KPI Properties Description
1 Gsln: 119
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: RAP
5 Indicator Code: OPR-PAU-RAP-004
242
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Approval
without pendency
7 Indicator Acronym:
PAU_RA~NP_PPD
PAU_RA~NP_PID
PAU_RA~NP_PTD
8 Indicator Description:
The number of therapies which have been disposed with Recommendation of Approval without pendency by preauth operator
9 Dimensions: NA
10 Role & Action: Preauth Trust Doctor&Recommended Approval
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PTD performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
243
120. OPR-PAU-RAP-005
# KPI Properties Description
1 Gsln: 120
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: PEN
5 Indicator Code: OPR-PAU-RAP-005
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Approval after pendency
7 Indicator Acronym:
PAU_RA~P_PPD
PAU_RA~P_PID
PAU_RA~P_PTD
8 Indicator Description:
The number of therapies which have been disposed with a Recommendation of Approval after pendency by preauth operator
9 Dimensions: NA
10 Role & Action: Preauth Trust Doctor&Recommended Approval
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PTD performance and preauthorisation disposal pattern
244
17 Unit of measure for the Indicator:
Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
121.OPR-PAU-RAP-006
# KPI Properties Description
1 Gsln: 121
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: RAP
5 Indicator Code: OPR-PAU-RAP-006
6 Indicator Name: Therapies Preauth Cancellation request Disposed by Preauth operator with Recommendation for Approval
7 Indicator Acronym:
PAUC_RA_PPD
PAUC_RA_PID
PAUC_RA_PTD
8 Indicator Description:
The number of therapies Preauth Cancellation request which have been disposed with a Recommendation for Approval by preauth operator
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator &Recommended approval
11 Formula: NA
12 Data required: NA
245
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Preauth operator performance and preauth cancellations disposal pattern
17 Unit of measure for the Indicator:
Preauth cancellation Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
122. OPR-PAU-RAP-007
# KPI Properties Description
1 Gsln: 122
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: RAP
5 Indicator Code: OPR-PAU-RAP-007
6 Indicator Name: Therapies Preauth Cancellation request Disposed by Preauth operator with Recommendation for Approval (RA)and Live
7 Indicator Acronym:
LPAUC_RA_PPD
LPAUC_RA_PID
LPAUC_RA_PTD
246
8 Indicator Description:
The number of therapies Preauth Cancellation request which have been disposed with a Recommendation for Approval by the preauth operator and awaiting final disposal at various levels of Trust at this moment
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator&Recommended approval
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Preauth operator performance and preauth cancellations disposal pattern
17 Unit of measure for the Indicator:
Preauth cancellation Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
247
123. OPR-PAU-RAP-008
# KPI Properties Description
1 Gsln: 123
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: RAP
5 Indicator Code: OPR-PAU-RAP-008
6 Indicator Name: Therapies Preauth Cancellation request Disposed by with Preauth operator with Recommendation for Approval RA in the Past
7 Indicator Acronym:
PPAUC_RA_PPD
PPAUC_RA_PID
PPAUC_RA_PTD
8 Indicator Description:
The number of therapies Preauth Cancellation request which have been disposed with a Recommendation for Approval by the preauth operator
9 Dimensions: PPD (P)
PID (I)
PTD (T)
10 Role & Action: Preauth operator&Recommended approval
11 Formula: PAUC_RA_PPD (-)LPAUC_RA_PPD
PAUC_RA_PID (-)LPAUC_RA_PID
PAUC_RA_PTD (-)LPAUC_RA_PTD
12 Data required: PAUC_RA_PPD; LPAUC_RA_PPD; PAUC_RA_PID; LPAUC_RA_PID;PAUC_RA_PTD; LPAUC_RA_PTD
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
248
15 Indicator Monitors:
Output
16 Indicator use: To monitor Preauth operator performance and preauth cancellations disposal pattern
17 Unit of measure for the Indicator:
Preauth cancellation Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
124.OPR-PAU-RRJ-001
# KPI Properties Description
1 Gsln: 124
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: RRJ
5 Indicator Code: OPR-PAU-RRJ-001
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection(RR)
7 Indicator Acronym:
PAU_RR_PPD
PAU_RR_PID
PAU_RR_PTD
8 Indicator Description:
The number of therapies Preauth which have been disposed with a Recommendation for Rejection by the preauth operator
9 Dimensions: PPD
PID
PTD
249
10 Role & Action: Preauth Panel doctor&Recommended Rejection
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
125. OPR-PAU-RRJ-002
# KPI Properties Description
1 Gsln: 125
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: RRJ
5 Indicator Code: OPR-PAU-RRJ-002
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection and live
250
7 Indicator Acronym:
LPAU_RR_PPD
LPAU_RR_PID
LPAU_RR_PTD
8 Indicator Description:
The number of therapies Preauth which have been disposed with a Recommendation for Rejection by the preauth operator and awaiting final disposal at various levels of Trust at this moment
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator&Recommended Rejection
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
251
126. OPR-PAU-RRJ-003
# KPI Properties Description
1 Gsln: 126
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: RRJ
5 Indicator Code: OPR-PAU-RRJ-003
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection in the Past
7 Indicator Acronym:
PPAU_RR_PPD
PPAU_RR_PID
PPAU_RR_PTD
8 Indicator Description:
The number of therapies Preauth which have been disposed with a Recommendation for Rejection(RR) by the Preauth operator in the past
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator&Recommended Rejection
11 Formula: PAU_RR_PPD (-) LPAU_RR_PPD
PAU_RR_PID (-) LPAU_RR_PID
PAU_RR_PTD (-) LPAU_RR_PTD
12 Data required: PAU_RR_PPD; LPAU_RR_PPD;PAU_RR_PID; LPAU_RR_PID;PAU_RR_PTD; LPAU_RR_PTD
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
252
15 Indicator Monitors:
Output
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
127.OPR-PAU-RRJ-004
# KPI Properties Description
1 Gsln: 127
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: RRJ
5 Indicator Code: OPR-PAU-RRJ-004
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection without pendency
7 Indicator Acronym:
PAU_RR~NP_PPD
PAU_RR~NP_PID
PAU_RR~NP_PTD
8 Indicator Description:
The number of therapies Preauth which have been disposed with a Recommendation for Rejection without pendency by the preauth operator
9 Dimensions: NA
10 Role & Action: Preauth operator &Recommended rejection
11 Formula: NA
253
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
128.OPR-PAU-RRJ-005
# KPI Properties Description
1 Gsln: 128
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: RRJ
5 Indicator Code: OPR-PAU-RRJ-005
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Recommendation for Rejection after pendency
7 Indicator Acronym:
PAU_RR~P_PPD
PAU_RR~P_PID
PAU_RR~P_PTD
254
8 Indicator Description:
The number of therapies Preauth which have been disposed with a Recommendation for Rejection after pendency by the preauth operator
9 Dimensions: NA
10 Role & Action: Preauth operator &Recommended rejection
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PTD performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
129.OPR-PAU-PEN-001
# KPI Properties Description
1 Gsln: 129
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: PEN
255
5 Indicator Code: OPR-PAU-PEN-001
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Pendency
7 Indicator Acronym:
PAU_P_PPD
PAU_P_PID
PAU_P_PTD
8 Indicator Description:
The number of therapies Preauth which have been disposed with a Pendency by the Preauth operator
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator &Pendency
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
256
130. OPR-PAU-PEN-002
# KPI Properties Description
1 Gsln: 130
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: PEN
5 Indicator Code: OPR-PAU-PEN-002
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Pendency and Live
7 Indicator Acronym:
LPAU_P_PPD
LPAU_P_PID
LPAU_P_PTD
8 Indicator Description:
The number of therapies Preauth which have been disposed with a Pendency by the Preauth operator and awaiting final disposal at various levels of Trust at this moment
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator &Pendency
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
257
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
131. OPR-PAU-PEN-003
# KPI Properties Description
1 Gsln: 131
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: PEN
5 Indicator Code: OPR-PAU-PEN-003
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Pendency in the Past
7 Indicator Acronym:
PPAU_P_PPD
PPAU_P_PID
PPAU_P_PTD
8 Indicator Description:
The number of therapies which have been disposed with a Pendency by the Preauth operator in the past
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator &Pendency
258
11 Formula: PAU_P_PPD (-) LPAU_P_PPD
PAU_P_PID (-) LPAU_P_PID
PAU_P_PTD (-) LPAU_P_PTD
12 Data required: PAU_P_PPD; LPAU_P_PPD; PAU_P_PID; LPAU_P_PID; PAU_P_PTD; LPAU_P_PTD
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
132.OPR-PAU-PEN-004
# KPI Properties Description
1 Gsln: 132
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: PEN
5 Indicator Code: OPR-PAU-PEN-004
6 Indicator Name: Total number of therapies preauthorisation kept pending during specified period
259
7 Indicator Acronym:
PAU_P_T
8 Indicator Description:
Total number of therapies preauth kept pending by Preauth operators
9 Dimensions: NA
10 Role & Action: Preauth operator &Total Pendency
11 Formula: PAU_P_PPD + PAU_P_PID + PAU_P_PTD
12 Data required: PAU_P_PPD; PAU_P_PID; PAU_P_PTD
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: NA
********************************************************************
133.OPR-PAU-PEN-005
# KPI Properties Description
1 Gsln: 133
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: PEN
260
5 Indicator Code: OPR-PAU-PEN-005
6 Indicator Name: Therapies Preauth cancellation request disposed by Preauth operator with Pendency
7 Indicator Acronym:
PAUC_P_PPD
PAUC_P_PID
PAUC_P_PTD
8 Indicator Description:
The number of therapies Preauth cancellation request which have been disposed with a Pendency by the Preauth operator
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator &Pendency
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Preauth operator performance and preauth cancellations disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cancellation Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
261
134.OPR-PAU-PEN-006
# KPI Properties Description
1 Gsln: 134
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: PEN
5 Indicator Code: OPR-PAU-PEN-006
6 Indicator Name: Therapies Preauth cancellation request Disposed by Preauth operator with Pendency and Live
7 Indicator Acronym:
LPAUC_P_PPD
LPAUC_P_PID
LPAUC_P_PTD
8 Indicator Description:
The number of therapies Preauth cancellation request which have been disposed with a Pendency by the Preauth operator and awaiting final disposal at various levels of Trust at this moment
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator &Pendency
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
262
16 Indicator use: To monitor Preauth operator performance and preauth cancellations disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cancellation Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
135.OPR-PAU-PEN-007
# KPI Properties Description
1 Gsln: 135
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: PEN
5 Indicator Code: OPR-PAU-PEN-007
6 Indicator Name: Therapies Preauth cancellation request disposed by Preauth operator with Pendency in the Past
7 Indicator Acronym:
PPAUC_P_PPD
PPAUC_P_PID
PPAUC_P_PTD
8 Indicator Description:
The number of therapies Preauth cancellation request which have been disposed with a Pendency by the Preauth operator in the past
9 Dimensions: PPD
PID
PTD
10 Role & Action: Preauth operator &Pendency
263
11 Formula: PAUC_P_PPD (-) LPAUC_P_PPD
PAUC_P_PID (-) LPAUC_P_PID
PAUC_P_PTD (-) LPAUC_P_PTD
12 Data required: PAUC_P_PPD; LPAUC_P_PPD;PAUC_P_PID; LPAUC_P_PID;PAUC_P_PTD; LPAUC_P_PTD
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor Preauth operator performance and preauth cancellations disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cancellation Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
136.OPR-PAU-APP-001
# KPI Properties Description
1 Gsln: 136
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: APP
5 Indicator Code: OPR-PAU-APP-001
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Approval
264
7 Indicator Acronym:
PAU_A_PTD
PAU_A_PAO
8 Indicator Description:
The number of therapies which have been disposed with Final Approval by the preauth operator
9 Dimensions: PTD
PAO
10 Role & Action: Preauth operator&Preauth Approval
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Preauth Cancellation cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
137.OPR-PAU-APP-002
# KPI Properties Description
1 Gsln: 137
2 Major Group: OPR
3 Minor Group: PAU
265
4 Sub Category: APP
5 Indicator Code: OPR-PAU-APP-002
6 Indicator Name: Total number of therapies preauthorisation approved during specified period
7 Indicator Acronym:
PAU_A_T
8 Indicator Description:
Total number of therapies preauth approved by preauth operators
9 Dimensions: NA
10 Role & Action: Preauth operator&Preauth Approval
11 Formula: PAU_A_PAO + PAU_A_PTD
12 Data required: PAU_A_PAO; PAU_A_PTD
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Preauth Cases
18 Type: A
19 Remarks: NA
********************************************************************
266
138.OPR-PAU-APP-003
# KPI Properties Description
1 Gsln: 138
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: APP
5 Indicator Code: OPR-PAU-APP-003
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Approval without pendency
7 Indicator Acronym:
PAU_A~NP_PTD
PAU_A~NP_PAO
8 Indicator Description:
The number of therapies which have been disposed with Final Approval without pendency by the Preauth operator
9 Dimensions: PTD
PAO
10 Role & Action: Preauth operator&Preauth Approval
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
267
17 Unit of measure for the Indicator:
Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
139.OPR-PAU-APP-004
# KPI Properties Description
1 Gsln: 139
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: APP
5 Indicator Code: OPR-PAU-APP-004
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Approval after pendency
7 Indicator Acronym:
PAU_A~P_PTD
PAU_A~P_PAO
8 Indicator Description:
The number of therapies which have been disposed with Final Approval after pendency by the Preauth operator
9 Dimensions: PTD
PAO
10 Role & Action: Preauth operator&Preauth Approval
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
268
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
140.OPR-PAU-APP-005
# KPI Properties Description
1 Gsln: 140
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: APP
5 Indicator Code: OPR-PAU-APP-005
6 Indicator Name: Therapies Preauth cancellation request Disposed by Preauth operator with Approval
7 Indicator Acronym:
PAUC_A_PTD
PAUC_A_PAO
8 Indicator Description:
The number of therapies cancellation request which have been disposed with Final Approval by the Preauth operator
9 Dimensions: PTD
PAO
10 Role & Action: Preauth operator&Preauth Approval
269
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Preauth operator performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Preauth cancellation Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
141.OPR-PAU-APP-006
# KPI Properties Description
1 Gsln: 141
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: APP
5 Indicator Code: OPR-PAU-APP-006
6 Indicator Name: Total number of Therapies Preauth cancellation request disposed by Approval
7 Indicator Acronym:
PAUC_A_T
270
8 Indicator Description:
The number of therapies cancellation request which have been disposed with Final Approval by the Preauth operators
9 Dimensions: NA
10 Role & Action: Preauth operator&Preauth Cancellation
11 Formula: PAUC_A_PTD + PAUC_A_PAO
12 Data required: PAUC_A_PTD; PAUC_A_PAO
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor Preauth operator performance and preauth cancellations disposal pattern
17 Unit of measure for the Indicator:
Preauth Cancellation Cases
18 Type: A
19 Remarks: NA
********************************************************************
142.OPR-PAU-REJ-001
# KPI Properties Description
1 Gsln: 142
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: REJ
5 Indicator Code: OPR-PAU-REJ-001
271
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Rejection
7 Indicator Acronym:
PAU_R_PTD
PAU_R_PAO
8 Indicator Description:
The number of therapies which have been disposed with Final Rejection by the Preauth operator
9 Dimensions: PTD
PAO
10 Role & Action: Preauth operator&Preauth Rejection
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PTD performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
272
143.OPR-PAU-REJ-002
# KPI Properties Description
1 Gsln: 143
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: REJ
5 Indicator Code: OPR-PAU-REJ-002
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Rejection without pendency
7 Indicator Acronym:
PAU_R~NP_PTD
PAU_R~NP_PAO
8 Indicator Description:
The number of therapies which have been disposed with Final Rejection without pendency by the Preauth operator
9 Dimensions: PTD
PAO
10 Role & Action: Preauth operator &Preauth Rejection
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PTD performance and preauthorisation disposal pattern
273
17 Unit of measure for the Indicator:
Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
144.OPR-PAU-REJ-003
# KPI Properties Description
1 Gsln: 144
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: REJ
5 Indicator Code: OPR-PAU-REJ-003
6 Indicator Name: Therapies Preauth Disposed by Preauth operator with Rejection after pendency
7 Indicator Acronym:
PAU_R~P_PTD
PAU_R~P_PAO
8 Indicator Description:
The number of therapies which have been disposed with Final Rejection after pendency by the Preauth operator
9 Dimensions: PTD
PAO
10 Role & Action: Preauth operator&Preauth Rejection
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
274
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PTD performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Preauth Cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
145.OPR-PAU-REJ-004
# KPI Properties Description
1 Gsln: 145
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: REJ
5 Indicator Code: OPR-PAU-REJ-004
6 Indicator Name: Total number of therapies preauthorisation rejected during specified period
7 Indicator Acronym:
PAU_R_T
8 Indicator Description:
Total number of therapies preauth rejected by the Preauth operator
9 Dimensions: NA
10 Role & Action: Preauth operator&Total Preauth approval
11 Formula: PAU_R_PAO + PAU_R_PTD
275
12 Data required: PAU_R_PAO; PAU_R_PTD
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Preauth Cases
18 Type: A
19 Remarks: NA
********************************************************************
146.OPR-PAU-TDP-001
# KPI Properties Description
1 Gsln: 146
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: TDP
5 Indicator Code: OPR-PAU-TDP-001
6 Indicator Name: Total Therapies Preauth Disposed by PPD
7 Indicator Acronym:
PAU_D_PPD
8 Indicator Description:
Total Therapies Preauth Disposed by Preauth panel doctor with recommended approval,recommended rejection and pendency
9 Dimensions: NA
276
10 Role & Action: Preauth paneldoctor&Recommended Pendency
11 Formula: PAU_RA_PPD + PAU_RR_PPD + PAU_P_PPD
12 Data required: PAU_RA_PPD; PAU_RR_PPD;PAU_P_PPD
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor PPD performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Fresh Preauth Cases
18 Type: A
19 Remarks: NA
********************************************************************
147.OPR-PAU-TDP-002
# KPI Properties Description
1 Gsln: 147
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: TDP
5 Indicator Code: OPR-PAU-TDP-002
6 Indicator Name: Total Therapies Preauth Disposed by PTD
7 Indicator Acronym:
PAU_D_PTD
277
8 Indicator Description:
Total Therapies Preauth Disposed by Preauth trust doctor with approval,rejection,pendency,recommended approval and recommended rejection
9 Dimensions: PTD
PAO
10 Role & Action: Preauth Trust Doctor&Disposals
11 Formula: PAU_A_PTD + PAU_R _PTD+ PAU_P_PTD + PAU_RA_PTD + PAU_RR_PTD
12 Data required: PAU_A_PTD; PAU_R _PTD; PAU_P_PTD; PAU_RA_PTD; PAU_RR_PTD
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor PTD performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Preauth Cases
18 Type: A
19 Remarks: NA
********************************************************************
148.OPR-PAU-TDP-003
# KPI Properties Description
1 Gsln: 148
2 Major Group: OPR
3 Minor Group: PAU
278
4 Sub Category: TDP
5 Indicator Code: OPR-PAU-TDP-003
6 Indicator Name: Total Therapies Preauth Disposed by PAO
7 Indicator Acronym:
PAU_D_PAO
8 Indicator Description:
Total Therapies Preauth Disposed by PAO with approval,rejection and pendency
9 Dimensions: PTD
PAO
10 Role & Action: Preauth Trust Doctor&Disposals
11 Formula: PAU_A_PAO + PAU_R _PAO+ PAU_P_PAO
12 Data required: PAU_A_PAO; PAU_R _PAO; PAU_P_PAO
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor PAO performance and preauthorisation disposal pattern
17 Unit of measure for the Indicator:
Preauth Cases
18 Type: A
19 Remarks: NA
********************************************************************
279
149. OPR-PAU-AUC-001
# KPI Properties Description
1 Gsln: 149
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: AUC
5 Indicator Code: OPR-PAU-AUC-001
6 Indicator Name: Therapies Preauth disposed by auto cancellation
7 Indicator Acronym:
PAU_D_AUC
8 Indicator Description:
Number of Preauths auto cancelled due to expiry of time limit
9 Dimensions: NA
10 Role & Action: Preauth
Auto Cancellation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor preauth cancellations
17 Unit of measure for the Indicator:
Preauth Cases
18 Type: A
280
19 Remarks: NA
********************************************************************
150. OPR-TRT-UPD-001
# KPI Properties Description
1 Gsln: 150
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: UPD
5 Indicator Code: OPR-TRT-UPD-001
6 Indicator Name: Therapies treatment Updated by MEDCO
7 Indicator Acronym:
TRT_U_R_SUR
TRT_U_R_MTR
8 Indicator Description:
The number of preauthed therapies for which treatment has been updated by MEDCO
9 Dimensions: Surgery
Medical Treatment
10 Role & Action: MEDCO&Treatment Updated
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
281
16 Indicator use: To monitor status of preauth approved cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Preauth Approved cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
151. OPR-TRT-UPD-002
# KPI Properties Description
1 Gsln: 151
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: UPD
5 Indicator Code: OPR-TRT-UPD-002
6 Indicator Name: Therapies treatment Updated by MEDCO and Live
7 Indicator Acronym:
LTRT_U_R_SUR
LTRT_U_R_MTR
8 Indicator Description:
The number of therapies Preauths for which treatment have been updated by MEDCO and awaiting final discharge
9 Dimensions: Surgery
Medical Treatment
10 Role & Action: MEDCO&Treatment Updated
11 Formula: NA
12 Data required: NA
282
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor status of preauth approved cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Preauth Approved cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
152.OPR-TRT-UPD-003
# KPI Properties Description
1 Gsln: 152
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: UPD
5 Indicator Code: OPR-TRT-UPD-003
6 Indicator Name: Therapies treatment Updated by MEDCO in Past
7 Indicator Acronym:
PTRT_U_R_SUR
PTRT_U_R_MTR
8 Indicator Description:
The number of therapies Preauths for which treatment have been updated by MEDCO in the past
9 Dimensions: Surgery
Medical Treatment
283
10 Role & Action: MEDCO&Treatment Updated
11 Formula: TRT_U_R_SUR (-)LTRT_U_R_SUR
TRT_U_R_MTR (-) LTRT_U_R_MTR
12 Data required: TRT_U_R_SUR; LTRT_U_R_SUR;TRT_U_R_MTR; LTRT_U_R_MTR
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor status of preauth approved cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Preauth Approved cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
153.OPR-TRT-UPD-004
# KPI Properties Description
1 Gsln: 153
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: UPD
5 Indicator Code: OPR-TRT-UPD-004
6 Indicator Name: Total Therapies Treatment Updated by MEDCO
284
7 Indicator Acronym:
TRT_U_R_T
8 Indicator Description:
The number of therapies Preauths for which Treatment has been updated by MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO&Treatment Updated
11 Formula: TRT_U_R_SUR + TRT_U_R_MTR
12 Data required: TRT_U_R_SUR; TRT_U_R_MTR
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor status of preauth approved cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Preauth Approved cases
18 Type: A
19 Remarks: NA
********************************************************************
154.OPR-TRT-UPD-005
# KPI Properties Description
1 Gsln: 154
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: UPD
285
5 Indicator Code: OPR-TRT-UPD-005
6 Indicator Name: Total Therapies Treatment Updated by MEDCO and Live
7 Indicator Acronym:
LTRT_U_R_T
8 Indicator Description:
The number of therapies Preauths for which Treatment has been updated by MEDCO and awaiting final discharge
9 Dimensions: NA
10 Role & Action: MEDCO&Treatment Updated
11 Formula: LTRT_U_R_SUR + LTRT_U_R_MTR
12 Data required: LTRT_U_R_SUR; LTRT_U_R_MTR
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor status of preauth approved cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Preauth Approved cases
18 Type: A
19 Remarks: NA
********************************************************************
286
155. OPR-TRT-UPD-006
# KPI Properties Description
1 Gsln: 155
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: UPD
5 Indicator Code: OPR-TRT-UPD-006
6 Indicator Name: Total Therapies Treatment Updated by MEDCO in Past
7 Indicator Acronym:
PTRT_U_R_T
8 Indicator Description:
Total number of therapies Preauths for which Treatment has been updated by MEDCO in the past
9 Dimensions: NA
10 Role & Action: MEDCO&Total Therapy Updated
11 Formula: PTRT_U_R_SUR + PTRT_U_R_MTR
12 Data required: PTRT_U_R_SUR; PTRT_U_R_MTR
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor status of preauth approved cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Preauth Approved cases
18 Type: A
287
19 Remarks: NA
********************************************************************
156. OPR-DSC-UPD-001
# KPI Properties Description
1 Gsln: 156
2 Major Group: OPR
3 Minor Group: DSC
4 Sub Category: UPD
5 Indicator Code: OPR-DSC-UPD-001
6 Indicator Name: Therapies Discharge Updated by MEDCO
7 Indicator Acronym:
DSC_U_R
8 Indicator Description:
The number of preauthed therapies for which Discharge has been updated by MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO&Discharge Updated
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor status of preauth approved cases at NWH and performance of MEDCO
288
17 Unit of measure for the Indicator:
Preauth Approved cases
18 Type: A
19 Remarks: NA
********************************************************************
157.OPR-DEA-UPD-001
# KPI Properties Description
1 Gsln: 157
2 Major Group: OPR
3 Minor Group: DEA
4 Sub Category: UPD
5 Indicator Code: OPR-DEA-UPD-001
6 Indicator Name: Therapies Death Updated by MEDCO/Executive
7 Indicator Acronym:
DEA_U_R
DEA_U_X
8 Indicator Description:
The number of preauthed therapies for which Death has been updated by MEDCO/Executive
9 Dimensions: MEDCO Executive
10 Role & Action: MEDCO&Death Updated
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
289
15 Indicator Monitors:
Activity
16 Indicator use: To monitor status of preauth approved cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Preauth Approved cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
158.OPR-PAU-WTC-001
# KPI Properties Description
1 Gsln: 158
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: WTC
5 Indicator Code: OPR-PAU-WTC-001
6 Indicator Name: Therapies Preauth Waiting for <12 hrs at preauth operator
7 Indicator Acronym:
PAU_W<12hrs-NAM
PAU_W<12hrs-MEDCO
PAU_W<12hrs-PPD
PAU_W<12hrs-PTD
PAU_W<12hrs-PAO
8 Indicator Description:
The number of therapies preauth waiting for disposal for less than 12 hrs at preauth operator
9 Dimensions: NAM, MEDCO, PPD, PTD, PAO
10 Role & Action: Preauth operator&Preauthorisation
290
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PPD performance in disposal of preauth cases
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
159. OPR-PAU-WTC-002
# KPI Properties Description
1 Gsln: 159
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: WTC
5 Indicator Code: OPR-PAU-WTC-002
6 Indicator Name: Therapies Preauth Waiting for >12 hrs at various levels
291
7 Indicator Acronym:
PAU_W>12hrs_NAM
PAU_W>12hrs_MEDCO
PAU_W>12hrs_PPD
PAU_W>12hrs_PTD
PAU_W>12hrs_PAO
8 Indicator Description:
The number of therapies preauths waiting for disposal for greater than 12 hrs at preauth operator
9 Dimensions: NAM
MEDCO
PPD
PTD
PAO
10 Role & Action: Preauth operator&Preauthorisation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PPD performance in disposal of preauth cases
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
292
160. OPR-PAU-WTC-003
# KPI Properties Description
1 Gsln: 160
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: WTC
5 Indicator Code: OPR-PAU-WTC-003
6 Indicator Name: Therapies Preauth Waiting at Preauth operator afresh
7 Indicator Acronym:
PAUF_W_PPD
PAUF_W_PTD
PAUF_W_PAO
8 Indicator Description:
The number of fresh therapies preauths waiting for disposal at preauth operator
9 Dimensions: PPDPTDPAO
10 Role & Action: Preauth operator&Preauthorisation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PPD performance in disposal of preauth cases
17 Unit of measure for the Indicator:
Preauth cases
293
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
161.OPR-PAU-WTC-004
# KPI Properties Description
1 Gsln: 161
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: WTC
5 Indicator Code: OPR-PAU-WTC-004
6 Indicator Name: Therapies Preauth Waiting at Preauth operator after updation of pendency
7 Indicator Acronym:
PAUP_W_PPD
PAUP_W_PTD
PAUP_W_PAO
8 Indicator Description:
The number of therapies preauths which have been updated by MEDCO and waiting for disposal at preauth operator
9 Dimensions: PPD
PTD
PAO
10 Role & Action: Preauth operator&Preauthorisation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
294
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PPD performance in disposal of preauth cases
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
162.OPR-PAU-TWT-001
# KPI Properties Description
1 Gsln: 162
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: TWT
5 Indicator Code: OPR-PAU-TWT-001
6 Indicator Name: Total Therapies Preauth Waiting at NAM
7 Indicator Acronym:
PAU_W_N
8 Indicator Description:
The total number of therapies which have been Submitted by MEDCO to NAM and awaiting disposal at this moment
9 Dimensions: NA
10 Role & Action: NAM &Preauth Forwarding
11 Formula: PAU_W<12hrs_NAM + PAU_W>12hrs_NAM
12 Data required: PAU_W<12hrs_NAM; PAU_W>12hrs_NAM
295
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor NAM performance in disposal of preauth cases
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
163.OPR-PAU-TWT-002
# KPI Properties Description
1 Gsln: 163
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: TWT
5 Indicator Code: OPR-PAU-TWT-002
6 Indicator Name: Therapies Preauth Waiting at MEDCO
7 Indicator Acronym:
PAU_W_R
8 Indicator Description:
The total number of therapies which have been returned to MEDCO after pendency at PPD/PTD levels and awaiting disposal at this moment
9 Dimensions: NA
296
10 Role & Action: MEDCO &Preauth Submitting
11 Formula: PAU_W<12hrs_MEDCO + PAU_W>12hrs_MEDCO
12 Data required: PAU_W<12hrs_MEDCO; PAU_W>12hrs_MEDCO
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor MEDCO performance in disposal of preauth cases
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
164.OPR-PAU-TWT-003
# KPI Properties Description
1 Gsln: 164
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: TWT
5 Indicator Code: OPR-PAU-TWT-003
6 Indicator Name: Total Therapies Preauth Waiting at Preauth operator
7 Indicator Acronym:
PAU_W_PPD
297
8 Indicator Description:
The total number of therapies which have been forwarded by NAM/MEDCO and waiting for disposal at Preauth Panel Doctor
9 Dimensions: NA
10 Role & Action: Preauth operator&Preauthorisation
11 Formula: PAU_W<12hrs_PPD+PAU_W>12hrs_PPD (or) FPAU_W_PPD+PPAU_W_PPD
12 Data required: PAU_W<12hrs_PPD; PAU_W>12hrs_PPD; FPAU_W_PPD; PPAU_W_PPD
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor PPD performance in disposal of preauth cases
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
165.OPR-PAU-TWT-004
# KPI Properties Description
1 Gsln: 165
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: TWT
298
5 Indicator Code: OPR-PAU-TWT-004
6 Indicator Name: Total Therapies Preauth Waiting at Preauth operator
7 Indicator Acronym:
PAU_W_PTD
8 Indicator Description:
The total number of therapies which have been forwarded by Preauth Panel Doctor and waiting for disposal at Preauth Trust Doctor
9 Dimensions: NA
10 Role & Action: Preauth operator&Preauthorisation
11 Formula: PAU_W<12hrs_PTD+PAU_W>12hrs_PTD (or) FPAU_W_PTD+PPAU_W_PTD
12 Data required: PAU_W<12hrs_PTD; PAU_W>12hrs_PTD; FPAU_W_PTD; PPAU_W_PTD
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor PTD performance in disposal of preauth cases
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
299
166.OPR-PAU-TWT-005
# KPI Properties Description
1 Gsln: 166
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: TWT
5 Indicator Code: OPR-PAU-TWT-005
6 Indicator Name: Total Therapies Preauth Waiting at Preauth operator
7 Indicator Acronym:
PAU_W_PAO
8 Indicator Description:
The total number of therapies which have been forwarded by Preauth Trust Doctor and waiting for disposal at Preauth officer
9 Dimensions: NA
10 Role & Action: Preauth operator&Preauthorisation
11 Formula: PAU_W<12hrs_PAO+PAU_W>12hrs_PAO (or) FPAU_W_PAO+PPAU_W_PAO
12 Data required: PAU_W<12hrs_PAO; PAU_W>12hrs_PAO; FPAU_W_PAO; PPAU_W_PAO
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor PAO performance in disposal of preauth cases
300
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
167.OPR-PAU-TWT-006
# KPI Properties Description
1 Gsln: 167
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: TWT
5 Indicator Code: OPR-PAU-TWT-006
6 Indicator Name: Therapies Preauth Waiting at Trust
7 Indicator Acronym:
PAU_W_TRU
8 Indicator Description:
The total number of therapies Preauth waiting for disposal at Trust
9 Dimensions: NA
10 Role & Action: Trust&Preauthorisation
11 Formula: PAU_W_PPD+PAU_W_PTD + PAU_W_PAO
12 Data required: PAU_W_PPD; PAU_W_PTD; PAU_W_PAO
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
301
16 Indicator use: To monitor disposal of preauth cases at Trust
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
168.OPR-PAU-TWT-007
# KPI Properties Description
1 Gsln: 168
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: TWT
5 Indicator Code: OPR-PAU-TWT-007
6 Indicator Name: Therapies Preauth Waiting at NWH
7 Indicator Acronym:
PAU_W_NWH
8 Indicator Description:
The total number of therapies Preauth waiting for disposal at NWH
9 Dimensions: NA
10 Role & Action: NWH&Preauthorisation
11 Formula: PAU_W_N + PAU_W_R
12 Data required: PAU_W_N; PAU_W_R
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
302
15 Indicator Monitors:
Output
16 Indicator use: To monitor disposal of preauth cases at NWH
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
169.OPR-PAU-TWT-008
# KPI Properties Description
1 Gsln: 169
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: TWT
5 Indicator Code: OPR-PAU-TWT-008
6 Indicator Name: Total Therapies Preauth Waiting
7 Indicator Acronym:
PAU_W_T
8 Indicator Description:
The total number of therapies Preauth waiting for disposal at Trust and NWH
9 Dimensions: NA
10 Role & Action: Total&Preauthorisation
11 Formula: PAU_W_TRU + PAU_W_NWH
12 Data required: PAU_W_TRU; PAU_W_NWH
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
303
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor disposal of preauth cases
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
170.OPR-TRT-WTC-001
# KPI Properties Description
1 Gsln: 170
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: WTC
5 Indicator Code: OPR-TRT-WTC-001
6 Indicator Name: Therapies preauthed waiting for Treatment for >15 days
7 Indicator Acronym:
TRT_W>15days_R_SUR
TRT_W>15days_R_MTR
8 Indicator Description:
The number of therapies preauthed for which Treatment updation by MEDCO has not taken place for >15 days from the time of preauthorisation
9 Dimensions: Surgery
Medical Treatment
10 Role & Action: MEDCO&Treatment updation
11 Formula: NA
304
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth approved cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Preauth approved cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
171.OPR-TRT-WTC-002
# KPI Properties Description
1 Gsln: 171
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: WTC
5 Indicator Code: OPR-TRT-WTC-002
6 Indicator Name: Therapies preauthed waiting for Treatment for <15 days
7 Indicator Acronym:
TRT_W<15days_R SUR
TRT_W<15days_R_MTR
305
8 Indicator Description:
The number of therapies preauthed for which Treatment updation by MEDCO has not taken place for >15 days from the time of preauthorisation
9 Dimensions: Surgery
Medical Treatment
10 Role & Action: MEDCO&Treatment updation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth approved cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Preauth approved cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
172.OPR-TRT-WTC-003
# KPI Properties Description
1 Gsln: 172
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: WTC
306
5 Indicator Code: OPR-TRT-WTC-003
6 Indicator Name: Total Therapies waiting for Treatment for >15 days
7 Indicator Acronym:
TRT_W>15days_R_T
8 Indicator Description:
Total number of therapies preauthed for which Treatment updation by MEDCO has not taken place for >15 days from the time of preauthorisation
9 Dimensions: NA
10 Role & Action: MEDCO&
Treatment updation
11 Formula: TRT_W>15days_R_SUR+TRT_W>15days_R_MTR
12 Data required: TRT_W>15days_R_SUR;TRT_W>15days_R_MTR
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor disposal of preauth approved cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Preauth approved cases
18 Type: A
19 Remarks: NA
********************************************************************
307
173.OPR-TRT-WTC-004
# KPI Properties Description
1 Gsln: 173
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: WTC
5 Indicator Code: OPR-TRT-WTC-004
6 Indicator Name: Total Therapies waiting for <15 days Treatment
7 Indicator Acronym:
TRT_W<15days_R_T
8 Indicator Description:
Total number of therapies preauthed for which Treatment updation by MEDCO has not taken place for <15 days from the time of preauthorisation
9 Dimensions: NA
10 Role & Action: MEDCO&Treatment updation
11 Formula: TRT_W<15days_R_SUR+TRT_W<15days_R_MTR
12 Data required: TRT_W<15days_R_SUR;TRT_W<15days_R_MTR
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth approved cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Preauth approved cases
18 Type: A
308
19 Remarks: NA
********************************************************************
174.OPR-TRT-WTC-005
# KPI Properties Description
1 Gsln: 174
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: WTC
5 Indicator Code: OPR-TRT-WTC-005
6 Indicator Name: Total Therapies preauthed waiting for Treatment
7 Indicator Acronym:
TRT_W_R_T
8 Indicator Description:
The number of live preauthed surgical therapies for which surgery has to be updated by MEDCO
9 Dimensions: Surgery
Medical Treatment
10 Role & Action: MEDCO&Treatment updation
11 Formula: TRT_W>15days_R_T + TRT_W<15days_R_T
12 Data required: TRT_W>15days_R_T; TRT_W<15days_R_T
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor disposal of preauth approved cases at NWH and performance of MEDCO
309
17 Unit of measure for the Indicator:
Preauth approved cases
18 Type: A
19 Remarks: NA
********************************************************************
175.OPR-DSC-WTC-001
# KPI Properties Description
1 Gsln: 175
2 Major Group: OPR
3 Minor Group: DSC
4 Sub Category: WTC
5 Indicator Code: OPR-DSC-WTC-001
6 Indicator Name: Therapies waiting for discharge after Treatment for <15 days
7 Indicator Acronym:
DSC_W<15days_R_SUR
DSC_W<15days_R_MTR
8 Indicator Description:
The number of Treatment updated therapies waiting for discharge updation for <15 days
9 Dimensions: After surgery
After Medical Treatment
10 Role & Action: MEDCO&Discharge updation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
310
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of treatment updated cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Treatment updated Preauth cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
176.OPR-DSC-WTC-002
# KPI Properties Description
1 Gsln: 176
2 Major Group: OPR
3 Minor Group: DSC
4 Sub Category: WTC
5 Indicator Code: OPR-DSC-WTC-002
6 Indicator Name: Therapies waiting for discharge after treatment for >15 days
7 Indicator Acronym:
DSC_W>15days_R_SUR
DSC_W>15days_R_MTR
8 Indicator Description:
The number of treatment updated therapies waiting for which discharge updation for >15 days
9 Dimensions: After surgery
After Medical Treatment
10 Role & Action: MEDCO&Treatment Discharge updation
11 Formula: NA
12 Data required: NA
311
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of treatment updated cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Treatment updated Preauth cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
177.OPR-DSC-WTC-003
# KPI Properties Description
1 Gsln: 177
2 Major Group: OPR
3 Minor Group: DSC
4 Sub Category: WTC
5 Indicator Code: OPR-DSC-WTC-003
6 Indicator Name: Total Therapies waiting for discharge after treatment
7 Indicator Acronym:
DSC_W_R_T
8 Indicator Description:
Total number of treatment updated therapies waiting for which discharge updation
9 Dimensions: NA
312
10 Role & Action: MEDCO&Treatment Discharge updation
11 Formula: DSC_W<15days_R_SUR + DSC_W<15days_R_MTR
+DSC_W>15days_R_SUR + DSC_W>15days_R_MTR
12 Data required: DSC_W<15days_R_SUR; DSC_W<15days_R_MTR;
DSC_W>15days_R_SUR; DSC_W>15days_R_MTR
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of treatment updated cases at NWH and performance of MEDCO
17 Unit of measure for the Indicator:
Treatment updated Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
178.OPR-PAU-AWT-001
# KPI Properties Description
1 Gsln: 178
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: AWT
5 Indicator Code: OPR-PAU-AWT-001
6 Indicator Name: Average Case Waiting time for a therapy preauth case at NAM during a specified period
313
7 Indicator Acronym:
PAU_AWT N
8 Indicator Description:
Average time taken by NAM to forward a preauth case after arriving from MEDCO
9 Dimensions: NA
10 Role & Action: NAM&
Case Waiting Time
11 Formula: Sum of (The time at which a case is forwarded by NAM (- ) The time at which the case arrived at NAM from MEDCO)for all cases/ Number of cases
12 Data required: PaN_CWT; Number of cases
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor NAM performance in disposal of preauth cases
17 Unit of measure for the Indicator:
Time hrs
18 Type: A
19 Remarks: NA
********************************************************************
314
179.OPR-PAU-AWT-002
# KPI Properties Description
1 Gsln: 179
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: AWT
5 Indicator Code: OPR-PAU-AWT-002
6 Indicator Name: Average case waiting time for a therapy preauth case at MEDCO during a specified period
7 Indicator Acronym:
PAU_AWT_R
8 Indicator Description:
Average time taken by MEDCO to update a preauth case after pendency
9 Dimensions: NA
10 Role & Action: MEDCO&Case Waiting Time
11 Formula: Sum of( The time at which a case is updated by MEDCO (-) The time at which the case arrived at MEDCO from preauth operator after pendency) for all disposed cases/ Number of cases
12 Data required: PaR_CWT; Number of cases
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor NAM performance in disposal of preauth cases
315
17 Unit of measure for the Indicator:
Time hrs
18 Type: A
19 Remarks: NA
********************************************************************
180.OPR-PAU-AWT-003
# KPI Properties Description
1 Gsln: 180
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: AWT
5 Indicator Code: OPR-PAU-AWT-003
6 Indicator Name: Average case waiting time for a therapy preauth case at Preauth operator for a case during a specified period
7 Indicator Acronym:
PAU_AWT_PPD
PAU_AWT_PTD
PAU_AWT_PAO
8 Indicator Description:
Average time taken by Preauth operator to dispose a preauth case when afresh
9 Dimensions: PPD
PTD
PAO
10 Role & Action: PPD&Case Waiting Time
11 Formula: Sum of (The time at which a preauth case is disposed by Preauth operator (-) The time at which the preauth case arrived at Preauth operator)/ Number of cases
12 Data required: PaP_CWT1; Number of cases
316
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PPD performance in disposal of preauth cases
17 Unit of measure for the Indicator:
Time hrs
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
181.OPR-PAU-AWT-004
# KPI Properties Description
1 Gsln: 181
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: AWT
5 Indicator Code: OPR-PAU-AWT-004
6 Indicator Name: Average case waiting time for a fresh therapy preauth case at Preauth operator during a specified period
7 Indicator Acronym:
PAUF_AWT_PPD
PAUF_AWT_PTD
PAUF_AWT_PAO
8 Indicator Description:
Average time taken by Preauth operator to dispose a case when afresh
317
9 Dimensions: PPD;PTD;PAO
10 Role & Action: PPD&Case Waiting Time
11 Formula: Sum of (The time at which a fresh preauth case is disposed by Preauth operator (-) The time at which the preauth case arrived at Preauth operator)/ Number of cases
12 Data required: PaP_CWT1; Number of cases
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PPD performance in disposal of preauth cases
17 Unit of measure for the Indicator:
Time hrs
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
182.OPR-PAU-AWT-005
# KPI Properties Description
1 Gsln: 182
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: AWT
5 Indicator Code: OPR-PAU-AWT-005
318
6 Indicator Name: Average case waiting time at Preauth operator for a pending preauth updated case during a specified period
7 Indicator Acronym:
PAUP_AWT_PPD
PAUP_AWT_PTD
PAUP_AWT_PAO
8 Indicator Description:
Average time taken by Preauth operator to dispose a pending updated preauth case
9 Dimensions: PPD
PTD
PAO
10 Role & Action: PPD&Case Waiting Time
11 Formula: Sum of (The time at which a pending updated case is disposed by Preauth operator (-) The time at which the pending case arrived at Preauth operator)/ Number of cases
12 Data required: The time at which a pending updated case is disposed by PPD; The time at which the pending case arrived at PPD; Number of cases
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor PPD performance in disposal of preauth cases
17 Unit of measure for the Indicator:
Time hrs
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
319
********************************************************************
183.OPR-PAU-AWT-006
# KPI Properties Description
1 Gsln: 183
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: AWT
5 Indicator Code: OPR-PAU-AWT-006
6 Indicator Name: Average waiting time at Trust for a preauth case during a specified period
7 Indicator Acronym:
PAU_AWT_TRU
8 Indicator Description:
Average total time taken at Trust to dispose a preauth case
9 Dimensions: NA
10 Role & Action: TRUST&Case Waiting Time
11 Formula: PAUF_AWT_PPD + PAUP_AWT_PPD+PAUF_AWT_PTD + PAUP_AWT_PTD+PAUF_AWT_PAO + PAUP_AWT_PAO
12 Data required: PAUF_AWT_PPD; PAUP_AWT_PPD;PAUF_AWT_PTD; PAUP_AWT_PTD;PAUF_AWT_PAO; PAUP_AWT_PAO
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth cases
320
17 Unit of measure for the Indicator:
Time hrs
18 Type: A
19 Remarks: NA
********************************************************************
184.OPR-PAU-AWT-007
# KPI Properties Description
1 Gsln: 184
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: AWT
5 Indicator Code: OPR-PAU-AWT-007
6 Indicator Name: Average waiting time at NWH for a preauth case during a specified period
7 Indicator Acronym:
PAU_AWT_NWH
8 Indicator Description:
Average total time taken at NWH to dispose a preauth case
9 Dimensions: NA
10 Role & Action: NWH&Case Waiting Time
11 Formula: PAU_AWT N + PAU_AWT_R
12 Data required: PAU_AWT_N; PAU_AWT_R
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
321
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth cases
17 Unit of measure for the Indicator:
Time hrs
18 Type: A
19 Remarks: NA
********************************************************************
185.OPR-PAU-AWT-008
# KPI Properties Description
1 Gsln: 185
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: AWT
5 Indicator Code: OPR-PAU-AWT-008
6 Indicator Name: Average total waiting time for a preauth case
7 Indicator Acronym:
PAU_AWT_T
8 Indicator Description:
Average total time taken to dispose a preauth case
9 Dimensions: NA
10 Role & Action: TRUST,NWH&Case Waiting Time
11 Formula: PAU_AWT_TRU + PAU_AWT_NWH
12 Data required: PAU_AWT_TRU; PAU_AWT_NWH
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
322
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth cases
17 Unit of measure for the Indicator:
Time hrs
18 Type: A
19 Remarks: NA
********************************************************************
186. OPR-TRT-AWT-001
# KPI Properties Description
1 Gsln: 186
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: AWT
5 Indicator Code: OPR-TRT-AWT-001
6 Indicator Name: Average waiting time for treatment updation for a preauth approved case
7 Indicator Acronym:
TRT_AWT_SUR
TRT_AWT_MTR
8 Indicator Description:
Average time taken for treatment updation for a preauth approved case
9 Dimensions: Surgery
Medical treatment
10 Role & Action: MEDCO&Treatment updation
323
11 Formula: Sum of(The time at which a case is Surgery/Medical treatment updated (-) The time at which the case is preauthed)/ Number of cases
12 Data required: The time at which a case is surgery updated; The time at which the case is preauthed; Number of cases
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth approved cases
17 Unit of measure for the Indicator:
Time hrs
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
187. OPR-DSC-AWT-001
# KPI Properties Description
1 Gsln: 187
2 Major Group: OPR
3 Minor Group: TRT
4 Sub Category: AWT
5 Indicator Code: OPR-DSC-AWT-001
6 Indicator Name: Average discharge updation waiting time for a preauth approved case during a specified period
324
7 Indicator Acronym:
DSC_AWT_SUR
DSC_AWT_MTR
8 Indicator Description:
Average time taken for a preauth approved case for discharge updation
9 Dimensions: Surgery
Medical treatment
10 Role & Action: MEDCO&Discharge updation
11 Formula: Sum of(The time at which the case is discharge updated (-) The time at which the case is preauthed)/Number of cases
12 Data required: The time at which the case is discharge updated; The time at which the case is preauthed; Number of cases
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of treatment updated cases
17 Unit of measure for the Indicator:
Time hrs
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
325
188. OPR-OBD-AWT-001
# KPI Properties Description
1 Gsln: 188
2 Major Group: OPR
3 Minor Group: OBD
4 Sub Category: AWT
5 Indicator Code: OPR-OBD-AWT-001
6 Indicator Name: On-bed time for a case
7 Indicator Acronym:
OBD_AWT_SUR
OBD_AWT_MTR
8 Indicator Description:
Average time taken for case from preauth initiation to discharge updation
9 Dimensions: NA
10 Role & Action: CaseOn Bed time
11 Formula: Sum of(Time at which the case is discharge updated (-) the time at which the preauth is initiated)/Number of cases
12 Data required: Time at which the case is discharge updated; The time at which the preauth is initiated; Number of cases
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth cases
17 Unit of measure for the Indicator:
Time hrs
D W M Q H Y Cum Other
Y N N N N N N N
326
18 Type: Time
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
189.OPR-PAU-HPA-001
D W M Q H Y Cum Other
Y N N N N N N N
# KPI Properties Description
1 Gsln: 189
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: HPA
5 Indicator Code: OPR-PAU-HPA-001
6 Indicator Name: Hourly Preauth Arrival for each of the 24 hours in a day
7 Indicator Acronym:
PAU_HA
8 Indicator Description:
Number of cases forwarded for preauth by NAM every hour during the 24 hours
9 Dimensions: NA
10 Role & Action: NAM&Preauth Arrivals
11 Formula: NA
12 Data required: PAU_F_N
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
327
16 Indicator use: To monitor disposal of preauth cases and performance of NAM
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
190.OPR-PAU-ART-001
# KPI Properties Description
1 Gsln: 190
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: ART
5 Indicator Code: OPR-PAU-ART-001
6 Indicator Name: Preauth Arrival Rate
7 Indicator Acronym:
PAU_ART
8 Indicator Description:
Number of cases forwarded for preauth by NAM
9 Dimensions: NA
10 Role & Action: NAM&Preauth Arrivals
11 Formula: PAU_F_N in a given period / number of days in the period
12 Data required: PAU_F_N in a given period;
Number of days in the period
328
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth cases and performance of NAM
17 Unit of measure for the Indicator:
Preauth cases
18 Type: R
19 Remarks: NA
********************************************************************
191.OPR-PAU-HAP-001
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 191
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: HAP
5 Indicator Code: OPR-PAU-HAP-001
6 Indicator Name: Hourly Preauth approval for each of the 24 hours in a day
7 Indicator Acronym:
PAU_HAP
8 Indicator Description:
Hourly Preauth approval for each of the 24 hours in a day
9 Dimensions: NA
10 Role & Action: Preauth operator&Preauth Approvals
329
11 Formula: (PAU_A_PTD + PAU_A_PAO ) every hour during the 24 hours
12 Data required: PAU_A_PTD; PAU_A_PAO
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth cases
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
192.OPR-PAU-APR-001
D W M Q H Y Cum Other
Y N N N N N N N
# KPI Properties Description
1 Gsln: 192
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: APR
5 Indicator Code: OPR-PAU-APR-001
6 Indicator Name: Preauth Approval rate
7 Indicator Acronym:
PAU_APR
8 Indicator Description:
Number of cases preauth approved per day
330
9 Dimensions: NA
10 Role & Action: Preauth operator&Preauth Approvals
11 Formula: Number of therapies preauth approved
(PAU_A_PTD + PAU_A_PAO) during a specified period / number of days in the period
12 Data required: PAU_A_PTD; PAU_A_PAO
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth cases
17 Unit of measure for the Indicator:
Preauth cases
18 Type: R
19 Remarks: NA
********************************************************************
193. OPR-PAU-DTO-001
# KPI Properties Description
1 Gsln: 193
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: DTO
5 Indicator Code: OPR-PAU-DTO-001
6 Indicator Name: Daily Turnover of preauth cases by Preauth operator
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
331
7 Indicator Acronym:
PAU_DTO_PPD
PAU_DTO_PTD
PAU_DTO_PAO
8 Indicator Description:
Actual number of preauth cases disposed by Preauth operator in specified day
9 Dimensions: PPD
PTD
PAO
10 Role & Action: Preauth operator& Preauth cases disposals
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth cases
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
Y N N N N N N N
332
194. OPR-PAU-TOR-001
# KPI Properties Description
1 Gsln: 194
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: TOR
5 Indicator Code: OPR-PAU-TOR-001
6 Indicator Name: Preauth Turnover Rate for Preauth operator
7 Indicator Acronym:
PAU_TOR_PPD
PAU_TOR_PTD
PAU_TOR_PAO
8 Indicator Description:
Average number of Preauth cases disposed by Preauth operator
9 Dimensions: PPD
PTD
PAO
10 Role & Action: Preauth operator& Preauth cases disposals
11 Formula: Number of preauth cases disposed by Panel doctor during the period / Number of days in the period
12 Data required: Preauth cases disposed by Preauth operator; Number of days in the period
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth cases
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
333
17 Unit of measure for the Indicator:
Preauth cases
18 Type: R
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
195.OPR-PAU-CPT-001
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 195
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CPT
5 Indicator Code: OPR-PAU-CPT-001
6 Indicator Name: Average Case Processing Time of Preauth Operator, during a specified period
7 Indicator Acronym:
PAU_ACPT
8 Indicator Description:
Average time taken to process a preauth case by preauth operator
9 Dimensions: NA
10 Role & Action: Preauth operator&Preauth case processing time
11 Formula: Sum of the (time taken from opening the case to closing the case) for all cases of that operator / number of cases
12 Data required: Time taken from opening the case to closing the case for all cases of that operator; Number of cases
13 Frequency of
Monitoring:
334
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of preauth cases
17 Unit of measure for the Indicator:
Time hrs
18 Type: A
19 Remarks: NA
********************************************************************
196.OPR-PAU-PPP-001
# KPI Properties Description
1 Gsln: 196
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: PPP
5 Indicator Code: OPR-PAU-PPP-001
6 Indicator Name: Preauth Pendency Percentage for Preauth Operator during a specified period
7 Indicator Acronym:
PAU_PPP_PPD
PAU_PPP_PTD
PAU_PPP_PAO
8 Indicator Description:
The percentage of preauth cases disposed with pendency by Preauth Operator
9 Dimensions: PPD
PTD
PAO
10 Role & Action: Preauth Operator&Preauth cases pendency
335
11 Formula: PAU_P_PPD/PAU_D_PPD*100
PAU_P_PTD/PAU_D_PTD*100
PAU_P_PAO/PAU_D_PAO*10
0 12 Data required: PAU_P_PPD; PAU_D_PPD;
PAU_P_PTD; PAU_D_PTD;
PAU_P_PAO; PAU_D_PAO
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor disposal pattern of preauth cases
17 Unit of measure for the Indicator:
Time hrs
18 Type: P
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
197.OPR-PAU-TIN-001
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 197
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: TIN
5 Indicator Code: OPR-PAU-TIN-001
6 Indicator Name: Telephonic Intimations PEX Approved
336
7 Indicator Acronym:
PAU_TIN_A_X
8 Indicator Description:
Number of emergency preauth cases approved
9 Dimensions: NA
10 Role & Action: PEX&Telephonic Intimations
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of emergency preauth cases
17 Unit of measure for the Indicator:
Emergency preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
198.OPR-PAU-BUF-001
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 198
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: BUF
337
5 Indicator Code: OPR-PAU-BUF-001
6 Indicator Name: Preauthorisations-Regular-With buffer PTD Recommended Approval
7 Indicator Acronym:
BPAU_RA_PTD
8 Indicator Description:
Number of preauth cases approved for buffer by PTD
9 Dimensions: NA
10 Role & Action: PTD&Preauthorisations-Regular-With buffer
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal pattern of preauth cases for buffer
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
338
199.OPR-PAU-BUF-002
# KPI Properties Description
1 Gsln: 199
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: BUF
5 Indicator Code: OPR-PAU-BUF-002
6 Indicator Name: Preauthorisations-Regular-With buffer PTD Recommended Rejection
7 Indicator Acronym:
BPAU_RR_PTD
8 Indicator Description:
Number of preauth cases Rejected for buffer by PTD
9 Dimensions: NA
10 Role & Action: PTD&Preauthorisations-Regular-With buffer
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal pattern of preauth cases for buffer
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
339
19 Remarks: NA
********************************************************************
200.OPR-PAU-BUF-003
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 200
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: BUF
5 Indicator Code: OPR-PAU-BUF-003
6 Indicator Name: Preauthorisations-Regular-With buffer PTD Pending
7 Indicator Acronym:
BPAU_P_PTD
BPAU_P_PAO
8 Indicator Description:
Number of preauth cases kept pending for buffer by PTD
9 Dimensions: PTD
PAO
10 Role & Action: PTD&Preauthorisations-Regular-With buffer
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal pattern of preauth cases for buffer
340
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
******************************************************************** 201.OPR-PAU-BUF-004
# KPI Properties Description
1 Gsln: 201
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: BUF
5 Indicator Code: OPR-PAU-BUF-004
6 Indicator Name: Preauthorisations-Regular-With buffer PAO Approved
7 Indicator Acronym:
BPAU_A_PAO
8 Indicator Description:
Number of preauth cases approved for buffer by PAO
9 Dimensions: NA
10 Role & Action: PAO&Preauthorisations-Regular-With buffer
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
341
16 Indicator use: To monitor disposal pattern of preauth cases for buffer
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
202.OPR-PAU-BUF-005
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 202
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: BUF
5 Indicator Code: OPR-PAU-BUF-005
6 Indicator Name: Preauthorisations-Regular-With buffer PAO Rejected
7 Indicator Acronym:
BPAU_R_PAO
8 Indicator Description:
Number of preauth cases Rejected for buffer by PAO
9 Dimensions: NA
10 Role & Action: PAO&Preauthorisations-Regular-With buffer
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
342
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal pattern of preauth cases for buffer
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
203.OPR-PAU-ENH-001
# KPI Properties Description
1 Gsln: 203
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: ENH
5 Indicator Code: OPR-PAU-ENH-001
6 Indicator Name: Pre-authorisations - Enhancement MEDCO Initiated
7 Indicator Acronym:
PAU_ENH_I_R
8 Indicator Description:
Number of preauth cases initiated by MEDCO for enhancement
9 Dimensions: NA
10 Role & Action: MEDCO&Pre-authorisations Enhancement
11 Formula: NA
12 Data required: NA
343
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal pattern of preauth cases for enhancement
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
204.OPR-PAU-ENH-002
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 204
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: ENH
5 Indicator Code: OPR-PAU-ENH-002
6 Indicator Name: Pre-authorisations - Enhancement MEDCO Updated
7 Indicator Acronym:
PAU_ENH_U_R
8 Indicator Description:
Number of preauth cases Updated by MEDCO for enhancement after pendency
9 Dimensions: NA
10 Role & Action: MEDCO&Pre-authorisations Enhancement
344
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal pattern of preauth cases for enhancement
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
205.OPR-PAU-ENH-003
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 205
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: ENH
5 Indicator Code: OPR-PAU-ENH-003
6 Indicator Name: Pre-authorisations Enhancement updation waiting MEDCO
7 Indicator Acronym:
PAU_ENH_U_W_R
8 Indicator Description:
Pre-authorisations Enhancement updation waiting MEDCO
345
9 Dimensions: NA
10 Role & Action: MEDCO&Pre-authorisations Enhancement
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal pattern of preauth cases for enhancement
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
206. OPR-PAU-ENH-004
# KPI Properties Description
1 Gsln: 206
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: ENH
5 Indicator Code: OPR-PAU-ENH-004
6 Indicator Name: Pre-authorisations - Enhancement Preauth Operator Recommended Approval
D W M Q H Y Cum Other
Y Y N N N N N N
346
7 Indicator Acronym:
PAU_ENH_RA_PTD
PAU_ENH_RA_MC-ETC
8 Indicator Description:
Number of preauth Enhancement cases Recommended Approval by Preauth Operator
9 Dimensions: PTD
MC-ETC
10 Role & Action: Preauth Operator&Pre-authorisationsEnhancement
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal pattern of preauth cases for enhancement
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
347
207. OPR-PAU-ENH-005
# KPI Properties Description
1 Gsln: 207
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: ENH
5 Indicator Code: OPR-PAU-ENH-005
6 Indicator Name: Pre-authorisations - Enhancement Preauth Operator Rejected
7 Indicator Acronym:
PAU_ENH_R_PTD
PAU_ENH_R_MC-ETC
PAU_ENH_R_PAO
8 Indicator Description:
Number of preauth Enhancement cases Recommended rejection by Preauth Operator
9 Dimensions: PTD
MC-ETC
PAO
10 Role & Action: Preauth Operator &Pre-authorisationsEnhancement
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal pattern of preauth cases for enhancement
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
348
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
208. OPR-PAU-ENH-006
# KPI Properties Description
1 Gsln: 208
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: ENH
5 Indicator Code: OPR-PAU-ENH-006
6 Indicator Name: Pre-authorisations - Enhancement Preauth Operator Pending
7 Indicator Acronym:
PAU_ENH_P_PTD
PAU_ENH_P_MC-ETC
PAU_ENH_P_PAO
8 Indicator Description:
Number of preauth Enhancement cases Recommended pending by Preauth Operator
9 Dimensions: PTD
MC-ETC
PAO
10 Role & Action: Preauth Operator&Pre-authorisationsEnhancement
11 Formula: NA
12 Data required: NA
349
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal pattern of preauth cases for enhancement
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
209.OPR-PAU-ENH-07
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 209
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: ENH
5 Indicator Code: OPR-PAU-ENH-07
6 Indicator Name: Pre-authorisations - Enhancement PAO Approved
7 Indicator Acronym:
PAU_ENH_A_PAO
8 Indicator Description:
Number of preauth Enhancement cases Approval by PAO
9 Dimensions: NA
10 Role & Action: PAO&Pre-authorisations Enhancement
350
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal pattern of preauth cases for enhancement
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: NA
********************************************************************
210.OPR-PAU-ENH-008
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 210
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: ENH
5 Indicator Code: OPR-PAU-ENH-008
6 Indicator Name: Pre-authorisations Enhancement cases waiting at Preauth Operator
7 Indicator Acronym:
PAU_ENH_W_PTD
PAU_ENH_W_MC-ETC
PAU_ENH_W_PAO
351
8 Indicator Description:
Number of preauth enhancement cases waiting with Preauth Operator
9 Dimensions: PTD
MC-ETC
PAO
10 Role & Action: Preauth Operator&Pre-authorisationsEnhancement
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal pattern of preauth cases for enhancement
17 Unit of measure for the Indicator:
Preauth cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
211.OPR-PAU-CCH-001
D W M Q H Y Cum Other
Y Y N N N N N N
# KPI Properties Description
1 Gsln: 211
2 Major Group: OPR
3 Minor Group: PAU
352
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-001
6 Indicator Name: Pre-Authorisations-Cochlear Cases Initiated by MEDCO
7 Indicator Acronym:
PAU_CCH_I_R
8 Indicator Description:
Number of preauth Cochlear cases initiated by MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO&Pre-AuthorisationsCochlear Cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of MEDCO in disposal of Cochlear preauth cases
17 Unit of measure for the Indicator:
Preauth Cochlear cases
18 Type: A
19 Remarks: NA
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
353
212.OPR-PAU-CCH-002
# KPI Properties Description
1 Gsln: 212
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-002
6 Indicator Name: Pre-Authorisations-Cochlear Cases Updated by MEDCO
7 Indicator Acronym:
PAU_CCH_U_R
8 Indicator Description:
Number of preauth Cochlear cases updated by MEDCO after pendency
9 Dimensions: NA
10 Role & Action: MEDCO&Pre-AuthorisationsCochlear Cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of MEDCO in disposal of Cochlear preauth cases
17 Unit of measure for the Indicator:
Preauth Cochlear cases
18 Type: A
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
354
19 Remarks: NA
********************************************************************
213.OPR-PAU-CCH-003
D W M Q H Y Cum Other
Y Y N N N N N N
# KPI Properties Description
1 Gsln: 213
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-003
6 Indicator Name: Pre-authorisations Cochlear cases updation waiting at MEDCO
7 Indicator Acronym:
PAU_CCH_W_R
8 Indicator Description:
Number of preauth Cochlear cases waiting with MEDCO for updation after pendency
9 Dimensions: NA
10 Role & Action: MEDCO&Pre-AuthorisationsCochlear Cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of MEDCO in disposal of Cochlear preauth cases
355
17 Unit of measure for the Indicator:
Preauth Cochlear cases
18 Type: A
19 Remarks: NA
********************************************************************
214.OPR-PAU-CCH-004
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 214
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-004
6 Indicator Name: Pre-Authorisations-Cochlear Cases forwarded by Preauth Operator
7 Indicator Acronym:
PAU_CCH_F_N
PAU_CCH_F_X
8 Indicator Description:
Number of preauth Cochlear cases forwarded by Preauth Operator
9 Dimensions: NAM
PEX-C
10 Role & Action: Preauth Operator&Pre-AuthorisationsCochlear Cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
356
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cases
17 Unit of measure for the Indicator:
Preauth Cochlear cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
215.OPR-PAU-CCH-005
# KPI Properties Description
1 Gsln: 215
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-005
6 Indicator Name: Pre-authorisations Cochlear cases waiting at Preauth Operator
7 Indicator Acronym:
PAU_CCH_W_N
PAU_CCH_W_X
8 Indicator Description:
Number of preauth Cochlear cases waiting at Preauth Operator
9 Dimensions: NAM
PEX-C
10 Role & Action: Preauth Operator&Pre-AuthorisationsCochlear Cases
11 Formula: NA
357
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cases
17 Unit of measure for the Indicator:
Preauth Cochlear cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
216.OPR-PAU-CCH-006
# KPI Properties Description
1 Gsln: 216
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-006
6 Indicator Name: Pre-Authorisations-Cochlear Cases Recommended Approval by Preauth Operator
7 Indicator Acronym:
PAU_CCH_RA_MC-CC
PAU_CCH_RA_C-CC
D W M Q H Y Cum Other
Y Y N N N N N N
358
8 Indicator Description:
Number of preauth Cochlear cases recommended Approval by Preauth Operator
9 Dimensions: MC-CC
C-CC
10 Role & Action: Preauth Operator&Pre-AuthorisationsCochlear Cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cases
17 Unit of measure for the Indicator:
Preauth Cochlear cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
217.OPR-PAU-CCH-007
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 217
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
359
5 Indicator Code: OPR-PAU-CCH-007
6 Indicator Name: Pre-Authorisations-Cochlear Cases Recommended Rejection by Preauth Operator
7 Indicator Acronym:
PAU_CCH_RR_MC-
CC PAU_CCH_RR_C-
CC 8 Indicator Description:
Number of preauth Cochlear cases recommended rejection by Preauth Operator
9 Dimensions: MC-CC
C-CC
10 Role & Action: Preauth Operator&Pre-AuthorisationsCochlear Cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cases
17 Unit of measure for the Indicator:
Preauth Cochlear cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
360
218. OPR-PAU-CCH-008
# KPI Properties Description
1 Gsln: 218
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-008
6 Indicator Name: Pre-Authorisations-Cochlear Cases Pending with Preauth Operator
7 Indicator Acronym:
PAU_CCH_P_MC-CC
PAU_CCH_P_C-CC
PAU_CCH_P_PAO
8 Indicator Description:
Number of preauth Cochlear cases kept Pending with Preauth Operator
9 Dimensions: MC-CC
C-CC
PAO
10 Role & Action: Preauth Operator&Pre-AuthorisationsCochlear Cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cases
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
361
17 Unit of measure for the Indicator:
Preauth Cochlear cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
219. OPR-PAU-CCH-009
# KPI Properties Description
1 Gsln: 219
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-009
6 Indicator Name: Pre-authorisations Cochlear cases waiting with Preauth Operator
7 Indicator Acronym:
PAU_CCH_W_MC-CC
PAU_CCH_W_C-CC
PAU_CCH_W_PAO
8 Indicator Description:
Number of preauth Cochlear cases waiting with Preauth Operator
9 Dimensions: MC-CC
C-CC
PAO
10 Role & Action: Preauth Operator&Pre-AuthorisationsCochlear Cases
11 Formula: NA
12 Data required: NA
362
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cases
17 Unit of measure for the Indicator:
Preauth Cochlear cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
220.OPR-PAU-CCH-010
D W M Q H Y Cum Other
Y Y N N N N N N
# KPI Properties Description
1 Gsln: 220
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-010
6 Indicator Name: Pre-Authorisations-Cochlear Cases C-CC Rejected by Preauth Operator
7 Indicator Acronym:
PAU_CCH_R_C-CC
PAU_CCH_R_PAO
8 Indicator Description:
Number of preauth Cochlear cases recommended rejection by Preauth Operator
363
9 Dimensions: C-CC
PAO
10 Role & Action: Preauth Operator&Pre-AuthorisationsCochlear Cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cases
17 Unit of measure for the Indicator:
Preauth Cochlear cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
221.OPR-PAU-CCH-011
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 221
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-011
6 Indicator Name: Pre-Authorisations-Cochlear Cases PAO Approved
364
7 Indicator Acronym:
PAU_CCH_A_C-CC
PAU_CCH_A_PAO
8 Indicator Description:
Number of preauth Cochlear cases recommended Approval by PAO
9 Dimensions: C-CC
PAO
10 Role & Action: Preauth Operator&Pre-AuthorisationsCochlear Cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of PAO in disposal of Cochlear preauth cases
17 Unit of measure for the Indicator:
Preauth Cochlear cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
365
222. OPR-PAU-CCH-012
# KPI Properties Description
1 Gsln: 222
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-012
6 Indicator Name: Pre-auth Cochlear Cancel Requests MEDCO Initiated
7 Indicator Acronym:
PAUC _CCH_I_R
8 Indicator Description:
NWH Requested Cancellation of Pre-auth Cochlear cases
9 Dimensions: NA
10 Role & Action: MEDCO& Pre-auth Cochlear Cases Cancel Request
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of MEDCO in disposal of Cochlear preauth cancellation cases
17 Unit of measure for the Indicator:
Preauth Cochlear cancellation cases
18 Type: A
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
366
19 Remarks: NA
********************************************************************
223. OPR-PAU-CCH-013
# KPI Properties Description
1 Gsln: 223
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-013
6 Indicator Name: Pre-auth Cochlear cases Cancel Requests MEDCO Updated
7 Indicator Acronym:
PAUC_CCH_U_R
8 Indicator Description:
Number of preauth Cochlear Cancel Requests cases Committee Pending and Trust Pending Updated by MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO&Pre-auth Cochlear Cases Cancel Request
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of MEDCO in disposal of Cochlear preauth cancellation cases
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
367
17 Unit of measure for the Indicator:
Preauth Cochlear cancellation cases
18 Type: A
19 Remarks: NA
********************************************************************
224. OPR-PAU-CCH-014
# KPI Properties Description
1 Gsln: 224
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-014
6 Indicator Name: Pre-auth Cochlear cases Cancel Requests waiting with MEDCO
7 Indicator Acronym:
PAUC_CCH_W_R
8 Indicator Description:
Number of preauth Cochlear Cancel Requests cases waiting for Updation by MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO&Pre-auth Cochlear Cases Cancel Request
11 Formula: CPAU_CCH_W>15days_R + CPAU_CCH_W<15days_R
12 Data required: CPAU_CCH_W>15days_R; CPAU_CCH_W<15days_R
13 Frequency of
Monitoring:
14 Data source: RAS Database
D W M Q H Y Cum Other
Y N N N N N N N
368
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of MEDCO in disposal of Cochlear preauth cancellation cases
17 Unit of measure for the Indicator:
Preauth Cochlear cancellation cases
18 Type: A
19 Remarks: NA
********************************************************************
225.OPR-PAU-CCH-015
# KPI Properties Description
1 Gsln: 225
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-015
6 Indicator Name: Pre-Authorisations-Cochlear Cases Cancel Requests Recommended Approval by preauth operator
7 Indicator Acronym:
PAUC_CCH_RA_MC-CC
PAUC_CCH_RA_C-CC
8 Indicator Description:
Number of preauth Cochlear Cancel Requests cases Recommended Approval by preauth operator
9 Dimensions: MC-CC
C-CC
10 Role & Action: Preauth operator&Pre-auth Cochlear Cases Cancel Request
11 Formula: NA
12 Data required: NA
369
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cancellation cases
17 Unit of measure for the Indicator:
Preauth Cochlear cancellation cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
226. OPR-PAU-CCH-016
# KPI Properties Description
1 Gsln: 226
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-016
6 Indicator Name: Pre-Authorisations-Cochlear Cases Cancel Requests Recommended Rejection by preauth operator
7 Indicator Acronym:
PAUC_CCH_RR_MC-CC
PAUC_CCH_RR_C-CC
8 Indicator Description:
Number of preauth Cochlear Cancel Requests cases Recommended Rejection by MC-CC
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
370
9 Dimensions: MC-CC
C-CC
10 Role & Action: Preauth operator&Pre-auth Cochlear Cases Cancel Request
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cancellation cases
17 Unit of measure for the Indicator:
Preauth Cochlear cancellation cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
227. OPR-PAU-CCH-017
# KPI Properties Description
1 Gsln: 227
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-017
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
371
6 Indicator Name: Pre-Authorisations-Cochlear Cases Cancel Requests Pending by preauth operator
7 Indicator Acronym:
PAUC_CCH_P_MC-CC
PAUC_CCH_P_C-CC
8 Indicator Description:
Number of preauth Cochlear Cancel Requests cases kept pending by MC-CC
9 Dimensions: MC-CC
C-CC
10 Role & Action: Preauth operator&Pre-auth Cochlear Cases Cancel Request
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cancellation cases
17 Unit of measure for the Indicator:
Preauth Cochlear cancellation cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
372
228. OPR-PAU-CCH-018
# KPI Properties Description
1 Gsln: 228
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-018
6 Indicator Name: Pre-auth Cochlear cases Cancel Requests waiting with preauth operator
7 Indicator Acronym:
PAUC_CCH_W_MC-CC
PAUC_CCH_W_C-CC
8 Indicator Description:
Number of preauth Cochlear Cancel Requests cases waiting for disposal by MC-CC
9 Dimensions: MC-CC;C-CC
10 Role & Action: Preauth operator&Pre-auth Cochlear Cases Cancel Request
11 Formula: PAUC_CCH_W>15days_MC-CC + PAUC_CCH_W<15days_MC-CC
PAUC_CCH_W>15days_C-CC + PAUC_CCH_W<15days_C-CC
12 Data required: PAUC_CCH_W>15days_MC-CC; PAUC_CCH_W<15days_MC- CC; PAUC_CCH_W>15days_C-CC; PAUC_CCH_W<15days_C- CC
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of Preauth Operator in disposal of Cochlear preauth cancellation cases
D W M Q H Y Cum Other
Y N N N N N N N
373
17 Unit of measure for the Indicator:
Preauth Cochlear cancellation cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
229.OPR-PAU-CCH-019
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 229
2 Major Group: OPR
3 Minor Group: PAU
4 Sub Category: CCH
5 Indicator Code: OPR-PAU-CCH-019
6 Indicator Name: Pre-Authorisations-Cochlear Cases Cancel Requests Rejected by preauth operator
7 Indicator Acronym:
PAUC_CCH_R_C-CC
8 Indicator Description:
Number of preauth Cochlear Cancel Requests cases Rejected by C-CC
9 Dimensions: NA
10 Role & Action: Preauth operator&Pre-auth Cochlear Cases Cancel Request
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
374
15 Indicator Monitors:
Activity
16 Indicator use: To monitor performance of C-CC in disposal of Cochlear preauth cancellation cases
17 Unit of measure for the Indicator:
Preauth Cochlear cancellation cases
18 Type: A
19 Remarks: NA
********************************************************************
230.OPR-CLM-ELG-001
# KPI Properties Description
1 Gsln: 230
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: ELG
5 Indicator Code: OPR-CLM-ELG-001
6 Indicator Name: Therapy Claims Eligible
7 Indicator Acronym:
CLM_ELG
8 Indicator Description:
The number of therapies whose discharge has been updated more than 11 days ago and number of days from date of discharge update has not crossed 90 days, and yet to be submitted for claim by MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO&Claims disposal
11 Formula: NA
12 Data required: NA
375
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claim submission for discharge updated cases by MEDCO
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
231.OPR-CLM-SUB-001
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 231
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: SUB
5 Indicator Code: OPR-CLM-SUB-001
6 Indicator Name: Therapy Claims submitted
7 Indicator Acronym:
CLM_S_R
8 Indicator Description:
The number of therapies for which Claims have been submitted by MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO&Claims disposal
376
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claim submission for discharge updated cases by MEDCO
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
232.OPR-CLM-SUB-002
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 232
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: SUB
5 Indicator Code: OPR-CLM-SUB-002
6 Indicator Name: Therapy Claims submitted and Live
7 Indicator Acronym:
LCLM_S_R
8 Indicator Description:
The number of therapies for which Claims have been submitted by MEDCO and awaiting final disposal at various levels of Trust at this moment.
377
9 Dimensions: NA
10 Role & Action: MEDCO&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of claim submitted by MEDCO cases
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
233.OPR-CLM-SUB-003
D W M Q H Y Cum Other
Y Y Y N N N N N
# KPI Properties Description
1 Gsln: 233
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: SUB
5 Indicator Code: OPR-CLM-SUB-003
6 Indicator Name: Therapy Claims submitted in Past
7 Indicator Acronym:
PCLM_S_R
378
8 Indicator Description:
The number of therapies for which Claims have been submitted by MEDCO in the past
9 Dimensions: NA
10 Role & Action: MEDCO&Claims disposal
11 Formula: CLM_S_R (-)LCLM_S_R
12 Data required: CLM_S_R; LCLM_S_R
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claim submission for discharge updated cases by MEDCO
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
234.OPR-CLM-UPD-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 234
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: UPD
5 Indicator Code: OPR-CLM-UPD-001
6 Indicator Name: Therapy Claims Updated by MEDCO
379
7 Indicator Acronym:
CLM_U_R
8 Indicator Description:
The number of therapies for which Claims have been updated by MEDCO after pendency and returned to Trust
9 Dimensions: NA
10 Role & Action: MEDCO&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims pendency cases updation by MEDCO
17 Unit of measure for the Indicator:
Claim pendency cases
18 Type: A
19 Remarks: NA
********************************************************************
235.OPR-CLM-UPD-002
D W M Q H Y Cum Other
Y Y Y N N N N N
# KPI Properties Description
1 Gsln: 235
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: UPD
5 Indicator Code: OPR-CLM-UPD-002
380
6 Indicator Name: Therapy Claims Updated by MEDCO and Live
7 Indicator Acronym:
LCLM_U_R
8 Indicator Description:
The number of therapies for which Claims have been updated by MEDCO after pendency and awaiting final disposal at various levels of Trust at this moment
9 Dimensions: NA
10 Role & Action: MEDCO&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims pendency cases updation by MEDCO
17 Unit of measure for the Indicator:
Claim pendency cases
18 Type: A
19 Remarks: NA
********************************************************************
D W M Q H Y Cum Other
Y Y Y N N N N N
381
236.OPR-CLM-UPD-003
# KPI Properties Description
1 Gsln: 236
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: UPD
5 Indicator Code: OPR-CLM-UPD-003
6 Indicator Name: Therapy Claims Updated by MEDCO in Past
7 Indicator Acronym:
PCLM_U_R
8 Indicator Description:
The number of therapies for which Claims have been updated by MEDCO after pendency in the past
9 Dimensions: NA
10 Role & Action: MEDCO&Claims disposal
11 Formula: CLM_U_R (-) LCLM_U_R
12 Data required: CLM_U_R; LCLM_U_R
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims pendency cases updation by MEDCO
17 Unit of measure for the Indicator:
Claim pendency cases
18 Type: A
19 Remarks: NA
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
382
********************************************************************
237.OPR-CLM-WTC-001
D W M Q H Y Cum Other
Y Y Y N N N N N
# KPI Properties Description
1 Gsln: 237
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: WTC
5 Indicator Code: OPR-CLM-WTC-001
6 Indicator Name: Therapy Claims Updated by MEDCO and sent to Claims operator
7 Indicator Acronym:
CLM_W_CPD
CLM_W_CTD
CLM_W_CH
CLM_W_CAO
8 Indicator Description:
The number of therapies for which Claims have been updated by MEDCO and waiting at Claims operator
9 Dimensions: CPD
CTD
CH
CAO
10 Role & Action: MEDCO&
Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
383
15 Indicator Monitors:
Activity
16 Indicator use: To monitor disposal of claims updated cases by Claims operator
17 Unit of measure for the Indicator:
Claim pendency cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
238.OPR-CLM-FWD-001
# KPI Properties Description
1 Gsln: 238
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: FWD
5 Indicator Code: OPR-CLM-FWD-001
6 Indicator Name: Therapy Claims Forwarded by CEX
7 Indicator Acronym:
CLM_F_X
8 Indicator Description:
The number of therapies for which Claims have been forwarded by CEX(Claims Executive) after being raised for the first time by MEDCO
9 Dimensions: NA
10 Role & Action: CEX&Claims disposal
11 Formula: NA
12 Data required: NA
384
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by CEX
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
239.OPR-CLM-FWD-002
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 239
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: FWD
5 Indicator Code: OPR-CLM-FWD-002
6 Indicator Name: Therapy Claims Forwarded by CEX and Live
7 Indicator Acronym:
LCLM_F_X
8 Indicator Description:
The number of therapies for which Claims have been forwarded by CEX after being raised for the first time by MEDCO and awaiting final disposal at various levels of Trust at this moment
9 Dimensions: NA
10 Role & Action: CEX&Claims disposal
385
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by CEX
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
240.OPR-CLM-FWD-003
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 240
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: FWD
5 Indicator Code: OPR-CLM-FWD-003
6 Indicator Name: Therapy Claims Forwarded by CEX in Past
7 Indicator Acronym:
PCLM_F_X
8 Indicator Description:
The number of therapies for which claims have been forwarded by CEX in the past after being raised for the first time by MEDCO
386
9 Dimensions: NA
10 Role & Action: CEX&Claims disposal
11 Formula: CLM_F_X (-) LCLM_F_X
12 Data required: CLM_F_X; LCLM_F_X
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by CEX
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
241. OPR-CLM-RAP-001
# KPI Properties Description
1 Gsln: 241
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: RAP
5 Indicator Code: OPR-CLM-RAP-001
6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommended for Approval
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
387
7 Indicator Acronym:
CLM_RA_CPD
CLM_RA_CTD
CLM_RA_CH
8 Indicator Description:
The number of claims which have been disposed with a Recommended for Approval by the Claims operator
9 Dimensions: CPD
CTD
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
388
242. OPR-CLM-RAP-002
# KPI Properties Description
1 Gsln: 242
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: RAP
5 Indicator Code: OPR-CLM-RAP-002
6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommended for Approval and Live
7 Indicator Acronym:
LCLM_RA_CPD
LCLM_RA_CTD
LCLM_RA_CH
8 Indicator Description:
The number of claims which have been disposed with a Recommended for Approval by the Claims operator and awaiting final disposal at various levels of Trust at this moment
9 Dimensions: CPD
CTD
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
D W M Q H Y Cum Other
Y Y Y Y N N N N
389
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
243.OPR-CLM-RAP-003
# KPI Properties Description
1 Gsln: 243
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: RAP
5 Indicator Code: OPR-CLM-RAP-003
6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommended for Approval in the Past
7 Indicator Acronym:
PCLM_RA_CPD
PCLM_RA_CTD
PCLM_RA_CH
8 Indicator Description:
The number of claims which have been disposed with a Recommended for Approval by the Claims operator in the past
9 Dimensions: CPD
CTD
10 Role & Action: Claims operator&Claims disposal
11 Formula: CLM_RA_CPD(-)LCLM_RA_CPD
CLM_RA_CTD(-)LCLM_RA_CTD
CLM_RA_CH(-)LCLM_RA_CH
390
12 Data required: CLM_RA_CPD; LCLM_RA_CPD; CLM_RA_CTD; LCLM_RA_CTD; CLM_RA_CH; LCLM_RA_CH
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
244.OPR-CLM-RAP-004
# KPI Properties Description
1 Gsln: 244
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: RAP
5 Indicator Code: OPR-CLM-RAP-004
6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommended for Approval without pendency
7 Indicator Acronym:
CLM_RA~NP_CTD
CLM_RA~NP_CH
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
391
8 Indicator Description:
The claims which have been disposed with Recommendation of Approval without pendency by the Claims operator
9 Dimensions: CTD
CH
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
245.OPR-CLM-RAP-005
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 245
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: RAP
392
5 Indicator Code: OPR-CLM-RAP-005
6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommended for Approval after pendency
7 Indicator Acronym:
CLM_RA~P_CTD
CLM_RA~P_CH
8 Indicator Description:
The claims which have been disposed with a Recommendation of Approval after pendency by the Claims operator
9 Dimensions: CTD
CH
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
393
246. OPR-CLM-RRJ-001
# KPI Properties Description
1 Gsln: 246
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: RRJ
5 Indicator Code: OPR-CLM-RRJ-001
6 Indicator Name: Therapy Claims Disposed by Claims operator with RR
7 Indicator Acronym:
CLM_RR_CPD
CLM_RR_CTD
CLM_RR_CH
8 Indicator Description:
The number of claims which have been disposed with a Recommended for Rejection(RR) by the CPD
9 Dimensions: CPD
CTD
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
394
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
247. OPR-CLM-RRJ-002
# KPI Properties Description
1 Gsln: 247
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: RRJ
5 Indicator Code: OPR-CLM-RRJ-002
6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommendation for Rejection and Live
7 Indicator Acronym:
LCLM_RR_CPD
LCLM_RR_CTD
LCLM_RR_CH
8 Indicator Description:
The claims which have been disposed with a Recommendation for Rejection by the Claims operator and awaiting final disposal at various levels of Trust at this moment
9 Dimensions: CPD
CTD
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
395
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
248.OPR-CLM-RRJ-003
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 248
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: RRJ
5 Indicator Code: OPR-CLM-RRJ-003
6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommendation for Rejection in the Past
7 Indicator Acronym:
PCLM_RR_CPD
PCLM_RR_CTD
PCLM_RR_CH
8 Indicator Description:
The claims which have been disposed with a Recommendation for Rejection by the Claims operator in the past
396
9 Dimensions: CPD
CTD
10 Role & Action: Claims operator&Claims disposal
11 Formula: CLM_RR_CPD(-)CLML_RR_CPD
CLM_RR_CTD(-)CLML_RR_CTD
12 Data required: CLM_RR_CPD; CLML_RR_CPD; CLM_RR_CTD; CLML_RR_CTD
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
249.OPR-CLM-RRJ-004
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 249
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: RRJ
5 Indicator Code: OPR-CLM-RRJ-004
397
6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommendation for Rejection without pendency
7 Indicator Acronym:
CLM_RR~NP_CTD
CLM_RR~NP_CH
8 Indicator Description:
The claims which have been disposed with a Recommendation for Rejection without pendency by the Claims operator
9 Dimensions: CTD
CH
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
398
250.OPR-CLM-RRJ-005
# KPI Properties Description
1 Gsln: 250
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: RRJ
5 Indicator Code: OPR-CLM-RRJ-005
6 Indicator Name: Therapy Claims Disposed by Claims operator with Recommendation for Rejection after pendency
7 Indicator Acronym:
CLM_RR~P_CTD
CLM_RR~P_CH
8 Indicator Description:
The claims which have been disposed with a Recommendation for Rejection after pendency by the Claims operator
9 Dimensions: CTD
CH
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
399
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
251.OPR-CLM-PEN-001
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 251
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: PEN
5 Indicator Code: OPR-CLM-PEN-001
6 Indicator Name: Therapy Claims Disposed by Claims operator with Pendency
7 Indicator Acronym:
CLM_P_CPD
CLM_P_CTD
CLM_P_CH
CLM_P_CAO
8 Indicator Description:
The claims which have been disposed with a Pendency by the Claims operator
9 Dimensions: CPD
CTD
CH
CAO
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
400
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
252.OPR-CLM-PEN-002
# KPI Properties Description
1 Gsln: 252
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: PEN
5 Indicator Code: OPR-CLM-PEN-002
6 Indicator Name: Therapy Claims Disposed by Claims operator with Pendency and Live
7 Indicator LCLM_P_CPD Acronym: LCLM_P_CTD
LCLM_P_CH
LCLM_P_CAO
8 Indicator Description:
The claims which have been disposed with a Pendency by the Claims operator and awaiting final disposal at various levels of Trust at this moment
401
9 Dimensions: CPD
CTD
CH
CAO
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
253.OPR-CLM-PEN-003
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 253
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: PEN
5 Indicator Code: OPR-CLM-PEN-003
402
6 Indicator Name: Therapy Claims Disposed by Claims operator with Pendency in the Past
7 Indicator Acronym:
PCLM_P_CPD
PCLM_P_CTD
PCLM_P_CH
PCLM_P_CAO
8 Indicator Description:
The claims which have been disposed with a Pendency by the Claims operator in the past
9 Dimensions: CPD;CTD;CH;CAO
10 Role & Action: Claims operator&Claims disposal
11 Formula: CLM_P_CPD(-)LCLM_RR_CPD
CLM_P_CTD(-)LCLM_RR_CTD
CLM_P_CH(-)LCLM_RR_CH
CLM_P_CAO(-)LCLM_RR_CAO
12 Data required: CLM_P_CPD; LCLM_RR_CPD; CLM_P_CTD; LCLM_RR_CTD; CLM_P_CH; LCLM_RR_CH;
CLM_P_CAO;LCLM_RR_CAO
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
403
254.OPR-CLM-APP-001
# KPI Properties Description
1 Gsln: 254
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: APP
5 Indicator Code: OPR-CLM-APP-001
6 Indicator Name: Therapy Claims Disposed by Claims operator with Approval
7 Indicator Acronym:
CLM_A_CH
CLM_A_CAO
8 Indicator Description:
The claims which have been disposed with Approval by the Claims operator
9 Dimensions: CH;CAO
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
404
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
255.OPR-CLM-APP-002
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 255
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: APP
5 Indicator Code: OPR-CLM-APP-002
6 Indicator Name: Therapy Claims Disposed by Claims operator with Approval without pendency
7 Indicator Acronym:
CLM_A~NP_CH
CLM_A~NP_CAO
8 Indicator Description:
The claims which have been disposed with Approval without pendency by the Claims operator
9 Dimensions: CH
CAO
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
405
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
256.OPR-CLM-APP-003
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 256
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: APP
5 Indicator Code: OPR-CLM-APP-003
6 Indicator Name: Therapy Claims Disposed by Claims operator with Approval after pendency
7 Indicator Acronym:
CLM_A~P_CH
CLM_A~P_CAO
8 Indicator Description:
The claims which have been disposed with a Approval after pendency by the Claims operator
9 Dimensions: CH
CAO
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
406
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
257.OPR-CLM-REJ-001
# KPI Properties Description
1 Gsln: 257
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: REJ
5 Indicator Code: OPR-CLM-REJ-001
6 Indicator Name: Therapy Claims Disposed by Claims operator with Rejection
7 Indicator Acronym:
CLM_R_CH
CLM_R_CAO
8 Indicator Description:
The claims which have been disposed with a Rejection by the Claims operator
9 Dimensions: CH
CAO
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
407
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
258.OPR-CLM-REJ-002
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 258
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: REJ
5 Indicator Code: OPR-CLM-REJ-002
6 Indicator Name: Therapy Claims Disposed by Claims operator with Rejection without pendency
7 Indicator Acronym:
CLM_R~NP_CH
CLM_R~NP_CAO
8 Indicator Description:
The claims which have been disposed with a Rejection without pendency by the Claims operator
9 Dimensions: CH
CAO
408
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
259.OPR-CLM-REJ-003
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 259
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: REJ
5 Indicator Code: OPR-CLM-REJ-003
6 Indicator Name: Therapy Claims Disposed by Claims operator with Rejection after pendency
7 Indicator Acronym:
CLM_R~P_CH
CLM_R~P_CAO
409
8 Indicator Description:
The claims which have been disposed with a Rejection after pendency at CH level, by the Claims operator
9 Dimensions: CH
CAO
10 Role & Action: Claims operator&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
260.OPR-CLM-TDP-001
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 260
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TDP
5 Indicator Code: OPR-CLM-TDP-001
410
6 Indicator Name: Total Therapy claims Disposed by CPD
7 Indicator Acronym:
CLM_D_CPD
8 Indicator Description:
Total number of claims disposed by CPD
9 Dimensions: NA
10 Role & Action: CPD&Claims disposal
11 Formula: CLM_RA_CPD + CLM_RR_CPD + CLM_P_CPD
12 Data required: CLM_RA_CPD; CLM_RR_CPD; CLM_P_CPD
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claims panel doctor
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
261.OPR-CLM-TDP-002
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 261
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TDP
411
5 Indicator Code: OPR-CLM-TDP-002
6 Indicator Name: Total Therapy claims Disposed by CTD
7 Indicator Acronym:
CLM_D_CTD
8 Indicator Description:
Total number of claims disposed by CTD
9 Dimensions: NA
10 Role & Action: CTD&Claims disposal
11 Formula: CLM_RA_CTD + CLM_RR_CTD + CLM_P_CTD
12 Data required: CLM_RA_CTD; CLM_RR_CTD; CLM_P_CTD
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claims trust doctor
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
412
262.OPR-CLM-TDP-003
# KPI Properties Description
1 Gsln: 262
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TDP
5 Indicator Code: OPR-CLM-TDP-003
6 Indicator Name: Total Therapy claims Disposed by CH
7 Indicator Acronym:
CLM_D_CH
8 Indicator Description:
Total number of claims disposed by CH
9 Dimensions: NA
10 Role & Action: CH&Claims disposal
11 Formula: CLM_RA_CH + CLM_RR_CH+CLM_A_CH+CLM_R_CH+CLM_P_CH
12 Data required: CLM_RA_CH; CLM_RR_CH; CLM_A_CH; CLM_R_CH; CLM_P_CH
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claims head
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
413
19 Remarks: NA
********************************************************************
263.OPR-CLM-TDP-004
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 263
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TDP
5 Indicator Code: OPR-CLM-TDP-004
6 Indicator Name: Therapy claims Disposed by CH (for insurance)
7 Indicator Acronym:
CLM_D_ICH
8 Indicator Description:
Total claims disposed by ICH
9 Dimensions: NA
10 Role & Action: ICH&Claims disposal
11 Formula: CLM_RA_ICH + CLM_RR_ICH +CLM_A_ICH+CLM_R_CH+CLM_P_ICH
12 Data required: CLM_RA_ICH; CLM_RR_ICH; CLM_A_ICH; CLM_R_CH;
CLM_P_ICH
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claims insurance Claims head
414
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
264.OPR-CLM-TDP-005
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 264
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TDP
5 Indicator Code: OPR-CLM-TDP-005
6 Indicator Name: Therapy claims Disposed by CAO
7 Indicator Acronym:
CLM_D_CAO
8 Indicator Description:
Total claims disposed by CAO
9 Dimensions: NA
10 Role & Action: CH&Claims disposal
11 Formula: CLM_A_CAO+CLM_R_CAO+CLM_P_CAO
12 Data required: CLM_A_CAO; CLM_R_CAO; CLM_P_CAO
13 Frequency of
Monitoring:
14 Data source: RAS Database
415
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claims authorisation officer
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
265.OPR-CLM-TDP-006
# KPI Properties Description
1 Gsln: 265
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TDP
5 Indicator Code: OPR-CLM-TDP-006
6 Indicator Name: Therapy Claims Disposed by A/C with Approval
7 Indicator Acronym:
CLM_A_AC
8 Indicator Description:
The claims which have been disposed with Accounts Approval(A) by the A/C
9 Dimensions: NA
10 Role & Action: A/C&Claims disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
416
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims accountant
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
266.OPR-CLM-TDP-007
# KPI Properties Description
1 Gsln: 266
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TDP
5 Indicator Code: OPR-CLM-TDP-007
6 Indicator Name: Therapy Claims Paid by Bank
7 Indicator Acronym:
CLM_A_B
8 Indicator Description:
The claims which have been paid by the Bank
9 Dimensions: NA
10 Role & Action: Bank&Claims disposal
11 Formula: NA
12 Data required: NA
417
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by bank
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
267.OPR-CLM-HAR-001
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 267
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: HAR
5 Indicator Code: OPR-CLM-HAR-001
6 Indicator Name: Average Hourly Claims Arrival for each of the 24 hours in a day
7 Indicator Acronym:
CLM_HA
8 Indicator Description:
Average claims submitted by MEDCO every hour during the 24 hours
9 Dimensions: NA
10 Role & Action: MEDCO&Claims arrivals
418
11 Formula: NA
12 Data required: CLM_S_R
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by MEDCO
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
268.OPR-CLM-CAR-001
D W M Q H Y Cum Other
Y N N N N N N N
# KPI Properties Description
1 Gsln: 268
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: CAR
5 Indicator Code: OPR-CLM-CAR-001
6 Indicator Name: Claims Arrival Rate
7 Indicator Acronym:
CLM_ART
8 Indicator Description:
Average claims submitted by MEDCO in a specified period
9 Dimensions: NA
419
10 Role & Action: MEDCO&Claims arrivals
11 Formula: CLM_S_R in a given period / number of days in the period
12 Data required: CLM_S_R; Number of days in the period
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by MEDCO
17 Unit of measure for the Indicator:
Claim cases
18 Type: R
19 Remarks: NA
********************************************************************
269.OPR-CLM-HCD-001
# KPI Properties Description
1 Gsln: 269
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: HCD
5 Indicator Code: OPR-CLM-HCD-001
6 Indicator Name: Average Hourly Claims Disposal for each of the 24 hours in a day
7 Indicator Acronym:
CLM_HD
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
420
8 Indicator Description:
Average claims disposed every hour during the 24 hours
9 Dimensions: NA
10 Role & Action: Claims operator& Claims Disposal
11 Formula: CLM_CH_A + CLM_CAO_A+CLM_CH_R + CLM_CAO_R
12 Data required: CLM_CH_A; CLM_CAO_A; CLM_CH_R; CLM_CAO_R
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: R
19 Remarks: NA
********************************************************************
270.OPR-CLM-CDR-001
D W M Q H Y Cum Other
Y N N N N N N N
# KPI Properties Description
1 Gsln: 270
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: CDR
5 Indicator Code: OPR-CLM-CDR-001
6 Indicator Name: Claims Disposal Rate
421
7 Indicator Acronym:
CLM_DR
8 Indicator Description:
Average claims disposed in a specified period
9 Dimensions: NA
10 Role & Action: Claims operator& Claims Disposal
11 Formula: CLM_CH_A + CLM_CAO_A+CLM_CH_R + CLM_CAO_R in a given period / number of days in the period
12 Data required: CLM_CH_A, CLM_CAO_A, CLM_CH_R, CLM_CAO_R, number of days in the period
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: R
19 Remarks: NA
********************************************************************
271.OPR-CLM-WTC-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 271
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: WTC
422
5 Indicator Code: OPR-CLM-WTC-001
6 Indicator Name: Therapy Claims Waiting at MEDCO
7 Indicator Acronym:
CLM_W>7days_R
CLM_W<7days_R
8 Indicator Description:
The claims which have been returned to MEDCO after pendency and awaiting disposal at this moment, and have crossed 7 days since first raised by MEDCO
9 Dimensions: >7days
<7 days
10 Role & Action: MEDCO& Claims Disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by MEDCO
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y N N N N
423
272.OPR-CLM-WTC-002
# KPI Properties Description
1 Gsln: 272
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: WTC
5 Indicator Code: OPR-CLM-WTC-002
6 Indicator Name: Therapy Claims Waiting at CEX
7 Indicator Acronym:
CLM_W>7days_CX
CLM_W<7days_CX
8 Indicator Description:
The claims which have been Submitted by MEDCO to CEX and awaiting disposal at this moment, and have crossed 7 days since first raised by MEDCO
9 Dimensions: >7days
<7 days
10 Role & Action: CEX&Claims Disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by CEX
17 Unit of measure for the Indicator:
Claim cases
D W M Q H Y Cum Other
Y Y N N N N N N
424
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
273.OPR-CLM-WTC-003
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 273
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: WTC
5 Indicator Code: OPR-CLM-WTC-003
6 Indicator Name: Therapy Claims Waiting at Claims operator afresh
7 Indicator Acronym:
CLMF_W_CPD
CLMF_W_CTD
CLMF_W_CH
CLMF_W_CAO
8 Indicator Description:
The fresh/new claims which have been forwarded by CEX and waiting for disposal for the first time at CPD level
9 Dimensions: CPD
CTD
CH
CAO
10 Role & Action: Claims operator&Claims Disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
425
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
274.OPR-CLM-WTC-004
# KPI Properties Description
1 Gsln: 274
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: WTC
5 Indicator Code: OPR-CLM-WTC-004
6 Indicator Name: Therapy Claims Waiting at Claims operator after updation of pendency
7 Indicator CLMP_W_CPD Acronym: CLMP_W_CTD
CLMP_W_CH
CLMP_W_CAO
8 Indicator Description:
The claims which have been updated by MEDCO, after pendency by CPD, and waiting for disposal at CPD level
426
9 Dimensions: CPD
CTD
CH
CAO
10 Role & Action: Claims operator& Claims Disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
275.OPR-CLM-WTC-005
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 275
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: WTC
5 Indicator Code: OPR-CLM-WTC-005
427
6 Indicator Name: Therapy Claims Waiting at CPD for <7 days
7 Indicator Acronym:
CLM_W<7_CPD
CLM_W<7_CTD
CLM_W<7_CH
CLM_W<7_CAO
8 Indicator Description:
The claims which have been forwarded by CEX and waiting for disposal for less than 7 days at CPD level
9 Dimensions: CPD
CTD
CH
CAO
10 Role & Action: CPD&Claims Disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
Y Y N N N N N N
428
276.OPR-CLM-WTC-006
# KPI Properties Description
1 Gsln: 276
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: WTC
5 Indicator Code: OPR-CLM-WTC-006
6 Indicator Name: Therapy Claims Waiting at Claims operator for >7 days
7 Indicator Acronym:
CLM_W>7_CPD
CLM_W>7_CTD
CLM_W>7_CH
CLM_W>7_CAO
8 Indicator Description:
The claims which have been forwarded by CEX and waiting for disposal for greater than 7 days at CPD level
9 Dimensions: CPD
CTD
CH
CAO
10 Role & Action: Claims operator& Claims Disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by MEDCO
D W M Q H Y Cum Other
Y Y Y Y N N N N
429
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
277.OPR-CLM-WTC-007
D W M Q H Y Cum Other
Y Y N N N N N N
# KPI Properties Description
1 Gsln: 277
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: WTC
5 Indicator Code: OPR-CLM-WTC-007
6 Indicator Name: Therapy Claims Waiting at A/C
7 Indicator Acronym:
CLM_W<7days_AC
CLM_W>7days_AC
8 Indicator Description:
The claims which have been forwarded by CAO and waiting for disposal for less than 7 days at A/C
9 Dimensions: <7days
>7days
10 Role & Action: A/C&Claims Disposal
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
430
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by CEX
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
278.OPR-CLM-WTC-008
# KPI Properties Description
1 Gsln: 278
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: WTC
5 Indicator Code: OPR-CLM-WTC-008
6 Indicator Name: Therapy Claims Waiting at Bank
7 Indicator Acronym:
CLM_W<7days_B
CLM_W>7days_B
8 Indicator Description:
Total therapies claims and waiting for disposal at bank
9 Dimensions: <7days
>7days
10 Role & Action: Bank&Claims Disposal
11 Formula: NA
12 Data required: NA
431
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor claims cases disposal by Bank
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
279.OPR-CLM-TWN-001
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 279
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TWN
5 Indicator Code: OPR-CLM-TWN-001
6 Indicator Name: Total Therapy Claims Waiting at MEDCO
7 Indicator Acronym:
CLM_W_R_T
8 Indicator Description:
Total number of therapies claim waiting at MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO& Claims Disposal
432
11 Formula: CLM_W>7days_R + CLM_W<7days_R
12 Data required: CLM_W>7days_R; CLM_W<7days_R
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by MEDCO
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
280.OPR-CLM-TWN-002
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 280
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TWN
5 Indicator Code: OPR-CLM-TWN-002
6 Indicator Name: Total Therapy Claims Waiting at CEX
7 Indicator Acronym:
CLM_W_CX_T
8 Indicator Description:
Total number of therapies claim which have been Submitted by MEDCO to CEX and awaiting disposal at this moment
9 Dimensions: NA
433
10 Role & Action: CEX& Claims Disposal
11 Formula: CLM_W>7days_X + CLM_W<7days_X
12 Data required: CLM_W>7days_X;
CLM_W<7days_X
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by CEX
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
281.OPR-CLM-TWN-003
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 281
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TWN
5 Indicator Code: OPR-CLM-TWN-003
6 Indicator Name: Total Therapy Claims Waiting at CPD
7 Indicator Acronym:
CLM_W_CPD_T
434
8 Indicator Description:
Total therapy claims waiting for disposal at CPD level
9 Dimensions: NA
10 Role & Action: CPD&Claims Disposal
11 Formula: CLMF_W_CPD+CLMP_W_CPD (or)
CLM_W<7_CPD+CLM_W>7_CPD
12 Data required: CLMF_W_CPD; CLMP_W_CPD; CLM_W<7_CPD; CLM_W>7_CPD
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by CPD
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
282.OPR-CLM-TWN-004
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 282
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TWN
5 Indicator Code: OPR-CLM-TWN-004
435
6 Indicator Name: Total Therapy Claims Waiting at CTD
7 Indicator Acronym:
CLM_W_CTD_T
8 Indicator Description:
Total therapy claims waiting for disposal at CTD level
9 Dimensions: NA
10 Role & Action: CTD&Claims Disposal
11 Formula: CLMF_W_CTD + CLMP_W_CTD (or)
CLM_W<7_CTD + CLM_W>7_CTD
12 Data required: CLMF_W_CTD; CLMP_W_CTD; CLM_W<7_CTD; CLM_W>7_CTD
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by CTD
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y N N N N
436
283.OPR-CLM-TWN-005
# KPI Properties Description
1 Gsln: 283
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TWN
5 Indicator Code: OPR-CLM-TWN-005
6 Indicator Name: Total Therapy Claims Waiting at CH
7 Indicator Acronym:
CLM_W_CH_T
8 Indicator Description:
Total therapy claims waiting for disposal at CH level
9 Dimensions: NA
10 Role & Action: CH&Claims Disposal
11 Formula: CLMF_W_CH +CLMP_W_CH (or)
CLM_W<7days_CH + CLM_W>7days_CH
12 Data required: CLMF_W_CH; PCLMP_W_CH;
CLM_W<7days_CH; CLM_W>7days_CH
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by CH
17 Unit of measure for the Indicator:
Claim cases
D W M Q H Y Cum Other
Y Y Y Y N N N N
437
18 Type: A
19 Remarks: NA
********************************************************************
284.OPR-CLM-TWN-006
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 284
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TWN
5 Indicator Code: OPR-CLM-TWN-006
6 Indicator Name: Total Therapy Claims Waiting at CAO
7 Indicator Acronym:
CLM_W_CAO_T
8 Indicator Description:
Total therapy claims waiting for disposal at CAO level
9 Dimensions: NA
10 Role & Action: CAO&Claims Disposal
11 Formula: CLMF_W_CAO + CLMP_W_CAO (or)
CLM_W<7days_CAO+CLM_W>7days_CAO
12 Data required: CLMF_W_CAO; CLMP_W_CAO;CLM_W<7days_CAO; CLM_W>7days_CAO
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
438
16 Indicator use: To monitor claims cases disposal by CAO
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
285.OPR-CLM-TWN-007
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 285
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TWN
5 Indicator Code: OPR-CLM-TWN-007
6 Indicator Name: Total Therapy Claims Waiting at A/C
7 Indicator Acronym:
CLM_W_AC
8 Indicator Description:
Total therapy claims waiting for disposal at A/C
9 Dimensions: NA
10 Role & Action: A/C&Claims Disposal
11 Formula: CLM_W<7days_AC + CLM_W>7days_AC
12 Data required: CLM_W<7days_AC; CLM_W>7days_AC
13 Frequency of
Monitoring:
14 Data source: RAS Database
439
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by A/C
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
286.OPR-CLM-TWN-008
D W M Q H Y Cum Other
Y Y N N N N N N
# KPI Properties Description
1 Gsln: 286
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TWN
5 Indicator Code: OPR-CLM-TWN-008
6 Indicator Name: Total Therapy Claims Waiting at Bank
7 Indicator Acronym:
CLM_W_B
8 Indicator Description:
The claims which have been forwarded by CAO and waiting for disposal for less than 7 days at Bank
9 Dimensions: NA
10 Role & Action: Bank&Claims Disposal
11 Formula: CLM_W<7days_B + CLM_W>7days_B
12 Data required: CLM_W<7days_B; CLM_W>7days_B
13 Frequency of
Monitoring:
440
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Bank
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
287.OPR-CLM-TWN-009
# KPI Properties Description
1 Gsln: 287
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TWN
5 Indicator Code: OPR-CLM-TWN-009
6 Indicator Name: Total Therapy Claims Waiting for approval at Trust
7 Indicator Acronym:
CLM_W_TRU
8 Indicator Description:
Total therapy claims waiting for disposal at Trust
9 Dimensions: NA
10 Role & Action: Trust&Claims Disposal
11 Formula: CLM_W_CPD_T + CLM_W_CTD_T + CLM_W_CH_T + CM_W_CAO_T + CLM_W_AC
12 Data required: CLM_W_CPD_T; CLM_W_CTD_T; CLM_W_CH_T; CM_W_CAO_T; CLM_W_AC
441
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal at Trust
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
288.OPR-CLM-TWN-010
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 288
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TWN
5 Indicator Code: OPR-CLM-TWN-010
6 Indicator Name: Total Therapy Claims Waiting for approval at NWH
7 Indicator Acronym:
CLM_W_NWH
8 Indicator Description:
Total therapy claims waiting for disposal at NWH
9 Dimensions: NA
10 Role & Action: NWH&Claims Disposal
11 Formula: NA
442
12 Data required: CLM_W_R _T
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal at NWH
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
289.OPR-CLM-TWN-011
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 289
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TWN
5 Indicator Code: OPR-CLM-TWN-011
6 Indicator Name: Total Therapy Claims Waiting for Approval
7 Indicator Acronym:
CLM_W_T
8 Indicator Description:
Total therapy claims waiting for disposal at various levels
9 Dimensions: NA
443
10 Role & Action: Claims Disposal
11 Formula: CLM_W_TRT + CLM_W_NWH
12 Data required: CLM_W_TRT; CLM_W_NWH
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
290.OPR-CLM-AWT-001
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 290
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: AWT
5 Indicator Code: OPR-CLM-AWT-001
6 Indicator Name: Average CWT for disposal of fresh claim cases at MEDCO during a specified period
7 Indicator Acronym:
CLMF_AWT_R
444
8 Indicator Description:
Average waiting time at MEDCO for disposal of fresh claim cases for a specified period
9 Dimensions: NA
10 Role & Action: MEDCO&Claim waiting times
11 Formula: Sum of (The time at which a Claim case is updated by MEDCO after pendency (-) The time at which the Claim case arrived at MEDCO due to pendency) for all disposed cases / Number of cases
12 Data required: Number of cases
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by MEDCO
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
291.OPR-CLM-AWT-002
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 291
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: AWT
5 Indicator Code: OPR-CLM-AWT-002
445
6 Indicator Name: Average CWT for updation of pending claim cases at MEDCO during a specified period
7 Indicator Acronym:
CLMP_AWT_R
8 Indicator Description:
Average waiting time at MEDCO for updation of pending claim cases for a specified period
9 Dimensions: NA
10 Role & Action: MEDCO&Claim waiting times
11 Formula: Sum of (The time at which a Claim case is updated by MEDCO after pendency (-) The time at which the Claim case arrived at MEDCO due to pendency) for all disposed cases / Number of cases
12 Data required: Number of cases
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by MEDCO
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
446
292. OPR-CLM-AWT-003
# KPI Properties Description
1 Gsln: 292
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: AWT
5 Indicator Code: OPR-CLM-AWT-003
6 Indicator Name: Average CWT at CEX for a fresh Claim case during a specified period
7 Indicator Acronym:
CLM_AWT_CX
8 Indicator Description:
Average Claim waiting time at CEX for disposal of a fresh claim cases specified period
9 Dimensions: NA
10 Role & Action: CEX&Claim waiting times
11 Formula: Sum of (The time at which a Claim case is forwarded by CEX(-) The time at which the Claim case arrived at CEX from MEDCO)for all disposed cases / Number of cases
12 Data required: Number of cases
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by CEX
17 Unit of measure for the Indicator:
Claim cases
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
447
18 Type: A
19 Remarks: NA
********************************************************************
293. OPR-CLM-AWT-004
# KPI Properties Description
1 Gsln: 293
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: AWT
5 Indicator Code: OPR-CLM-AWT-004
6 Indicator Name: Average CWT at Claims operator for a fresh Claim case during a specified period
7 Indicator Acronym:
CLMF_AWT_CPD
CLMF_AWT_CTD
CLMF_AWT_CH
CLMF_AWT_CAO
8 Indicator Description:
Average waiting time at CPD for disposal of fresh claim cases in a specified period
9 Dimensions: CPD
CTD
CH
CAO
10 Role & Action: Claims operator&Claim waiting time
11 Formula: Sum of The time at which the fresh Claim case is disposed at Claims operator (-) The time at which the fresh Claim case arrived at Claims operator for all disposed cases / Number of cases
12 Data required: Number of cases
448
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
294.OPR-CLM-AWT-005
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 294
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: AWT
5 Indicator Code: OPR-CLM-AWT-005
6 Indicator Name: Average CWT at claims operator for a pending updated Claim case during a specified period
7 Indicator CLMP_AWT_CPD Acronym: CLMP_AWT_CTD
CLMP_AWT_CH
CLMP_AWT_CAO
8 Indicator Description:
Average waiting time at CPD for disposal of pending claim cases in a specified period
449
9 Dimensions: CPD;CTD;CH;CAO
10 Role & Action: Claims operator&Claim waiting time
11 Formula: Sum of The time at which a pending updated Claim case is disposed by Claims operator (-) The time at which the pending Claim case arrived at Claims operator for all disposed cases / Number of cases
12 Data required: Number of cases
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
295.OPR-CLM-AWT-006
# KPI Properties Description
1 Gsln: 295
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: AWT
5 Indicator Code: OPR-CLM-AWT-006
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
450
6 Indicator Name: Average CWT at claims operator for a Claim case during a specified period
7 Indicator Acronym:
CLM_AWT_CPD
CLM_AWT_CTD
CLM_AWT_CH
CLM_AWT_CAO
8 Indicator Description:
Average waiting time at CPD for disposal of pending claim cases in a specified period
9 Dimensions: CPD;CTD;CH;CAO
10 Role & Action: Claims operator&Claim waiting time
11 Formula: Sum of The (CLMF_AWT_CPD+CLMP_AWT_CPD) for all disposed cases / Number of cases
Sum of The (CLMF_AWT_CTD+CLMP_AWT_CTD) for all disposed cases / Number of cases
Sum of The (CLMF_AWT_CH+CLMP_AWT_CH) for all disposed cases / Number of cases
Sum of The (CLMF_AWT_CAO+CLMP_AWT_CAO) for all disposed cases / Number of cases
12 Data required: CLMF_AWT_CPD; CLMP_AWT_CPD; CLMF_AWT_CTD;
CLMP_AWT_CTD; CLMF_AWT_CH; CLMP_AWT_CH;
CLMF_AWT_CAO; CLMP_AWT_CAO; Number of cases
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claims operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
451
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
296.OPR-CLM-AWT-007
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 296
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: AWT
5 Indicator Code: OPR-CLM-AWT-007
6 Indicator Name: Average CWT at A/C for a Claim case during a specified period
7 Indicator Acronym:
CLM_AWT_AC
8 Indicator Description:
Average Waiting time at A/C for disposal of a claim case
9 Dimensions: NA
10 Role & Action: A/C&Claim waiting time
11 Formula: Sum of The time at which the Claim case is disposed by A/C( -) The time at which the Claim case arrived at A/C for all disposed cases / Number of cases
12 Data required: Number of cases
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by A/C
452
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
297.OPR-CLM-AWT-008
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 297
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: AWT
5 Indicator Code: OPR-CLM-AWT-008
6 Indicator Name: Average CWT at Bank for a Claim case during a specified period
7 Indicator Acronym:
CLM_AWT_B
8 Indicator Description:
Average Waiting time at A/C for disposal of a claim case
9 Dimensions: NA
10 Role & Action: Bank&
Claim waiting time
11 Formula: Sum of The time at which the Claim case is Paid by Bank (-) The time at which the Claim case arrived at Bank for all disposed cases / Number of cases
12 Data required: Number of cases
13 Frequency of
Monitoring:
453
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Bank
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
298.OPR-CLM-AWT-009
# KPI Properties Description
1 Gsln: 298
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: AWT
5 Indicator Code: OPR-CLM-AWT-009
6 Indicator Name: Average CWT at Trust for a Claim case
7 Indicator Acronym:
CLM_AWT_TRU
8 Indicator Description:
Total waiting time at trust for disposal of a claim case
9 Dimensions: NA
10 Role & Action: Trust&Claim waiting time
11 Formula: CLM_AWT_CX + CLM_AWT_CPD +CLM_AWT_CTD + CLM_AWT_CH +CLM_AWT_CAO /Number of cases
12 Data required: CLM_AWT_CX; CLM_AWT_CPD; CLM_AWT_CTD; CLM_AWT_CH; CLM_AWT_CAO; Number of cases
454
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal at Trust
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
299.OPR-CLM-AWT-010
D W M Q H Y Cum Other
Y N N N N N N N
# KPI Properties Description
1 Gsln: 299
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: AWT
5 Indicator Code: OPR-CLM-AWT-010
6 Indicator Name: Average CWT at NWH for a Claim case
7 Indicator Acronym:
CLM_AWT_NWH
8 Indicator Description:
Total waiting time at NWH for disposal of a claim case
9 Dimensions: NA
10 Role & Action: NWH&Claim waiting time
455
11 Formula: CLMF_AWT_R + CLMP_AWT_R/ Number of cases
12 Data required: CLMF_AWT_R; CLMP_AWT_R;Number of cases
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal at NWH
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
300.OPR-CLM-AWT-011
D W M Q H Y Cum Other
Y N N N N N N N
# KPI Properties Description
1 Gsln: 300
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: AWT
5 Indicator Code: OPR-CLM-AWT-011
6 Indicator Name: Average CWT for approval of a claim case
7 Indicator Acronym:
CLM_AWT_TO
8 Indicator Description:
Total waiting time for disposal of a claim case
9 Dimensions: NA
456
10 Role & Action: TotalClaim waiting time
11 Formula: CLM_AWT_TRU + CLM_AWT_NWH/ Number of cases
12 Data required: CLM_AWT_TRU; CLM_AWT_NWH; Number of cases
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
301.OPR-CLM-AWT-012
D W M Q H Y Cum Other
Y Y Y Y N N N N
# KPI Properties Description
1 Gsln: 301
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: AWT
5 Indicator Code: OPR-CLM-AWT-012
6 Indicator Name: Average CWT for payment of a claim case during a specified period
7 Indicator Acronym:
CLM_AWT_P
457
8 Indicator Description:
Average waiting time for payment of a claim case
9 Dimensions: NA
10 Role & Action: Payment&Claim waiting time
11 Formula: CLM_AWT_TRU + CLM_AWT_NWH+CLM_AWT_AC+ CLM_AWT_B/ Number of cases
12 Data required: CLM_AWT_TRU; CLM_AWT_NWH; CLM_AWT_AC; CLM_AWT_B;Number of cases
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: NA
********************************************************************
302.OPR-CLM-TOR-001
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 302
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TOR
5 Indicator Code: OPR-CLM-TOR-001
458
6 Indicator Name: Turn over Rate for claims, of claims operator for a specified period
7 Indicator Acronym:
CLM_TOR_CX
CLM_TOR_CPD
CLM_TOR_CTD
CLM_TOR_CH
CLM_TOR_CAO
8 Indicator Description:
Number of claims disposed by claims operator in a specific period
9 Dimensions: CX
CPD
CTD
CH
CAO
10 Role & Action: Claims operator&Claims disposal
11 Formula: Number of cases disposed by Claim operator (CLM_D_CX or CLM_D_CPD or CLM_D_CTD or CLM_D_CH or CLM_D_CAO) during the period / Number of days in the period
12 Data required: CLM_D_CX; CLM_D_CPD; CLM_D_CTD; CLM_D_CH;
CLM_D_CAO; Number of days in the period
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claim operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: R
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
459
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
303.OPR-CLM-TOR-002
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 303
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: TOR
5 Indicator Code: OPR-CLM-TOR-002
6 Indicator Name: TOR for a role during a specified period
7 Indicator Acronym:
CLM_TOR_RO
8 Indicator Description:
Average number of claims disposed by specific role in a specific period
9 Dimensions: NA
10 Role & Action: Claims operator& Claims disposal
11 Formula: Sum cases disposed by all operators (CLM_D_CX + CLM_D_CPD + CLM_D_CTD + CLM_D_CH + CLM_D_CAO) in the role for the period / Number of days in the period
12 Data required: CLM_D_CX; CLM_D_CPD; CLM_D_CTD; CLM_D_CH;
CLM_D_CAO; Number of days in the period
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
460
16 Indicator use: To monitor claims cases disposal by Claim operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: R
19 Remarks: NA
********************************************************************
304.OPR-CLM-DTO-001
# KPI Properties Description
1 Gsln: 304
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: DTO
5 Indicator Code: OPR-CLM-DTO-001
6 Indicator Name: Daily Turnover of claims operator
7 Indicator Acronym:
CLM_DTO_CX
CLM_DTO_CPD
CLM_DTO_CTD
CLM_DTO_CH
CLM_DTO_CAO
8 Indicator Description:
Number of claims disposed by claims operator in a day
9 Dimensions: CX
CPD
CTD
CH
CAO
10 Role & Action: Claims operator&Claims disposal
461
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claim operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
305.OPR-CLM-CPP-001
# KPI Properties Description
1 Gsln: 305
2 Major Group: OPR
3 Minor Group: CLM
4 Sub Category: CPP
5 Indicator Code: OPR-CLM-CPP-001
6 Indicator Name: Claim Pendency Percentage for claims operator during a specified period
D W M Q H Y Cum Other
y N N N N N N N
462
7 Indicator Acronym:
CLM_CPP_CPD
CLM_CPP_CTD
CLM_CPP_CH
CLM_CPP_CAO
8 Indicator Description:
The percentage of claim cases disposed by CPD
9 Dimensions: CPD
CTD
CH
CAO
10 Role & Action: Claims operator& Claims disposal
11 Formula: CLM_P_CPD / CLM_D_CPD*100
CLM_P_CTD / CLM_D_CTD*100
CLM_P_CH / CLM_D_CH*100
CLM_P_CAO / CLM_D_CAO*100
12 Data required: CLM_P_CPD; CLM_D_CPD; CLM_P_CTD; CLM_D_CTD;
CLM_P_CH; CLM_D_CH;CLM_P_CAO; CLM_D_CAO
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor claims cases disposal by Claim operator
17 Unit of measure for the Indicator:
Claim cases
18 Type: P
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
463
********************************************************************
306.EMP-EAP-INT-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 306
2 Major Group: EMP
3 Minor Group: EAP
4 Sub Category: INT
5 Indicator Code: EMP-EAP-INT-001
6 Indicator Name: Empanelment Application Hospital User Initiated
7 Indicator Acronym:
EAP_I_R
8 Indicator Description:
Number of applications initiated by hospital user for Empanelment
9 Dimensions: NA
10 Role & Action: Hospital User&Empanelment Application Initiation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor empanelment process
17 Unit of measure for the Indicator:
Empanelment applications
18 Type: A
464
19 Remarks: NA
********************************************************************
307.EMP-EAP-UPD-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 307
2 Major Group: EMP
3 Minor Group: EAP
4 Sub Category: UPD
5 Indicator Code: EMP-EAP-UPD-001
6 Indicator Name: Empanelment Application Hospital User Updated
7 Indicator Acronym:
EAP_U_R
8 Indicator Description:
Number of Empanelment Application Updated by Hospital User after kept pending by EH
9 Dimensions: NA
10 Role & Action: Hospital User&Empanelment application updation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor empanelment process
17 Unit of measure for the Indicator:
Empanelment applications
465
18 Type: A
19 Remarks: NA
********************************************************************
308.EMP-ERE-FWD-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 308
2 Major Group: EMP
3 Minor Group: ERE
4 Sub Category: FWD
5 Indicator Code: EMP-ERE-FWD-001
6 Indicator Name: Empanelment Application Registration Forwarded by empanelment operator
7 Indicator Acronym:
EAP_RE_F_EEX
EAP_RE_F_EPO
EAP_RE_F_EPD
8 Indicator Description:
Number of Empanelment applications L1,L2,L3 Verified-for registration and forwarded by empanelment operator
9 Dimensions: EEX;EPO;EPD
10 Role & Action: Empanelment Operator & Empanelment application- registration
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
466
16 Indicator use: To monitor empanelment process
17 Unit of measure for the Indicator:
Empanelment applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
309.EMP-ERE-APP-002
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 309
2 Major Group: EMP
3 Minor Group: ERE
4 Sub Category: APP
5 Indicator Code: EMP-ERE-APP-002
6 Indicator Name: Empanelment Application-Registration approved by EH
7 Indicator Acronym:
EAP_RE_A_EH
8 Indicator Description:
Number of Empanelment applications L4 Verified-for registration and approved by EH
9 Dimensions: NA
10 Role & Action: EH&Empanelment application-registration
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
467
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor empanelment process
17 Unit of measure for the Indicator:
Empanelment applications
18 Type: A
19 Remarks: NA
********************************************************************
310.EMP-ERE-PEN-003
# KPI Properties Description
1 Gsln: 310
2 Major Group: EMP
3 Minor Group: ERE
4 Sub Category: PEN
5 Indicator Code: EMP-ERE-PEN-003
6 Indicator Name: Empanelment Application-Registration kept pending by EH
7 Indicator Acronym:
EAP_RE_P_EH
8 Indicator Description:
Number of Empanelment applications L4 Verified-for registration and kept pending by EH
9 Dimensions: NA
10 Role & Action: EH&Empanelment application-registration
11 Formula: NA
12 Data required: NA
468
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor empanelment process
17 Unit of measure for the Indicator:
Empanelment applications
18 Type: A
19 Remarks: NA
********************************************************************
311.EMP-ERE-REJ-004
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 311
2 Major Group: EMP
3 Minor Group: ERE
4 Sub Category: REJ
5 Indicator Code: EMP-ERE-REJ-004
6 Indicator Name: Empanelment Application-Registration rejected by EH
7 Indicator Acronym:
EAP_RE_R_EH
8 Indicator Description:
Number of Empanelment applications L4 Verified-for registration and rejected by EH
9 Dimensions: NA
10 Role & Action: EH&Empanelment application-registration
11 Formula: NA
469
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor empanelment process
17 Unit of measure for the Indicator:
Empanelment applications
18 Type: A
19 Remarks: NA
********************************************************************
312.EMP-EIP-INT-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 312
2 Major Group: EMP
3 Minor Group: EIP
4 Sub Category: INT
5 Indicator Code: EMP-EIP-INT-001
6 Indicator Name: Empanelment -Inspection EPO Initiated
7 Indicator Acronym:
EMP_IP_I_EPO
8 Indicator Description:
Number of Empanelment applications for which Inspection is assigned
9 Dimensions: NA
10 Role & Action: EPO (CMA)&EmpanelmentInspection
470
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor empanelment process
17 Unit of measure for the Indicator:
Empanelment applications
18 Type: A
19 Remarks: NA
********************************************************************
313.EMP-EIP-UPD-002
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 313
2 Major Group: EMP
3 Minor Group: EIP
4 Sub Category: UPD
5 Indicator Code: EMP-EIP-UPD-002
6 Indicator Name: Empanelment -Inspection MC-EDC Updated
7 Indicator Acronym:
EMP_IP_U_MC-EDC
8 Indicator Description:
Number of Empanelment applications for which Inspection is updated by MC-EDC
9 Dimensions: NA
471
10 Role & Action: Inspection team&EmpanelmentInspection
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor empanelment process
17 Unit of measure for the Indicator:
Empanelment applications
18 Type: A
19 Remarks: NA
********************************************************************
314.EMP-EAU-RAP-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 314
2 Major Group: EMP
3 Minor Group: EAU
4 Sub Category: RAP
5 Indicator Code: EMP-EAU-RAP-001
6 Indicator Name: Empanelment Authorisation Recommended Approval by empanelment operator
7 Indicator Acronym:
EMP_AU_RA_MC-EDC
EMP_AU_RA_EAO
472
8 Indicator Description:
Number of Empanelment applications for which MC-EDC Recommended Approval for Empanelment
9 Dimensions: MC-EDC
EAO
10 Role & Action: Empanelment Operator&Empanelment Authorisation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor empanelment process
17 Unit of measure for the Indicator:
Empanelment applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
315.EMP-EAU-RRE-002
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 315
2 Major Group: EMP
3 Minor Group: EAU
4 Sub Category: RRE
5 Indicator Code: EMP-EAU-RRE-002
473
6 Indicator Name: Empanelment Authorisation Recommended Rejection by empanelment operator
7 Indicator Acronym:
EMP_AU_RR_MC-EDC
EMP_AU_RR_EAO
8 Indicator Description:
Number of Empanelment applications for which MC-EDC Recommended Rejection for Empanelment
9 Dimensions: MC-EDC
EAO
10 Role & Action: Empanelment Operator&
Empanelment Authorisation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor empanelment process
17 Unit of measure for the Indicator:
Empanelment applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
474
316.EMP-EAU-REJ-003
# KPI Properties Description
1 Gsln: 316
2 Major Group: EMP
3 Minor Group: EAU
4 Sub Category: REJ
5 Indicator Code: EMP-EAU-REJ-003
6 Indicator Name: Empanelment Authorisation Rejected by empanelment operator
7 Indicator Acronym:
EMP_AU_R_MC-EDC
EMP_AU_R_EAO
EMP_AU_R_EH
8 Indicator Description:
Number of Empanelment applications for which MC-EDC Rejected for Empanelment
9 Dimensions: MC-EDC
EAO
EH
10 Role & Action: Empanelment Operator&Empanelment Authorisation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor empanelment process
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
475
17 Unit of measure for the Indicator:
Empanelment applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
317.EMP-EAU-PEN-004
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 317
2 Major Group: EMP
3 Minor Group: EAU
4 Sub Category: PEN
5 Indicator Code: EMP-EAU-PEN-004
6 Indicator Name: Empanelment Authorisation Pending by empanelment operator
7 Indicator Acronym:
EMP_AU_P_MC-EDC
EMP_AU_P_EAO
EMP_AU_P_EH
8 Indicator Description:
Number of Empanelment applications for which MC-EDC kept pending for Empanelment
9 Dimensions: NA
10 Role & Action: Empanelment Operator&Empanelment Authorisation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
476
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor empanelment process
17 Unit of measure for the Indicator:
Empanelment applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
318.EMP-EAU-APP-005
# KPI Properties Description
1 Gsln: 318
2 Major Group: EMP
3 Minor Group: EAU
4 Sub Category: APP
5 Indicator Code: EMP-EAU-APP-005
6 Indicator Name: Empanelment Authorisation-
EH Approved
7 Indicator Acronym:
EMP_AU_A_EH
8 Indicator Description:
Number of Empanelment applications for which EH Approved for Empanelment
9 Dimensions: NA
10 Role & Action: EH&Empanelment Authorisation
11 Formula: NA
12 Data required: NA
477
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor empanelment process
17 Unit of measure for the Indicator:
Empanelment applications
18 Type: A
19 Remarks: NA
********************************************************************
319.EMP-EAS-INT-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 319
2 Major Group: EMP
3 Minor Group: EAS
4 Sub Category: INT
5 Indicator Code: EMP-EAS-INT-001
6 Indicator Name: Additional Specialities Empanelment MEDCO Initiated
7 Indicator Acronym:
EAS_I_R
8 Indicator Description:
Number of applications initiated by hospital user for additional Specialities Empanelment
9 Dimensions: NA
10 Role & Action: MEDCO&Additional Specialities Empanelment
478
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional specialities empanelment process
17 Unit of measure for the Indicator:
Additional specialities Empanelment applications
18 Type: A
19 Remarks: NA
********************************************************************
320.EMP-EAS-UPD-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 320
2 Major Group: EMP
3 Minor Group: EAS
4 Sub Category: UPD
5 Indicator Code: EMP-EAS-UPD-001
6 Indicator Name: Additional Specialities Empanelment MEDCO Updated
7 Indicator Acronym:
EAS_U_R
8 Indicator Description:
Number of Applications for additional Specialities Empanelment updated by Hospital User after kept pending by EH
479
9 Dimensions: NA
10 Role & Action: MEDCO&Additional Specialities Empanelment
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional specialities empanelment process
17 Unit of measure for the Indicator:
Additional specialities Empanelment applications
18 Type: A
19 Remarks: NA
********************************************************************
321.EMP-EAS-RAP-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 321
2 Major Group: EMP
3 Minor Group: EAS
4 Sub Category: RAP
5 Indicator Code: EMP-EAS-RAP-001
6 Indicator Name: Additional Specialities Empanelment Recommended Approval Empanelment Operator
7 Indicator Acronym:
EAS_RA_EEX
EAS_RA_EPO
480
8 Indicator Description:
Number of Applications for additional Specialities Empanelment Recommended Approval by Empanelment Operator
9 Dimensions: EEX
EPO
10 Role & Action: Empanelment Operator&Additional Specialities Empanelment
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional specialities empanelment process
17 Unit of measure for the Indicator:
Additional specialities Empanelment applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
322.EMP-EAS-RRE-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 322
2 Major Group: EMP
3 Minor Group: EAS
481
4 Sub Category: RRE
5 Indicator Code: EMP-EAS-RRE-001
6 Indicator Name: Additional Specialities Empanelment Recommended Rejection Empanelment Operator
7 Indicator Acronym:
EAS_RR_EEX
EAS_RR_EPO
8 Indicator Description:
Number of Applications for additional Specialities Empanelment Recommended Rejection by Empanelment Operator
9 Dimensions: EEX
EPO (CMA)
10 Role & Action: Empanelment Operator&Additional Specialities Empanelment
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional specialities empanelment process
17 Unit of measure for the Indicator:
Additional specialities Empanelment applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
482
323. EMP-EAS-PEN-001
# KPI Properties Description
1 Gsln: 323
2 Major Group: EMP
3 Minor Group: EAS
4 Sub Category: PEN
5 Indicator Code: EMP-EAS-PEN-001
6 Indicator Name: Additional Specialities Empanelment Pending Empanelment Operator
7 Indicator Acronym:
EAS_P_EEX
EAS_P_EPO
EAS_P_MC-EDC
8 Indicator Description:
Number of Applications for Additional Specialities Empanelment kept pending by Empanelment Operator
9 Dimensions: EEX
EPO
MC-EDC
10 Role & Action: Empanelment Operator&Additional Specialities Empanelment
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional specialities empanelment process
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
483
17 Unit of measure for the Indicator:
Additional specialities Empanelment applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
324. EMP-EAS-IAP-001
# KPI Properties Description
1 Gsln: 324
2 Major Group: EMP
3 Minor Group: EAS
4 Sub Category: IAP
5 Indicator Code: EMP-EAS-IAP-001
6 Indicator Name: Additional Specialities Empanelment inspection Approved Empanelment Operator
7 Indicator Acronym:
EAS_IP_A_MC-EDC
EAS_IP_A_EPO
8 Indicator Description:
Number of Applications for Additional Specialities Empanelment inspection Approved by Empanelment Operator
9 Dimensions: MC-EDC
EPO
10 Role & Action: Empanelment Operator&Additional Specialities Empanelment
11 Formula: NA
12 Data required: NA
484
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional specialities empanelment process
17 Unit of measure for the Indicator:
Additional specialities Empanelment applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
325.EMP-EAS-IRE-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 325
2 Major Group: EMP
3 Minor Group: EAS
4 Sub Category: IRE
5 Indicator Code: EMP-EAS-IRE-001
6 Indicator Name: Additional Specialities Empanelment Inspection MC-EDC Rejected
7 Indicator Acronym:
EAS_IP_R_MC-EDC
EAS_IP_R_EH
8 Indicator Description:
Number of Applications for Additional Specialities Empanelment Rejected by Empanelment Operator
9 Dimensions: MC-EDC
EH
485
10 Role & Action: Empanelment Operator&Additional Specialities Empanelment
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional specialities empanelment process
17 Unit of measure for the Indicator:
Additional specialities Empanelment applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
326.EMP-EAS-IUP-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 326
2 Major Group: EMP
3 Minor Group: EAS
4 Sub Category: IUP
5 Indicator Code: EMP-EAS-IUP-001
6 Indicator Name: Additional Specialities Empanelment-Inspection MC-EDC Updated
7 Indicator Acronym:
EAS_IP_U_MC-EDC
486
8 Indicator Description:
Number of Applications for Additional Specialities Empanelment for which Inspection is updated by MC-EDC
9 Dimensions: NA
10 Role & Action: MC-EDC&Additional Specialities Empanelment-Inspection
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional specialities empanelment process
17 Unit of measure for the Indicator:
Additional specialities Empanelment applications
18 Type: A
19 Remarks: NA
********************************************************************
327.EMP-EAS-APP-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 327
2 Major Group: EMP
3 Minor Group: EAS
4 Sub Category: APP
5 Indicator Code: EMP-EAS-APP-001
6 Indicator Name: Additional Specialities Empanelment EH Approved
487
7 Indicator Acronym:
EAS_A_EH
8 Indicator Description:
Number of Applications for Additional Specialities Empanelment for which EH Approved for Empanelment
9 Dimensions: NA
10 Role & Action: EH&Additional Specialities Empanelment-
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional specialities empanelment process
17 Unit of measure for the Indicator:
Additional specialities Empanelment applications
18 Type: A
19 Remarks: NA
********************************************************************
328.EMP-ECR-INT-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 328
2 Major Group: EMP
3 Minor Group: ECR
4 Sub Category: INT
5 Indicator Code: EMP-ECR-INT-001
488
6 Indicator Name: Change Requests of MEDCO Initiated by MEDCO
7 Indicator Acronym:
ECR_I_R
8 Indicator Description:
Number of applications initiated by hospital user for Change request of MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO&Change Requests of MEDCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor MEDCO Change requests empanelment process
17 Unit of measure for the Indicator:
MEDCO Change requests applications
18 Type: A
19 Remarks: NA
********************************************************************
329.EMP-ECR-UPD-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 329
2 Major Group: EMP
3 Minor Group: ECR
4 Sub Category: UPD
489
5 Indicator Code: EMP-ECR-UPD-001
6 Indicator Name: Change Requests of MEDCO Updated by MEDCO
7 Indicator Acronym:
ECR_U_R
8 Indicator Description:
Number of Applications for Change request of MEDCO updated by Hospital User after kept pending by EH
9 Dimensions: NA
10 Role & Action: MEDCO&Change Requests of MEDCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor MEDCO Change requests empanelment process
17 Unit of measure for the Indicator:
MEDCO Change requests applications
18 Type: A
19 Remarks: NA
********************************************************************
330.EMP-ECR-RAP-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 330
2 Major Group: EMP
3 Minor Group: ECR
490
4 Sub Category: RAP
5 Indicator Code: EMP-ECR-RAP-001
6 Indicator Name: Change Requests of MEDCO-Recommended Approval by Empanelment Operator
7 Indicator Acronym:
ECR_RA_ITEX
ECR_RA_EEX
ECR_RA_MD-EDC
8 Indicator Description:
Number of Applications for Change request of MEDCO Recommended Approval
9 Dimensions: ITEX
EEX
MC-EDC
10 Role & Action: Empanelment Operator&Change Requests of MEDCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor MEDCO Change requests empanelment process
17 Unit of measure for the Indicator:
MEDCO Change requests applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
491
331.EMP-ECR-PEN-001
# KPI Properties Description
1 Gsln: 331
2 Major Group: EMP
3 Minor Group: ECR
4 Sub Category: PEN
5 Indicator Code: EMP-ECR-PEN-001
6 Indicator Name: Change Requests of MEDCO Pending by Empanelment Operator
7 Indicator Acronym:
ECR_P_ITEX
ECR_P_EEX
ECR_P_MD-EDC
ECR_P_EH
8 Indicator Description:
Number of Applications for Change request of MEDCO Kept pending
9 Dimensions: ITEX
EEX
MC-EDC
EH
10 Role & Action: Empanelment Operator&Change Requests of MEDCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
492
16 Indicator use: To monitor MEDCO Change requests empanelment process
17 Unit of measure for the Indicator:
MEDCO Change requests applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
332.EMP-ECR-REJ-001
# KPI Properties Description
1 Gsln: 332
2 Major Group: EMP
3 Minor Group: ECR
4 Sub Category: REJ
5 Indicator Code: EMP-ECR-REJ-001
6 Indicator Name: Change Requests of MEDCO Rejected by Empanelment Operator
7 Indicator Acronym:
ECR_R_EEX
ECR_R_MD-EDC
ECR_R_EH
8 Indicator Description:
Number of Applications for Change request of MEDCO Rejected
9 Dimensions: EEX
MC-EDC
EH
10 Role & Action: Empanelment Operator&Change Requests of MEDCO
11 Formula: NA
12 Data required: NA
493
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor MEDCO Change requests empanelment process
17 Unit of measure for the Indicator:
MEDCO Change requests applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
333.EMP-ECR-APP-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 333
2 Major Group: EMP
3 Minor Group: ECR
4 Sub Category: APP
5 Indicator Code: EMP-ECR-APP-001
6 Indicator Name: Change Requests of MEDCOApproved
7 Indicator Acronym:
ECR_A_EH
8 Indicator Description:
Number of Applications for Change request of MEDCO by Approved by EH
9 Dimensions: NA
10 Role & Action: EH&Change Requests of MEDCO
494
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor MEDCO Change requests empanelment process
17 Unit of measure for the Indicator:
MEDCO Change requests applications
18 Type: A
19 Remarks: NA
********************************************************************
334.EMP-ECA-INT-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 334
2 Major Group: EMP
3 Minor Group: ECA
4 Sub Category: INT
5 Indicator Code: EMP-ECA-INT-001
6 Indicator Name: Change Requests of AMCCO Initiated by MEDCO
7 Indicator Acronym:
ECA_I_R
8 Indicator Description:
Number of applications initiated by hospital user for Change request of AMCCO
9 Dimensions: NA
495
10 Role & Action: MEDCO&Change Requests of NVMCCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor AMCO Change requests empanelment process
17 Unit of measure for the Indicator:
AMCO Change requests applications
18 Type: A
19 Remarks: NA
********************************************************************
335.EMP-ECA-UPD-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 335
2 Major Group: EMP
3 Minor Group: ECA
4 Sub Category: UPD
5 Indicator Code: EMP-ECA-UPD-001
6 Indicator Name: Change Requests of AMCCO Updated by MEDCO
7 Indicator Acronym:
ECA_U_R
8 Indicator Description:
Number of Applications for Change request of AMCCO updated by Hospital User after kept pending by EH
496
9 Dimensions: NA
10 Role & Action: MEDCO&Change Requests of NVMCCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor AMCO Change requests empanelment process
17 Unit of measure for the Indicator:
AMCO Change requests applications
18 Type: A
19 Remarks: NA
********************************************************************
336.EMP-ECA-RAP-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 336
2 Major Group: EMP
3 Minor Group: ECA
4 Sub Category: RAP
5 Indicator Code: EMP-ECA-RAP-001
6 Indicator Name: Change Requests of AMCCO Recommended Approval by Empanelment Operator
497
7 Indicator Acronym:
ECA_RA_ITEX
ECA_RA_EEX
ECA_RA_MD-EDC
8 Indicator Description:
Number of Applications for Change request of NVMCCO Recommended Approval
9 Dimensions: ITEX
EEX
MC-EDC
10 Role & Action: Empanelment Operator&Change Requests of NVMCCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor AMCO Change requests empanelment process
17 Unit of measure for the Indicator:
AMCO Change requests applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
498
337.EMP-ECA-PEN-001
# KPI Properties Description
1 Gsln: 337
2 Major Group: EMP
3 Minor Group: ECA
4 Sub Category: PEN
5 Indicator Code: EMP-ECA-PEN-001
6 Indicator Name: Change Requests of NVMCCO Pending by Empanelment Operator
7 Indicator Acronym:
ECA_P_ITEX
ECA_P_EEX
ECA_P_MD-EDC
ECA_P_EH
8 Indicator Description:
Number of Applications for Change request of NVMCCO Kept pending
9 Dimensions: ITEX
EEX
MC-EDC
EH
10 Role & Action: Empanelment Operator&Change Requests of NVMCCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
499
16 Indicator use: To monitor AMCO Change requests empanelment process
17 Unit of measure for the Indicator:
AMCO Change requests applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
338 .EMP-ECA-REJ-001
# KPI Properties Description
1 Gsln: 338
2 Major Group: EMP
3 Minor Group: ECA
4 Sub Category: REJ
5 Indicator Code: EMP-ECA-REJ-001
6 Indicator Name: Change Requests of AMCCO Rejected by Empanelment Operator
7 Indicator Acronym:
ECA_R_EEX
ECA_R_MD-EDC
ECA_R_EH
8 Indicator Description:
Number of Applications for Change request of AMCCO Rejected
9 Dimensions: EEX
MC-EDC
EH
10 Role & Action: Empanelment Operator&Change Requests of AMCCO
11 Formula: NA
12 Data required: NA
500
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor AMCO Change requests empanelment process
17 Unit of measure for the Indicator:
AMCO Change requests applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
339.EMP-ECA-APP-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 339
2 Major Group: EMP
3 Minor Group: ECA
4 Sub Category: APP
5 Indicator Code: EMP-ECA-APP-001
6 Indicator Name: Change Requests of AMCCO Approved by Empanelment Operator
7 Indicator Acronym:
ECA_A_EH
8 Indicator Description:
Number of Applications for Change request of AMCCO Approved by EH
9 Dimensions: NA
501
10 Role & Action: EH&Change Requests of NVMCCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor AMCO Change requests empanelment process
17 Unit of measure for the Indicator:
AMCO Change requests applications
18 Type: A
19 Remarks: NA
********************************************************************
340.EMP-EAA-INT-001
# KPI Properties Description
1 Gsln: 340
2 Major Group: EMP
3 Minor Group: EAA
4 Sub Category: INT
5 Indicator Code: EMP-EAA-INT-001
6 Indicator Name: Change Requests of Additional NVMCCO Initiated by MEDCO
7 Indicator Acronym:
EAA_I_R
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
502
8 Indicator Description:
Number of applications initiated by hospital user for Change request for additional NVMCCO
9 Dimensions: NA
10 Role & Action: MEDCO&Change Requests of Additional NVMCCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional AMCO Change requests empanelment process
17 Unit of measure for the Indicator:
Change requests applications
18 Type: A
19 Remarks: NA
********************************************************************
341.EMP-EAA-UPD-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 341
2 Major Group: EMP
3 Minor Group: EAA
4 Sub Category: UPD
5 Indicator Code: EMP-EAA-UPD-001
503
6 Indicator Name: Change Requests of Additional NVMCCO Updated by MEDCO
7 Indicator Acronym:
EAA_U_R
8 Indicator Description:
Number of Applications for Change request for additional NVMCCO updated by Hospital User after kept pending by EH
9 Dimensions: NA
10 Role & Action: MEDCO&Change Requests of Additional NVMCCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional AMCO Change requests empanelment process
17 Unit of measure for the Indicator:
Additional AMCO Change requests applications
18 Type: A
19 Remarks: NA
********************************************************************
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
504
342.EMP-EAA-RAP-001
# KPI Properties Description
1 Gsln: 342
2 Major Group: EMP
3 Minor Group: EAA
4 Sub Category: RAP
5 Indicator Code: EMP-EAA-RAP-001
6 Indicator Name: Change Requests of Additional NVMCCO Recommended Approval by Empanelment Operator
7 Indicator Acronym:
EAA_RA_ITEX
EAA_RA_EEX
EAA_RA_MD-EDC
8 Indicator Description:
Number of Applications for Change request for additional NVMCCO Recommended Approval
9 Dimensions: ITEX
EEX
MC-EDC
10 Role & Action: Empanelment Operator&Change Requests of Additional NVMCCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional AMCO Change requests empanelment process
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
505
17 Unit of measure for the Indicator:
Additional AMCO Change requests applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
343.EMP-EAA-PEN-001
# KPI Properties Description
1 Gsln: 343
2 Major Group: EMP
3 Minor Group: EAA
4 Sub Category: PEN
5 Indicator Code: EMP-EAA-PEN-001
6 Indicator Name: Change Requests of Additional AMCCO Pending by Empanelment Operator
7 Indicator Acronym:
EAA_P_ITEX
EAA_P_EEX
EAA_P_MD-EDC
EAA_P_EH
8 Indicator Description:
Number of Applications for Change request for additional AMCCO Kept pending
9 Dimensions: ITEX
EEX
MC-EDC
EH
10 Role & Action: Empanelment Operator&Change Requests of Additional AMCCO
11 Formula: NA
506
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional AMCO Change requests empanelment process
17 Unit of measure for the Indicator:
Additional AMCO Change requests applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
344. EMP-EAA-REJ-001
# KPI Properties Description
1 Gsln: 344
2 Major Group: EMP
3 Minor Group: EAA
4 Sub Category: REJ
5 Indicator Code: EMP-EAA-REJ-001
6 Indicator Name: Change Requests of Additional NVMCCO Rejected by Empanelment Operator
7 Indicator Acronym:
EAA_R_EEX
EAA_R_MD-EDC
EAA_R_EH
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
507
8 Indicator Description:
Number of Applications for Change request for additional NVMCCO Rejected
9 Dimensions: EEX
MC-EDC
EH
10 Role & Action: Empanelment Operator&Change Requests of Additional NVMCCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional AMCO Change requests empanelment process
17 Unit of measure for the Indicator:
Additional AMCO Change requests applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
508
345. EMP-EAA-APP-001
# KPI Properties Description
1 Gsln: 345
2 Major Group: EMP
3 Minor Group: EAA
4 Sub Category: APP
5 Indicator Code: EMP-EAA-APP-001
6 Indicator Name: Change Requests of Additional NVMCCO Approved by EH
7 Indicator Acronym:
EAA_A_EH
8 Indicator Description:
Number of Applications for Change request for additional NVMCCO Approved by EH
9 Dimensions: NA
10 Role & Action: EH&Change Requests of Additional NVMCCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional AMCO Change requests empanelment process
17 Unit of measure for the Indicator:
Additional AMCO Change requests applications
18 Type: A
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
509
19 Remarks: NA
********************************************************************
346.EMP-EAR-INT-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 346
2 Major Group: EMP
3 Minor Group: EAR
4 Sub Category: INT
5 Indicator Code: EMP-EAR-INT-001
6 Indicator Name: Change Requests of Additional MEDCO Initiated by MEDCO
7 Indicator Acronym:
EAR_I_R
8 Indicator Description:
Number of applications initiated by hospital user for Change request for additional MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO&Change Requests of Additional MEDCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor AdditionalMEDCO Change requests empanelment process
510
17 Unit of measure for the Indicator:
Additional MEDCO Change requests applications
18 Type: A
19 Remarks: NA
********************************************************************
347.EMP-EAR-UPD-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 347
2 Major Group: EMP
3 Minor Group: EAR
4 Sub Category: UPD
5 Indicator Code: EMP-EAR-UPD-001
6 Indicator Name: Change Requests of Additional MEDCO Updated by MEDCO
7 Indicator Acronym:
EAR_U_R
8 Indicator Description:
Number of Applications for Change request for additional MEDCO updated by Hospital User after kept pending by EH
9 Dimensions: NA
10 Role & Action: MEDCO&Change Requests of Additional MEDCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
511
16 Indicator use: To monitor Additional MEDCO Change requests empanelment process
17 Unit of measure for the Indicator:
Additional MEDCO Change requests applications
18 Type: A
19 Remarks: NA
********************************************************************
348.EMP-EAR-RAP-001
# KPI Properties Description
1 Gsln: 348
2 Major Group: EMP
3 Minor Group: EAR
4 Sub Category: RAP
5 Indicator Code: EMP-EAR-RAP-001
6 Indicator Name: Change Requests of Additional MEDCO Recommended Approval by Empanelment Operator
7 Indicator Acronym:
EAR_RA_ITEX
EAR_RA_EEX
EAR_RA_MD-EDC
8 Indicator Description:
Number of Applications for Change request for additional MEDCO Recommended Approval
9 Dimensions: ITEX
EEX
MC-EDC
10 Role & Action: Empanelment Operator& Change Requests of Additional MEDCO
11 Formula: NA
12 Data required: NA
512
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional MEDCO Change requests empanelment process
17 Unit of measure for the Indicator:
Additional MEDCO Change requests applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
349.EMP-EAR-PEN-001
# KPI Properties Description
1 Gsln: 349
2 Major Group: EMP
3 Minor Group: EAR
4 Sub Category: PEN
5 Indicator Code: EMP-EAR-PEN-001
6 Indicator Name: Change Requests of Additional MEDCO Pending by Empanelment Operator
7 Indicator EAR_P_ITEX Acronym: EAR_P_EEX
EAR_P_MD-EDC
EAR_P_EH
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
513
8 Indicator Description:
Number of Applications for Change request for additional MEDCO Kept pending
9 Dimensions: ITEX
EEX
MC-EDC
EH
10 Role & Action: Empanelment Operator&Change Requests of Additional MEDCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional MEDCO Change requests empanelment process
17 Unit of measure for the Indicator:
Additional MEDCO Change requests applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
350.EMP-EAR-REJ-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 350
2 Major Group: EMP
514
3 Minor Group: EAR
4 Sub Category: REJ
5 Indicator Code: EMP-EAR-REJ-001
6 Indicator Name: Change Requests of Additional MEDCO Rejected by Empanelment Operator
7 Indicator Acronym:
EAR_R_EEX
EAR_R_MD-EDC
EAR_R_EH
8 Indicator Description:
Number of Applications for Change request for additional MEDCO Rejected
9 Dimensions: EEX
MC-EDC
EH
10 Role & Action: Empanelment Operator& Change Requests of Additional MEDCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional MEDCO Change requests empanelment process
17 Unit of measure for the Indicator:
Additional MEDCO Change requests applications
18 Type: A
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
515
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
351.EMP-EAR-APP-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 351
2 Major Group: EMP
3 Minor Group: EAR
4 Sub Category: APP
5 Indicator Code: EMP-EAR-APP-001
6 Indicator Name: Change Requests of Additional MEDCO Approved by Empanelment Operator
7 Indicator Acronym:
EAR_A
8 Indicator Description:
Number of Applications for Change request for additional MEDCO Approved by EH
9 Dimensions: EH
10 Role & Action: EH&Change Requests of Additional MEDCO
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Additional MEDCO Change requests empanelment process
516
17 Unit of measure for the Indicator:
Additional MEDCO Change requests applications
18 Type: A
19 Remarks: NA
********************************************************************
352.EMP-EBA-INT-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 352
2 Major Group: EMP
3 Minor Group: EBA
4 Sub Category: INT
5 Indicator Code: EMP-EBA-INT-001
6 Indicator Name: Change of Bank Account Number Initiated by MEDCO
7 Indicator Acronym:
EBA_I_R
8 Indicator Description:
Number of applications initiated by hospital user for Change of Bank Account Number
9 Dimensions: NA
10 Role & Action: MEDCOChange of Bank Account Number
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
517
16 Indicator use: To monitor Change of Bank Account Number requests empanelment process
17 Unit of measure for the Indicator:
Bank Account change requests Applications
18 Type: A
19 Remarks: NA
********************************************************************
353.EMP-EBA-UPD-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 353
2 Major Group: EMP
3 Minor Group: EBA
4 Sub Category: UPD
5 Indicator Code: EMP-EBA-UPD-001
6 Indicator Name: Change of Bank Account Number Updated by MEDCO
7 Indicator Acronym:
EBA_U_R
8 Indicator Description:
Number of Applications for Change of Bank Account Number updated by Hospital User after kept pending by EH
9 Dimensions: NA
10 Role & Action: MEDCO&Change of Bank Account Number
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
518
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Change of Bank Account Number requests empanelment process
17 Unit of measure for the Indicator:
Bank Account change requests Applications
18 Type: A
19 Remarks: NA
********************************************************************
354.EMP-EBA-RAP-001
# KPI Properties Description
1 Gsln: 354
2 Major Group: EMP
3 Minor Group: EBA
4 Sub Category: RAP
5 Indicator Code: EMP-EBA-RAP-001
6 Indicator Name: Change of Bank Account Number Recommended Approval by Empanelment Operator
7 Indicator Acronym:
EBA_RA_EEX
EBA_RA_DFO
8 Indicator Description:
Number of Applications for Change of Bank Account Number Recommended Approval
9 Dimensions: EEX
DFO
10 Role & Action: Empanelment Operator&Change of Bank Account Number
11 Formula: NA
519
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Change of Bank Account Number requests empanelment process
17 Unit of measure for the Indicator:
Bank Account change requests Applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
355.EMP-EBA-REJ-001
# KPI Properties Description
1 Gsln: 355
2 Major Group: EMP
3 Minor Group: EBA
4 Sub Category: REJ
5 Indicator Code: EMP-EBA-REJ-001
6 Indicator Name: Change of Bank Account Number Rejected by Empanelment Operator
7 Indicator Acronym:
EBA_R_EEX
EBA_R_DFO
EBA_R_CH
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
520
8 Indicator Description:
Number of Applications for Change of Bank Account Number Rejected
9 Dimensions: EEX
DFO
CH
10 Role & Action: Empanelment Operator&Change of Bank Account Number
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Change of Bank Account Number requests empanelment process
17 Unit of measure for the Indicator:
Bank Account change requests Applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
356.EMP-EBA-PEN-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 356
2 Major Group: EMP
3 Minor Group: EBA
4 Sub Category: PEN
521
5 Indicator Code: EMP-EBA-PEN-001
6 Indicator Name: Change of Bank Account Number Pending by Empanelment Operator
7 Indicator Acronym:
EBA_P_EEX
EBA_P_DFO
EBA_P_CH
8 Indicator Description:
Number of Applications for Change request for additional MEDCO Kept pending
9 Dimensions: EEX
DFO
CH
10 Role & Action: Empanelment Operator&Change of Bank Account Number
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Change of Bank Account Number requests empanelment process
17 Unit of measure for the Indicator:
Bank Account change requests Applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
522
357.EMP-EBA-APP-001
# KPI Properties Description
1 Gsln: 357
2 Major Group: EMP
3 Minor Group: EBA
4 Sub Category: APP
5 Indicator Code: EMP-EBA-APP-001
6 Indicator Name: Change of Bank Account Number Approved by CH
7 Indicator Acronym:
EBA_A_CH
8 Indicator Description:
Number of Applications for Change of Bank Account Number Approved
9 Dimensions: NA
10 Role & Action: CH(EO-ASII)&Change of Bank Account Number
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Change of Bank Account Number requests empanelment process
17 Unit of measure for the Indicator:
Bank Account change requests Applications
18 Type: A
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
523
19 Remarks: NA
********************************************************************
358.EMP-EXD-INT-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 358
2 Major Group: EMP
3 Minor Group: EXD
4 Sub Category: INT
5 Indicator Code: EMP-EXD-INT-001
6 Indicator Name: Expertise Details Initiated by MEDCO
7 Indicator Acronym:
EXD_I_R
8 Indicator Description:
Number of applications initiated by hospital user for Expertise Details Request
9 Dimensions: NA
10 Role & Action: MEDCO&Expertise Details Request
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Expertise Details requests empanelment process
524
17 Unit of measure for the Indicator:
Expertise Details applications
18 Type: A
19 Remarks: NA
********************************************************************
359.EMP-EXD-UPD-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 359
2 Major Group: EMP
3 Minor Group: EXD
4 Sub Category: UPD
5 Indicator Code: EMP-EXD-UPD-001
6 Indicator Name: Expertise Details Updated by MEDCO
7 Indicator Acronym:
EXD_U_R
8 Indicator Description:
Number of Applications for Expertise Details Request updated by Hospital User after kept pending by EH
9 Dimensions: NA
10 Role & Action: MEDCO&Expertise Details Request
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
525
16 Indicator use: To monitor Expertise Details requests empanelment process
17 Unit of measure for the Indicator:
Expertise Details applications
18 Type: A
19 Remarks: NA
********************************************************************
360.EMP-EXD-RAP-001
# KPI Properties Description
1 Gsln: 360
2 Major Group: EMP
3 Minor Group: EXD
4 Sub Category: RAP
5 Indicator Code: EMP-EXD-RAP-001
6 Indicator Name: Expertise Details Recommended Approval by Empanelment Operator
7 Indicator Acronym:
EXD_RA_EEX
EXD_RA_EPD
EXD_RA_MD-EDC
8 Indicator Description:
Number of Applications for Expertise Details Request Recommended Approval
9 Dimensions: EEX
EPD
MC-EDC
10 Role & Action: Empanelment Operator&Expertise Details Request
11 Formula: NA
12 Data required: NA
526
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Expertise Details requests empanelment process
17 Unit of measure for the Indicator:
Expertise Details applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
361.EMP-EXD-REJ-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
# KPI Properties Description
1 Gsln: 361
2 Major Group: EMP
3 Minor Group: EXD
4 Sub Category: REJ
5 Indicator Code: EMP-EXD-REJ-001
6 Indicator Name: Expertise Details Rejected Empanelment Operator
7 Indicator EXD_R_EEX Acronym: EXD_R_EPD
EXD_R_MD-EDC
EXD_R_EH
8 Indicator Description:
Number of Applications for Expertise Details Request Rejected
527
9 Dimensions: EEX;EPD;MC-EDC;EH
10 Role & Action: Empanelment Operator &Expertise Details Request
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor Expertise Details requests empanelment process
17 Unit of measure for the Indicator:
Expertise Details applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
362. EMP-EXD-PEN-001
# KPI Properties Description
1 Gsln: 362
2 Major Group: EMP
3 Minor Group: EXD
4 Sub Category: PEN
5 Indicator Code: EMP-EXD-PEN-001
6 Indicator Name: Expertise Details Pending Empanelment Operator
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
528
7 Indicator Acronym:
EXD_P_EEX
EXD_P_EPD
EXD_P_MD-EDC
EXD_P_EH
8 Indicator Description:
Number of Applications for Expertise Details Request kept Pending
9 Dimensions: EEX
EPD
MC-EDC
EH
10 Role & Action: Empanelment Operator& Expertise Details Request
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor Expertise Details requests empanelment process
17 Unit of measure for the Indicator:
Expertise Details applications
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
********************************************************************
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
529
363. EMP-EXD-APP-001
# KPI Properties Description
1 Gsln: 363
2 Major Group: EMP
3 Minor Group: EXD
4 Sub Category: APP
5 Indicator Code: EMP-EXD-APP-001
6 Indicator Name: Expertise Details Approved EH
7 Indicator Acronym:
EXD_A_EH
8 Indicator Description:
Number of Applications for Expertise Details Request Approved by EH
9 Dimensions: NA
10 Role & Action: EH &Expertise Details Request
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor Expertise Details requests empanelment process
17 Unit of measure for the Indicator:
Expertise Details applications
18 Type: A
19 Remarks: NA
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
530
*****************************************************************
364. OPR-FOL-SUB-001
# KPI Properties Description
1 Gsln: 364
2 Major Group: OPR
3 Minor Group: FOL
4 Sub Category: SUB
5 Indicator Code: OPR-FOL-SUB-001
6 Indicator Name: Therapies Follow-up cases submitted by MEDCO
7 Indicator Acronym:
FOL_S_R
8 Indicator Description:
The number of therapies follow-up cases submitted by MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO&
Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of MEDCO in disposal of follow-up cases
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
531
17 Unit of measure for the Indicator:
Follow-up cases
18 Type: A
19 Remarks: NA
*****************************************************************
365. OPR-FOL-UPD-001
# KPI Properties Description
1 Gsln: 365
2 Major Group: OPR
3 Minor Group: FOL
4 Sub Category: UPD
5 Indicator Code: OPR-FOL-UPD-001
6 Indicator Name: Therapies Follow-up cases updated by MEDCO
7 Indicator Acronym:
FOL_U_R
8 Indicator Description:
The number of therapies follow-up cases updated by MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO&
Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
532
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of MEDCO in disposal of follow-up cases
17 Unit of measure for the Indicator:
Follow-up cases
18 Type: A
19 Remarks: NA
*****************************************************************
366. OPR-FOL-FWD-001
# KPI Properties Description
1 Gsln: 366
2 Major Group: OPR
3 Minor Group: FOL
4 Sub Category: FWD
5 Indicator Code: OPR-FOL-FWD-001
6 Indicator Name: Therapies Follow-up cases forwarded by CEX
7 Indicator Acronym:
FOL_U_R
8 Indicator Description:
The number of therapies follow-up cases forwarded by CEX
9 Dimensions: NA
10 Role & Action: CEX &
Follow-up cases
11 Formula: NA
12 Data required: NA
533
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of CEX in disposal of follow-up cases
17 Unit of measure for the Indicator:
Follow-up cases
18 Type: A
19 Remarks: NA
*****************************************************************
367. OPR-FOL-RAP-001
# KPI Properties Description
1 Gsln: 367
2 Major Group: OPR
3 Minor Group: FOL
4 Sub Category: RAP
5 Indicator Code: OPR-FOL-RAP-001
6 Indicator Name: Therapies Follow-up cases Recommended Approval
7 Indicator Acronym:
FOL_RA_CTD
8 Indicator Description:
The number of therapies follow-up cases Recommended Approval by CTD
9 Dimensions: NA
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
534
10 Role & Action: CTD&
Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of CTD in disposal of follow-up cases
17 Unit of measure for the Indicator:
Follow-up cases
18 Type: A
19 Remarks: NA
*****************************************************************
368. OPR-FOL-RRJ-001
# KPI Properties Description
1 Gsln: 368
2 Major Group: OPR
3 Minor Group: FOL
4 Sub Category: RRJ
5 Indicator Code: OPR-FOL-RRJ-001
6 Indicator Name: Therapies Follow-up cases Recommended Rejection
7 Indicator Acronym:
FOL_RR_CTD
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
535
8 Indicator Description:
The number of therapies follow-up cases Recommended Rejection by CTD
9 Dimensions: NA
10 Role & Action: CTD&
Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of CTD in disposal of follow-up cases
17 Unit of measure for the Indicator:
Follow-up cases
18 Type: A
19 Remarks: NA
*****************************************************************
369. OPR-FOL-PEN-001
# KPI Properties Description
1 Gsln: 369
2 Major Group: OPR
3 Minor Group: FOL
4 Sub Category: PEN
5 Indicator Code: OPR-FOL-PEN-001
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
536
6 Indicator Name: Therapies Follow-up cases kept pending
7 Indicator Acronym:
FOL_P_CTD
FOL_P_CAO
8 Indicator Description:
The number of therapies follow-up cases kept pending by claims operator
9 Dimensions: CTD
CAO
10 Role & Action: Claim operator&
Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of Claim operator in disposal of follow-up cases
17 Unit of measure for the Indicator:
Follow-up cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
*****************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
537
370. OPR-FOL-APP-001
# KPI Properties Description
1 Gsln: 370
2 Major Group: OPR
3 Minor Group: FOL
4 Sub Category: APP
5 Indicator Code: OPR-FOL-APP-001
6 Indicator Name: Therapies Follow-up cases approved
7 Indicator Acronym:
FOL_A_CTD
FOL_A_CAO
FOL_A_AC
8 Indicator Description:
The number of therapies follow-up cases approved by claims operator
9 Dimensions: CTD
CAO
AC
10 Role & Action: Claim operator&
Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
538
16 Indicator use: To monitor performance of Claim operator in disposal of follow-up cases
17 Unit of measure for the Indicator:
Follow-up cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
*****************************************************************
371. OPR-FOL-REJ-001
# KPI Properties Description
1 Gsln: 371
2 Major Group: OPR
3 Minor Group: FOL
4 Sub Category: REJ
5 Indicator Code: OPR-FOL-REJ-001
6 Indicator Name: Therapies Follow-up cases rejected
7 Indicator Acronym:
FOL_R_CTD
FOL_R_CAO
8 Indicator Description:
The number of therapies follow-up cases rejected by claims operator
9 Dimensions: CTD
CAO
10 Role & Action: Claim operator&
Follow-up cases
11 Formula: NA
12 Data required: NA
539
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of Claim operator in disposal of follow-up cases
17 Unit of measure for the Indicator:
Follow-up cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
*****************************************************************
372. OPR-FCH-SUB-001
# KPI Properties Description
1 Gsln: 372
2 Major Group: OPR
3 Minor Group: FCH
4 Sub Category: SUB
5 Indicator Code: OPR-FCH-SUB-001
6 Indicator Name: Cochlear Therapies Follow-up cases submitted by MEDCO
7 Indicator Acronym:
FCH_S_R
8 Indicator Description:
The number of Cochlear therapies follow-up cases submitted by MEDCO
9 Dimensions: NA
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
540
10 Role & Action: MEDCO&
Cochlear Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of MEDCO in disposal of Cochlear follow-up cases
17 Unit of measure for the Indicator:
Cochlear follow-up cases
18 Type: A
19 Remarks: NA
*****************************************************************
373. OPR-FCH-UPD-001
# KPI Properties Description
1 Gsln: 373
2 Major Group: OPR
3 Minor Group: FCH
4 Sub Category: UPD
5 Indicator Code: OPR-FCH-UPD-001
6 Indicator Name: Cochlear Therapies Follow-up cases updated by MEDCO
7 Indicator Acronym:
FCH_U_R
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
541
8 Indicator Description:
The number of Cochlear therapies follow-up cases updated by MEDCO
9 Dimensions: NA
10 Role & Action: MEDCO&
Cochlear Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of MEDCO in disposal of Cochlear follow-up cases
17 Unit of measure for the Indicator:
Cochlear follow-up cases
18 Type: A
19 Remarks: NA
*****************************************************************
374. OPR-FCH-FWD-001
# KPI Properties Description
1 Gsln: 374
2 Major Group: OPR
3 Minor Group: FCH
4 Sub Category: FWD
5 Indicator Code: OPR-FCH-FWD-001
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
542
6 Indicator Name: Cochlear Therapies Follow-up cases forwarded by CEX
7 Indicator Acronym:
FCH_F_CEX
8 Indicator Description:
The number of Cochlear therapies follow-up cases forwarded by CEX
9 Dimensions: NA
10 Role & Action: CEX&
Cochlear Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of CEX in disposal of Cochlear follow-up cases
17 Unit of measure for the Indicator:
Cochlear follow-up cases
18 Type: A
19 Remarks: NA
*****************************************************************
375. OPR-FCH-RAP-001
# KPI Properties Description
1 Gsln: 375
2 Major Group: OPR
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
543
3 Minor Group: FCH
4 Sub Category: RAP
5 Indicator Code: OPR-FCH-RAP-001
6 Indicator Name: Cochlear Therapies Follow-up cases Recommended Approval
7 Indicator Acronym:
FCH_RA_MC-CC
FCH_RA_C-CC
8 Indicator Description:
The number of Cochlear therapies follow-up cases Recommended Approval by cochlear committee
9 Dimensions: MC-CC
C-CC
10 Role & Action: Cochlear Committee &
Cochlear Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of Cochlear Committee in disposal of Cochlear follow-up cases
17 Unit of measure for the Indicator:
Cochlear follow-up cases
18 Type: A
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
544
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
*****************************************************************
376. OPR-FCH-RRJ-001
# KPI Properties Description
1 Gsln: 376
2 Major Group: OPR
3 Minor Group: FCH
4 Sub Category: RRJ
5 Indicator Code: OPR-FCH-RRJ-001
6 Indicator Name: Cochlear Therapies Follow-up cases Recommended Rejection
7 Indicator Acronym:
FCH_RR_MC-CC
FCH_RR_C-CC
8 Indicator Description:
The number of Cochlear therapies follow-up cases Recommended Rejection by cochlear committee
9 Dimensions: MC-CC
C-CC
10 Role & Action: Cochlear Committee &
Cochlear Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
545
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of Cochlear Committee in disposal of Cochlear follow-up cases
17 Unit of measure for the Indicator:
Cochlear follow-up cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
*****************************************************************
377. OPR-FCH-PEN-001
# KPI Properties Description
1 Gsln: 377
2 Major Group: OPR
3 Minor Group: FCH
4 Sub Category: PEN
5 Indicator Code: OPR-FCH-PEN-001
6 Indicator Name: Cochlear Therapies Follow-up cases kept pending
7 Indicator Acronym:
FCH_P_MC-CC
FCH_P_C-CC
8 Indicator Description:
The number of Cochlear therapies follow-up cases kept pending by cochlear committee
9 Dimensions: MC-CC
C-CC
10 Role & Action: Cochlear Committee &
Cochlear Follow-up cases
11 Formula: NA
546
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of Cochlear Committee in disposal of Cochlear follow-up cases
17 Unit of measure for the Indicator:
Cochlear follow-up cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
*****************************************************************
378. OPR-FCH-APP-001
# KPI Properties Description
1 Gsln: 378
2 Major Group: OPR
3 Minor Group: FCH
4 Sub Category: APP
5 Indicator Code: OPR-FCH-APP-001
6 Indicator Name: Cochlear Therapies Follow-up cases approved
7 Indicator Acronym:
FCH_A_CAO
FCH_A_AC
8 Indicator Description:
The number of Cochlear therapies follow-up cases approved by claims operator
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
547
9 Dimensions: CAO
AC
10 Role & Action: Claim operator&
Cochlear Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Output
16 Indicator use: To monitor performance of Cochlear Committee in disposal of Cochlear follow-up cases
17 Unit of measure for the Indicator:
Cochlear follow-up cases
18 Type: A
19 Remarks: Based on the dimensions the acronyms are assigned appropriately for the indicator.
*****************************************************************
379. FOP-NAM-ATN-001
# KPI Properties Description
1 Gsln: 379
2 Major Group: FOP
3 Minor Group: NAM
4 Sub Category: ATN
D W M Q H Y Cum Other
N Y Y Y Y Y Y N
548
5 Indicator Code: FOP-NAM-ATN-001
6 Indicator Name: Attendance of NAM
7 Indicator Acronym:
ATN_N
8 Indicator Description:
Actual number and percentage of NAM attendance
9 Dimensions: Shift I
Shift II
Shift III
10 Role & Action: NAM&
Attendance
11 Formula: Attendance of NAM/(Total number of NAMS who are to attend in the particular shift)*100
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the attendance of NAM
17 Unit of measure for the Indicator:
Attendance
18 Type: A;P
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by NAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
D W M Q H Y Cum Other
Y N N N N N N N
549
380. FOP-NAM-PCL-001
# KPI Properties Description
1 Gsln: 380
2 Major Group: FOP
3 Minor Group: NAM
4 Sub Category: PCL
5 Indicator Code: FOP-NAM-PCL-001
6 Indicator Name: Regular preauth cases cleared by NAM
7 Indicator Acronym:
PAU_F_N
8 Indicator Description:
Number of preauths forwarded by NAM
9 Dimensions: NA
10 Role & Action: NAM&
Preauth cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the performance of NAM and utility of scheme
17 Unit of measure for the Indicator:
Preauth cases
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
550
18 Type: A
19 Remarks: Same as in operations indicator
This set of indicators are used to calcuate the percentage of target that has been achieved by NAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
381. FOP-NAM-REG-001
# KPI Properties Description
1 Gsln: 381
2 Major Group: FOP
3 Minor Group: NAM
4 Sub Category: REG
5 Indicator Code: FOP-NAM-REG-001
6 Indicator Name: Patient registrations done by NAM
7 Indicator Acronym:
REG_N
8 Indicator Description:
Number of patient registrations performed by NAM in a day in NWH
9 Dimensions: NA
10 Role & Action: NAM&
Registration of patients
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
551
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the performance of NAM
17 Unit of measure for the Indicator:
Registrations
18 Type: A
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by NAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
382. FOP-NAM-CON-001
# KPI Properties Description
1 Gsln: 382
2 Major Group: FOP
3 Minor Group: NAM
4 Sub Category: CON
5 Indicator Code: FOP-NAM-CON-001
6 Indicator Name: OP/IP Conversions done by NAM
7 Indicator Acronym:
CON_N
8 Indicator Description:
Number of OP/IP Conversions performed by NAM
9 Dimensions: NA
10 Role & Action: NAM&
OP to IP conversion of patients
11 Formula: NA
552
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the performance of NAM
17 Unit of measure for the Indicator:
Op/Ip conversion
18 Type: A
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by NAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
383. FOP-NAM-FOL-001
# KPI Properties Description
1 Gsln: 383
2 Major Group: FOP
3 Minor Group: NAM
4 Sub Category: FOL
5 Indicator Code: FOP-NAM-FOL-001
6 Indicator Name: Follow-up cases cleared by NAM
7 Indicator Acronym:
FOL_F_N
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
553
8 Indicator Description:
Number of follow-up preauths forwarded by NAM
9 Dimensions: NA
10 Role & Action: NAM&
Follow-up cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the performance of NAM
17 Unit of measure for the Indicator:
Follow-up cases
18 Type: A
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by NAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
384. FOP-NAM-REF-001
# KPI Properties Description
1 Gsln: 384
2 Major Group: FOP
3 Minor Group: NAM
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
554
4 Sub Category: REF
5 Indicator Code: FOP-NAM-REF-001
6 Indicator Name: 133 reserved procedure Cases referred by NAM
7 Indicator Acronym:
REF_N
8 Indicator Description:
Number of 133 reserved procedure Cases referred to Government NWH from private NWH by NAM
9 Dimensions: NA
10 Role & Action: NAM&Referral of 133 procedure cases
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the performance of NAM
17 Unit of measure for the Indicator:
133 Procedures
18 Type: A
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by NAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
D W M Q H Y Cum Other
Y Y Y Y Y Y Y N
555
385. FOP-NAM-BUP-001
# KPI Properties Description
1 Gsln: 385
2 Major Group: FOP
3 Minor Group: NAM
4 Sub Category: BUP
5 Indicator Code: FOP-NAM-BUP-001
6 Indicator Name: On bed updation by NAM
7 Indicator Acronym:
BUP_N
8 Indicator Description:
Number of on bed updation done by NAM in a day
9 Dimensions: Shift I
Shift III
10 Role & Action: NAM&On bed updation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the performance of NAM in on-bed updation of patient status as per target - SHIFT I 25% and SHIFT III 75%
17 Unit of measure for the Indicator:
Onbed updation
D W M Q H Y Cum Other
Y N N N N N N N
556
18 Type: A
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by PAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
386. FOP-PAM-ATN-001
# KPI Properties Description
1 Gsln: 386
2 Major Group: FOP
3 Minor Group: PAM
4 Sub Category: ATN
5 Indicator Code: FOP-PAM-ATN-001
6 Indicator Name: Attendance of PAM
7 Indicator Acronym:
ATN_PAM
8 Indicator Description:
Actual number and percentage of PAM attendance
9 Dimensions: Shift I
Shift II
Shift III
10 Role & Action: PAM&Attendance
11 Formula: (Attendance of PAM/Total number of PAMS who are to attend in the particular shift)*100
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
557
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the attendance of PAM
17 Unit of measure for the Indicator:
Attendance
18 Type: A;P
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by PAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
387. FOP-PAM-REG-001
# KPI Properties Description
1 Gsln: 387
2 Major Group: FOP
3 Minor Group: PAM
4 Sub Category: REG
5 Indicator Code: FOP-PAM-REG-001
6 Indicator Name: Patient registrations done by PAM
7 Indicator Acronym:
REG_PAM
8 Indicator Description:
Number of patient registrations performed by PAM in a day
9 Dimensions: PHC
Health camps
10 Role & Action: PAM&Registration of patients
558
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the performance of PAM in Registration of patients as per target - @ 30 PATIENT REGESTRATIONS per PHC in a day
17 Unit of measure for the Indicator:
Registrations
18 Type: A
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by PAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
388. FOP-PAM-REF-001
# KPI Properties Description
1 Gsln: 388
2 Major Group: FOP
3 Minor Group: PAM
4 Sub Category: REF
5 Indicator Code: FOP-PAM-REF-001
6 Indicator Name: Referral Capture count by PAM
D W M Q H Y Cum Other
Y N N N N N N N
559
7 Indicator Acronym:
REF_PAM
8 Indicator Description:
Number of Patients referred to NWH by PAM in a day
9 Dimensions: PHC
Health camps
10 Role & Action: PAM&
Referral of patients
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the performance of PAM in Referral of patients as per target -@ 2 REFERRAL CAPTURE Per PHC in a day
17 Unit of measure for the Indicator:
Referrals
18 Type: A
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by PAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
D W M Q H Y Cum Other
Y N N N N N N N
560
389. FOP-PAM-CON-001
# KPI Properties Description
1 Gsln: 389
2 Major Group: FOP
3 Minor Group: PAM
4 Sub Category: CON
5 Indicator Code: FOP-PAM-CON-001
6 Indicator Name: Referral Conversion Count by PAM
7 Indicator Acronym:
CON_PAM
8 Indicator Description:
Number of Patients converted to Dr.NTR Vaidya Seva cases from cases referred by PAM in a day
9 Dimensions: PHC
Health camps
10 Role & Action: PAM&
Conversion of patients
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the performance of PAM as per target -@ REFERRAL CONVERSION 1 PER WEEK Per PHC by PAM
D W M Q H Y Cum Other
N Y N N N N N N
561
17 Unit of measure for the Indicator:
Op/Ip conversion
18 Type: A
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by PAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
390. FOP-PAM-FVS-001
# KPI Properties Description
1 Gsln: 390
2 Major Group: FOP
3 Minor Group: PAM
4 Sub Category: FVS
5 Indicator Code: FOP-PAM-FVS-001
6 Indicator Name: Dr.NTR Vaidya Seva discharged patients visited by PAM
7 Indicator Acronym:
FVS_PAM
8 Indicator Description:
Number of Dr.NTR Vaidya Seva discharged patients visited by PAM in a day
9 Dimensions: NA
10 Role & Action: PAM&Field visits
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
D W M Q H Y Cum Other
Y N N N N N N N
562
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the performance of PAM in field visits as per target @ 5 PER DAY
17 Unit of measure for the Indicator:
Field visits
18 Type: A
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by PAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
391. FOP-PAM-FOL-001
# KPI Properties Description
1 Gsln: 392
2 Major Group: FOP
3 Minor Group: PAM
4 Sub Category: FOL
5 Indicator Code: FOP-PAM-FOL-001
6 Indicator Name: Dr.NTR Vaidya Seva patients mobilised for follow-up treatment by PAM
7 Indicator Acronym:
FOL_PAM
8 Indicator Description:
Number of Dr.NTR Vaidya Seva patients mobilised for follow-up treatment by PAM in a day
9 Dimensions: NA
563
10 Role & Action: PAM &Follow-up mobilisation
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the performance of PAM in follow-up mobilisation as per target –FOLLOW-UP CASES TARGET ACTUALS SET BY FIELD OPERATIONS DEPT in a day
17 Unit of measure for the Indicator:
Follow-up mobilisation
18 Type: A
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by PAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
392. FOP-PAM-IEC-001
# KPI Properties Description
1 Gsln: 393
2 Major Group: FOP
3 Minor Group: PAM
4 Sub Category: IEC
5 Indicator Code: FOP-PAM-IEC-001
6 Indicator Name: IEC Conducted by PAM
D W M Q H Y Cum Other
Y N N N N N N N
564
7 Indicator Acronym:
IEC_PAM
8 Indicator Description:
Number of IEC activities done for a Health Camp in a day by PAM
9 Dimensions: NA
10 Role & Action: PAM & IEC activities
11 Formula: NA
12 Data required: NA
13 Frequency of
Monitoring:
14 Data source: RAS Database
15 Indicator Monitors:
Activity
16 Indicator use: To monitor the performance of PAM in fin IEC activities as per target -5 PER FOR HC
17 Unit of measure for the Indicator:
IEC activities
18 Type: A
19 Remarks: This set of indicators are used to calcuate the percentage of target that has been achieved by PAM. Using target and the count of cases we can calculate the percentage of achievement.
*****************************************************************
D W M Q H Y Cum Other
Y N N N N N N N
565
16. APPENDIX
Forecast Notes:
Forecasting
Scenario:
In Dr.NTR Vaidya Seva Project, the implementation took place in a scale up manner. So in previous years, the project might not have the whole set of procedures. We term these different states of the project as 1. Fully loaded state of the project 2.Partially loaded state of the project. We want to forecast the amount that would incur for a specified period of time but since the past data we have is from a different state of business compared to the present state, the amount we get from forecasting wouldn't be appropriate. For this purpose, we use a method for calculating the amount that would have incurred to our business if our past status would be fully loaded state rather than a partially loaded state.
Data Preparation:
Weights are calculated from the fully loaded state on either 1st Jan/ 1st July of the current year.
Next, we want to find out the cost that would have incurred to us at a particular point of time if we were in a fully loaded state. For this purpose, under various assumptions we use the following methodology.
1. Weights calculated on 1st Jan/ 1st July of the current year (using cumulative data) are taken as the reference weights.
2. Next, to find the cost that would have been incurred at a past date when the scheme was not fully loaded, we calculate the sum of the reference weights for the available procedures at that particular point of time in the past. This would give us the percentage of contribution of the procedures available as on the past date.
3. So if x is the amount consumed for the set of procedures on the past date and p% is the contribution of those therapies as per todays weights then the total expenditure had the scheme been fully loaded as on the past date would have been x/p.
4. This scaled up amount would be considered as the amount that would have been
incurred by the scheme at the past time period, had it been fully loaded.
This is referred to as "Relative claim Paid for the month for RAS"
566
5. To calculate the amount of money that would be incurred by the scheme for a specific set of procedures, ex: a basket of 268 procedures, first calculate the weight of the 268 basket say q% The amount incurred on this basket had it existed in the past would have been (x/p)q . This is termed as "Relative Total Claim".
Depending on the requirements we either use "Relative claim paid for the month for RAS" or "Relative Total Claim" as the input dataset for final forecasting.
Note: Other approaches for making more reliable and accurate forecasts are being planned and would be tried while performing forecasting.
Weights used in our present system (Weights and Bare Weights):
Number 1 Formula Name
Bare weight of Therapy, as on a given date
Term Acronym
BW
Formula Description
A set of weights are calculated depending on the number of times a therapy has been performed during successive periods. These are termed as bare weights.
Formula ATPCC/ sum of ATPCCs for all the therapies available in all Categories (Note: ATPCC = Average Therapies Performed Per Covered Card Year)
Data Required
Average Therapies Performed Per Covered Card Year for every procedure available in the procedure basket during a specific period. Usually they are calculated cumulatively using the data from the inception of the scheme.
Data Source
RAS
Use Bare weights can be used for comparing various therapies or categories of therapies depending on the demand for them in the market and could also be used for creating other complex indicators. They could help in looking at a glance which therapies are in high demand and therapies which aren't being utilized at all if any etc and could be useful while re-designing the procedures basket.
Remarks Bare Weight of any set of procedures will always be less than 1 and the weight of all the procedures will always be equal to 1. They are
calculated on 1st Jan/ 1st July.
567
Number 2 Formula Name
Weight of Therapy as on a given date
Term Acronym
Wt
Formula Description
A set of weights are calculated depending on the amount that a particular therapy has bagged during a specific period. These are termed as weights.
Formula CLR of the Therapy / sum of CLRs for all the Therapies available
Data Required
Claim Rate of every therapy available in the procedure basket during a specific period. Usually they are calculated cumulatively using the data from the inception of the scheme.
Data Source
RAS
Use Weights can be used for comparing various therapies or categories depending upon the cost incurred for them during a specified period.
Remarks Weight of any set of procedures will always be less than 1 and the weight of all the procedures will always be equal to 1.
Dimensions of interest which were used for an indicator wherever applicable
Category Dimensions available in this category
Time
Financial Year (Ex: 1st April Year 1998 – 31st March Year 1999),
Calendar Year (Ex: 1st Jan 2001 – 31st Dec 2001),
Cumulative Year, Policy Period, Month, Quarter, Day, Hour
Scheme RAS, AS-1, AS-2, CMCO, Journalist
Geography PD, HD, Phase
Provider NWH, Provider Type (Government and Private)
Socio Economic Dimensions
Age, Community, Sex
Role
Preauth - MEDCO, NAM, PEX, PPD, PTD, PAO
Claims - MEDCO, CEX, CPD, CTD, CH, A/C, CAO
Empanelment - EEX, EPO, EPD, EAO, EH, MC-EDC, ITEX, DFO, CH
Preauth Cochlear Cases -MEDCO, NAM, PEX-C, MC- CC, C-CC, PAO
568
Levels of analyses which are of interest:
Our system could be affected by any of these parameters, so all of these levels of
analysis are of interest to the company.
For example, if the cards covered remain the same and population density per card
increases then the utility rates will go up.
The above mentioned example is just to make one visualize the various factors that
impact our company and are of interest for us to monitor.