Category: Queries – Insurance

Patients by Insurance Carrier and Group Number

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Is there a patient report that lists all patients by insurance group number?

 

SELECT 
  a.payorname,a.insgroup,b.lastname,b.firstname,b.id
FROM 
  sos.rv_policies a JOIN sos.patients b ON a.ptnum = b.ptnum
WHERE 
  today() BETWEEN COALESCE(a.active,'1900-01-01') AND COALESCE(a.inactive,'2100-12-31')
ORDER BY 
  payorname, insgroup, b.lastname, b.firstname, b.id

Count of Patients by Provider with and without Medicaid

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I need to know by provider how many active patients they have and how many have Medicaid coverage.

This query shows the combined use a an IF expression that evaluates based on a subquery that returns a count. In this case, if there is any Medicaid coverage (carriers.coverage = ‘D’) then the expression returns “Yes”, otherwise (no ‘caid coverage) it returns “No”.

SELECT
(a.provfname + ' '+a.provlname) AS "Provider",
(IF (SELECT COUNT(*)
    FROM sos.ptpayors s1 JOIN sos.payors s2 ON s1.payornum = s2.payornum JOIN sos.carriers s3 ON s2.payornum = s3.payornum
    WHERE s1.ptnum = a.ptnum AND s3.coverage = 'D') > 0
THEN 'YES'
ELSE 'NO'
END IF)
AS "Medicaid",
COUNT(DISTINCT a.ptnum) AS "Pt Count"
FROM
sos.rv_charges a
WHERE
a.trandate BETWEEN '2008-01-01' AND '2008-12-31'
GROUP BY
"Provider", "Medicaid"
ORDER BY
"Provider", "Medicaid"

Patients Seen In Period With Insurance And Provider

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Is there a query that will list all clients that were seen in a certain time frame along with name of insurance for a specific provider?

Adjust the desired date range and provider code in the WHERE clause below.

SELECT DISTINCT
  a.lastname,
  a.firstname,
  a.id,
  a.provcode,
  (IF c.payortype = 'I' THEN c.payorname ELSE '' ENDIF) AS "Insurance"
FROM
  sos.rv_charges a
  JOIN sos.ptpayors b ON a.ptpayornum = b.ptpayornum
  JOIN sos.payors c ON b.payornum = c.payornum
WHERE
  trandate BETWEEN '2002-01-01' AND '2002-01-31'
  AND a.provcode = '3'
ORDER BY
  a.lastname, a.firstname, a.id

Count of Patients by Provider with and without Medicaid

Posted on | by SOS Blog | Leave a Comment on Count of Patients by Provider with and without Medicaid

I need to know by provider how many active patients they have and how many have Medicaid coverage.

This query shows the combined use a an IF expression that evaluates based on a subquery that returns a count. In this case, if there is any Medicaid coverage (carriers.coverage = ‘D’) then the expression returns “Yes”, otherwise (no ‘caid coverage) it returns “No”.

SELECT
(a.provfname + ' '+a.provlname) AS "Provider",
(IF (SELECT COUNT(*)
    FROM sos.ptpayors s1 JOIN sos.payors s2 ON s1.payornum = s2.payornum JOIN sos.carriers s3 ON s2.payornum = s3.payornum
    WHERE s1.ptnum = a.ptnum AND s3.coverage = 'D') > 0
THEN 'YES'
ELSE 'NO'
END IF)
AS "Medicaid",
COUNT(DISTINCT a.ptnum) AS "Pt Count"
FROM
sos.rv_charges a
WHERE
a.trandate BETWEEN '2008-01-01' AND '2008-12-31'
GROUP BY
"Provider", "Medicaid"
ORDER BY
"Provider", "Medicaid"

Count Of Patients By Insurance Plan

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The SOS report “Patients by Insurance Carrier” lists every active patient. Can that report be trimmed to just giving the carrier and the number of active patients within each carrier, perhaps also with a grand total of active patients? Knowing the exact amount of patients we serve is helpful when negotiating with carriers about rates, etc.

The following query gives a count by Plan and (primary) Provider. For the count across providers, remove line 3, line 9, and the comma and d.provcode from the GROUP BY and ORDER BY clauses. Better yet, look at the second version of the query below, featuring a ROLLUP that gives you all the totals and subtotals without the need to edit.

SELECT
  c.payorname AS "Ins Plan",
  d.provcode,
  count(a.ptnum) AS "N"
FROM
  sos.patients a
  JOIN sos.ptpayors b ON a.ptnum = b.ptnum
  JOIN sos.payors c ON b.payornum = c.payornum
  JOIN sos.providers d ON a.providernum = d.providernum
WHERE
  a.flag = 0
  AND a.dischargedate IS NULL
  AND c.payortype = 'I'
GROUP BY
  c.payorname, d.provcode
ORDER BY
  c.payorname, d.provcode

The version below adds the ROLLUP operator to the GROUP BY. That creates a result set that includes NULL in various cells. Read NULL as “ALL.” Therefore if you see NULL in the ProvCode column, it means that this count is for all providers. There is also a row with NULL in both the Plan and Provider columns, meaning all plans and all providers, which in this case is the number of patients in the result set.

SELECT
  c.payorname AS "Ins Plan",
  d.provcode,
  count(a.ptnum) AS "N"
FROM
  sos.patients a
  JOIN sos.ptpayors b ON a.ptnum = b.ptnum
  JOIN sos.payors c ON b.payornum = c.payornum
  JOIN sos.providers d ON a.providernum = d.providernum
WHERE
  a.flag = 0
  AND a.dischargedate IS NULL
  AND c.payortype = 'I'
GROUP BY
  ROLLUP(c.payorname, d.provcode)
ORDER BY
  c.payorname, d.provcode