Active Analysis Report
Provider Type
- Participating Physician Groups (PPG)
- Hospitals
The Activity Analysis Report (BRM 11M) identifies and summarizes the following membership activity for the reporting period:
- Additions and cancellations
- Reinstatements
- Transfers in and out of the participating physician group (PPG)
- Contract changes
- Plan-type changes
The Activity Analysis Report is available monthly at the site level, but may be requested at the consolidated level.
PPGs may use the report to update their eligibility database, note new members, monitor retroactive cancellations, or identify members who should receive new member welcome letters.
Additional information on file layouts and formatting of the Activity Analysis Report is available as follows:
The Eligibility Report (BRM 42I and 42P) lists alphabetically all members eligible for at least one day in the reporting month. Participating physician groups (PPGs) must use this report to verify that a member is eligible to receive services for the dates of service.
PPGs may use the Eligibility Report in conjunction with the Remittance Detail Report to verify that they have received the correct capitation, and that the capitation includes members added retroactively. The summary portion of this report lists the number of members or contracts eligible with the PPG at least one day during the month and at month's end. The Eligibility Report is distributed monthly by site level, but may be requested at the consolidated or physician level.
The Eligibility Report reflects membership information as it appears in the computer on the date the report is run. If a newly added employer group is not included by the date the report is run or if an existing employer group has not reported all membership changes, the Eligibility Report does not reflect this information. Refer to the Eligibility Guarantee discussion under the Claims and Provider Reimbursement topic for additional information.
The Eligibility Report is generated at the end of the month for the following month.
Additional information on file layouts and formatting of the Eligibility Report is available as follows:
The Eligibility Summary by Group Report (BRM 13A and 13B) lists, by employer group, the number of members the participating physician group (PPG) has enrolled, and identifies each employer group's plan code and rerate month. The PPG may use this report to verify a group's open enrollment, plan code, benefits, or copayment amount.
The Eligibility Summary by Group Report is distributed to all PPG sites monthly.
Additional information on file layouts and formatting of the Eligibility Summary by Group Report is available as follows:
The Remittance Detail Report (BRM 12A) displays the capitation remittance for each member and is used to reconcile monthly capitation payments and review adjustments made to capitation. The amounts reported are the current month capitation amounts plus any retroactive or current adjustment amounts. The report lists all members.
The summary portion of the report helps participating physician groups (PPGs) maintain accrual-based accounting records. It specifies the total capitation paid for the reporting month in the Net Remittance field. The report also summarizes adjustments made to this amount by adjustment type and month.
The Remittance Detail Report is distributed monthly by site level but may be requested at the consolidated or physician level.
Additional information on file layouts and formatting of the Remittance Detail Report is available as follows: