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Generate Utilization Report

Radhalekshmi SS
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The Utilization Report has been designed to assist practices in monitoring the frequency of diagnosis relative to peers or industry standards, such as the ratio of SRPs to Standard Prophy for hygienists. It is also used to help negotiate insurance contract fees. This report will show the highest volume of codes that require focus, including average fee and reimbursement rates.

The Utilization Report is based on the Date of Service and shows real-time data. It is available both in the Summary view and Detail view. The default selection is Summary View.

Competitor Reports

  • Procedures by Provider Report (Eaglesoft)

Use Cases

  • Evaluate the differences between your UCR fees and your Contracted fees.
  • Assists in negotiating fees for insurance contracts and determining average fee/reimbursement rates.

Let's get started!

  • Navigate to the System Menu > select Operational Reports under Insights.

  • Click the + icon on the left or the Generate Report button on the right for the chosen report.

Explore below to learn more about the desired views, filter criteria, and results.

The Summary View of the Utilization Report provides essential information and allows you to drill down into grouped data. You can drill through options based on the Group By filter order.

Let's dive deep into the filters:
No Filters Description
1 Date of Service*
Filter the report by procedure codes within the selected date range, up to 1 year. By default, the range is set to the current day.
2 Group By*

Choose to group the report results by Treatment Location, Provider, Treatment Provider Type, Code, Code Category, Service Type, and/or Primary Insurance Carrier. The results will be displayed in the order of selected variables.

Users can also group the report by Service Type as needed.

By default, Treatment Location and Date of Service are selected.
3 Treatment Location*

Filter the report by the location where the codes were completed. You can select up to 10 locations (on-screen generation limit).

By default, the location will be the user's default location.
4 Treatment Provider Type Choose whether to focus your report on treatment completed by the selected provider type(s).
5 Treatment Provider Choose whether to focus the report on treatment completed by the selected provider(s).
6 Primary Insurance Carrier Choose whether to focus the report on procedure codes billed out to the selected insurance carrier(s).
7 CDT Category Choose whether to focus the report only on the CDT Category.
8 Code Choose whether to focus the report only on the selected procedure code(s).
9 Exclude Migrated Production Choose whether to exclude the Migrated Production from the report.
10 Exclude Membership Discount Credits Choose whether to exclude the Membership Discount Credits from the report.

Once you have selected the desired filters, click on the Generate button to generate your on-screen report or Download Report As button to download your report.

Generation/Download Criteria

  • Due to the volume of data, reports with more than 10 Treatment Locations or a date range exceeding 6 Months will not be generated on-screen.
  • Reports meeting these criteria will be accessible in the Scheduled Downloads section.

Result - Summary View 

Now, let's take a look at the results of the Utilization Report (Summary View).

Let's explore the columns in the report :

  • Treatment Location: The location in which the procedure code was completed.
  • # Codes: The number of these procedure codes that have been completed within the selected time frame.
  • # Patients: The number of patients that have had this procedure code completed within the selected time frame.
  • UCR: The total UCR fees calculated from these procedure codes are based on the office's standard fees.
  • Patient Gross Production (DOS): The total patient responsibility according to the patient payable at the time of code completion.
  • Insurance Gross Production (DOS): The total insurance responsibility according to the insurance payable at the time of code completion.
  • Total Gross Production (DOS): The total expected receivable according to the patient and insurance payables at the time of code completion.
  • Production Adjustments: Total dollar amount of patient and insurance production adjustments.
  • Net Production (DOS): Final dollar value after reducing production adjustments from gross production (DOS).
  • Collection Adjustments: Total dollar amount of patient and insurance collection adjustments.
  • Membership Discount Credits: Available Membership Discount Credits.
  • Contractual Adjustment (DOS): The contractual adjustment, which is the difference between the office's standard fee and payable according to what the insurance carrier has agreed to pay.
  • Average Contractual Adjustment (DOS): It is the Contractual Adjustment divided by the # Codes.
  • Patient Applied Payment (DOS): The dollar amount the patients have paid toward the expected receivables.
  • Insurance Applied Payment (DOS): The dollar amount insurance carriers have paid toward the expected receivables.
  • Average Patient Applied Payment (DOS): The average dollar amount your patients have paid towards this procedure code, calculated by dividing the Total Patient Paid by the Number of Codes.
  • Average Insurance Applied Payment (DOS): The average dollar amount insurance carriers have paid towards this procedure code is calculated by dividing the Total Insurance Paid by the Number of Codes.
  • Applied Payments (DOS): The total dollar amount paid toward this procedure code's expected receivables, including both patient and insurance payments.
  • Date Of Service: The Date of Service of the completed code.
  • Treatment Provider: The treatment provider of the completed procedure code.
  • Treatment Provider Type: The type of treatment provider (dentist, hygienist or inhouse) associated with the procedure.
  • Primary Insurance Carrier: The carrier of the patient's insurance plan.
  • CDT Category: The number of procedures under the CDT category, that have been completed within the selected time frame.
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The Detail View of the report will display the expanded view of the report.

No Filters Description
1 Date of Service*

Filter the report by procedure codes within the selected date range, up to 1 year. By default, the range is set to the current day.
2 Group By*

Choose to group the report results by Treatment Location, Provider, Treatment Provider Type, Code, Code Category, or Primary Insurance Carrier. The results will be displayed in the order of selected variables.

Users can also group the report by Service Type as needed. 

By default, the Treatment Location will be selected.
3 Treatment Location*

Filter the report by the location where the codes were completed. You can select up to 10 locations (on-screen generation limit).

By default, the location will be the user's default location.
4 Treatment Provider Type Choose whether to focus your report on treatment completed by the selected provider type(s).
5 Treatment Provider

 		 Choose whether to focus the report on treatment completed by the selected provider(s).
6 Primary Insurance Carrier

 		 Choose whether to focus the report on procedure codes billed out to the selected insurance carrier(s).
7 CDT Category Choose whether to focus the report only on the CDT Category.
8 Code Choose whether to focus the report only on the selected procedure code(s).
9 Columns* Choose the columns required in the report.
By default, all the columns except Code-Description, Def. Provider Short Name, Def. Hygienist Short Name, Production Adjustment, Net Production (DOS), and Collection Adjustment will be selected.
10 Exclude Migrated Production Choose whether to exclude the Migrated Production from the report.
11 Exclude Membership Discount Credits Choose whether to exclude the Membership Discount Credits from the report.

Once you’ve selected the desired filters, select ' Generate Report' or 'Download Report As' based on your practice's requirements.

Generation/Download Criteria

  • Due to the volume of data, reports with more than 10 Treatment Locations or a date range exceeding 6 Months will not be generated on-screen.
  • Reports meeting these criteria will be accessible in the Scheduled Downloads section.

Result - Detail View 

Now, let us examine the results of the Utilization Report (Detail View).

  • D.O.S: The Date Of Service of the code.
  • Patient ID: The system-assigned number used to identify this patient and their records. Click this hyperlink to be taken to this patient's completed procedures.
  • Patient Name: The name of the patient that was seen for treatment.
  • Code: The procedure code that has been completed.
  • CDT Category: The CDT Category corresponding to the procedure code that has been completed.
  • Code-Description: The description of the code.
  • Primary Insurance Carrier: The carrier pertaining to the patient's primary insurance plan.
  • Tx Provider Type: The Treatment provider type associated with the procedure.
  • Tx Provider Short Name: The Short name of the Tx provider.
  • Tx Provider: The name of the associated provider.
  • Def Provider Short Name: The short name of the default provider of the patient.
  • Def Provider: The name of the default provider of the patient.
  • Def Hygienist Short Name: The short name of the default hygienist of the patient.
  • Def Hygienist: The name of the default hygienist of the patient.
  • Tx Location Short Name: The short name of the treatment location.
  • Tx Location: The treatment location.
  • UCR Fee: The total UCR fees calculated from these procedure codes are based on your office's standard fees (according to your practice settings).
  • Pat. Gross Production (DOS): The total patient responsibility according to the patient payable at the time of code completion.
  • Ins Gross Production (DOS): The total insurance responsibility according to the insurance payable at the time of code completion.
  • Total Gross Production (DOS): The total expected receivable according to the patient and insurance payables at the time of code completion.
  • Production Adjustment: Total dollar amount of patient and insurance production adjustments.
  • Net Production (DOS): Final dollar value after reducing production adjustments from gross production (DOS).
  • Collection Adjustment: Total dollar amount of patient and insurance collection adjustments.
  • Contractual Adj (DOS): It is the difference between the office's standard fee and payable according to what the insurance carrier has agreed to pay.
  • Membership Discount Credits: Available Membership Discount Credits.
  • Patient Applied Payment (DOS): The dollar amount the patients have paid toward the expected receivables.
  • Insurance Applied Payment (DOS): The dollar amount insurance carriers have paid toward the expected receivables.
  • Applied Payment (DOS): The total dollar amount paid toward this procedure code's expected receivables, including both patient and insurance payments.
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If users in your practice cannot use this report, please ensure that the relevant permissions are enabled.

To enable permissions for the Payment Log Report:

  • Navigate to the System Menu > select Practice Settings > Administration > Profiles.

  • Click Manage Permissions for the intended profile.

  • Select Insights.
  • Check Generate Utilization Report under Operational Reports to enable the permission.
  • Click Save.

Practices can use this comprehensive guide to efficiently generate reports, explore various use cases, and apply the necessary filter criteria to generate the desired report. Following this guide will help you create reports quickly, understand the different views available, and customize reports to meet specific needs.

Click here to explore the complete list of permissions and their descriptions. 

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