Sum all claim charges based on its procedures and payments

[andreduarte]

After solving my calculation issues on a line level ( Issues with my dataset mapping or my sumover logic - need guidance - #2 by Xclipse ) I’m still struggling to sum these values up to generate month over month charts.

Looking at the data below, procedure charges is repeting 8 times as I have 2 payments from 2 payers + 2 adjustments on my claims.

After using the solution proposed above, I was able to calculate total charges and payments by using calculated fields:

Total Payments per Claim = sumOver(paymentamount, [{claim_id[Payments]}], PRE_AGG) / distinctCountOver({payment_id}, [{claim_id[Payments]}], PRE_AGG)

Total Charges per Claim = sumOver(procedurecharges, [id], PRE_AGG) / countOver(id, [id], PRE_AGG)

The issue now is: how do I calculate the sum of charges and payments for a group of claims/month? How about for all claims?

A simple sum of Total Charges per Claim will result in $1040 whereas it should be $130.

Thanks in advance.

[WLS-Luis]

Hi @andreduarte,

If possible, could you send an Arena view of your analysis (without any sensitive info)? That could help me to better try tweaking calculated fields and potentially finding an immediate solution for your use case.

Thank you!

[andreduarte]

Hi @WLS-Luis , hope this one helps.

See, on Claim Charges Sum ($), I’d like to see $3496 which is the sum of all charges of all procedures under the claims I filtered.

On Claim payments, I’d like to see $337.88.

This is not the visual I’m using but consolidates what I need.

I do have a breakdown of payments per payer, month, procedure and I need the granular data to be able to show it in different views.

[WLS-Luis]

Hi @andreduarte,

Thanks for providing a little more info of what fields you want to display. I think I understand your use case a little better, but just to make sure, you are trying to find out how to bring the claim charges sum and claim payments into the visual from your other post, correct?

Also, to make an Arena view so I can interact with a copy of your analysis, please feel free to check out this link as it explains the process of how to do so.

Thank you!

[Xclipse]

Hi @andreduarte

It’s been a while since we last heard from you. If you have any further questions, please let us know how we can assist you.

If we don’t hear back within the next 3 business days, we’ll proceed with close/archive this topic.

Thank you!

[Xclipse]

Hi @andreduarte

Since we have not heard back from you, I’ll go ahead and close/archive this topic. However, if you have any additional questions, feel free to create a new topic in the community and link this discussion for relevant information.

Thank you!