Provider Contract Analysis Summary
 
By Group Code Report Date: 10/30/2003
By PPO Contract Report Period: 09/01/2003 - 09/30/2003 Paid
 
Type Count Charge Paid Avg Paid Total Disc Avg Disc
Group: 99999
PPO Cnt:
Ben Type: CS
Non-PPO 137 $42,402.67 $23,554.07 $171.93 $7,686.22 $56.10
PPO 0 $0.00 $0.00 $0.00 $0.00 $0.00
OOA 0 $0.00 $0.00 $0.00 $0.00 $0.00
Total 137 $42,402.67 $23,554.07 $171.93 $7,686.22 $56.10
Ben Type: D DENTAL
Non-PPO 2333 $227,078.00 $105,476.42 $45.21 $0.00 $0.00
PPO 0 $0.00 $0.00 $0.00 $0.00 $0.00
OOA 0 $0.00 $0.00 $0.00 $0.00 $0.00
Total 2333 $227,078.00 $105,476.42 $45.21 $0.00 $0.00
Ben Type: M MEDICAL
Non-PPO 1097 $368,518.19 $154,919.14 $141.22 $10,854.82 $9.90
PPO 0 $0.00 $0.00 $0.00 $0.00 $0.00
OOA 0 $0.00 $0.00 $0.00 $0.00 $0.00
Total 1097 $368,518.19 $154,919.14 $141.22 $10,854.82 $9.90
Ben Type: V VISION
Non-PPO 244 $23,153.08 $10,323.32 $42.31 $115.86 $0.47
PPO 0 $0.00 $0.00 $0.00 $0.00 $0.00
OOA 0 $0.00 $0.00 $0.00 $0.00 $0.00
Total 244 $23,153.08 $10,323.32 $42.31 $115.86 $0.47
PPO Cnt:
Ben Type: M MEDICAL
Non-PPO 0 $0.00 $0.00 $0.00 $0.00 $0.00
PPO 1535 $333,001.91 $158,915.66 $103.53 $49,492.79 $32.24
OOA 0 $0.00 $0.00 $0.00 $0.00 $0.00
Total 1535 $333,001.91 $158,915.66 $103.53 $49,492.79 $32.24
PPO Cnt:
Ben Type: CS
Non-PPO 102 $16,371.40 $4,226.13 $41.43 $4,503.41 $44.15
PPO 0 $0.00 $0.00 $0.00 $0.00 $0.00
OOA 0 $0.00 $0.00 $0.00 $0.00 $0.00
Total 102 $16,371.40 $4,226.13 $41.43 $4,503.41 $44.15
PPO Cnt:
Ben Type: M MEDICAL
Non-PPO 0 $0.00 $0.00 $0.00 $0.00 $0.00
PPO 155 $20,701.91 $11,343.21 $73.18 $5,010.65 $32.33
OOA 0 $0.00 $0.00 $0.00 $0.00 $0.00
Total 155 $20,701.91 $11,343.21 $73.18 $5,010.65 $32.33
PPO Cnt:
Ben Type: CS CRS WRAP
Non-PPO 253 $70,610.11 $37,431.49 $147.95 $6,930.87 $27.39
PPO 0 $0.00 $0.00 $0.00 $0.00 $0.00
OOA 0 $0.00 $0.00 $0.00 $0.00 $0.00
Total 253 $70,610.11 $37,431.49 $147.95 $6,930.87 $27.39
PPO Cnt:
Ben Type: M MEDICAL
Non-PPO 38 $2,795.77 $37.58 $0.99 $0.00 $0.00
PPO 10132 $3,483,272.45 $1,011,042.34 $99.79 $1,286,187.40 $126.94
OOA 0 $0.00 $0.00 $0.00 $0.00 $0.00
Total 10170 $3,486,068.22 $1,011,079.92 $99.42 $1,286,187.40 $126.47
 
Totals:
Non-PPO 4204 $750,929.22 $335,968.15 $79.92 $30,091.18 $7.16
PPO 11822 $3,836,976.27 $1,181,301.21 $99.92 $1,340,690.84 $113.41
OOA 0 $0.00 $0.00 $0.00 $0.00 $0.00

Total 16026 $4,587,905.49 $1,517,269.36 $94.68 $1,370,782.02 $85.53
 
Provider Contract Analysis Summary
Requestor: Report Caster
Report Date: 10/30/2003
Sort Fields: Selected values:
Group: 99999
PPO Contract: ALL
Benefit Type(s): ALL
Date: Paid
Report Period: 09/01/2003 - 09/30/2003
Benefit Suffix: All