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SQL: Average Well Visit Payment by Ins Carrier (Without Vaccines)

About

This report lists the average payment for well visit by insurance carrier based on the date range you specify.

A sample image of this SQL report run in the Database Viewer is shown below:

Caveats

  • Insurance carrier is the PRIMARY insurance
  • "Well visit" is every CPT code that occurred for the same patient/DOS when a well code (9939x, 9938x) was used except for the vaccine and vaccine administration.
  • The date range you specify are DATES OF SERVICE, not payment dates.  
  • Enter dates old enough for the date range. If you pick recent dates of service (like yesterday), those claims won't be paid yet. Therefore, you would receive a bunch of zero payments averaged into the result.  
  • Payments include both the insurance side and patient side for ALL CPT codes (except the vaccines) associated with that visit.

Code

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select count(patno) as patients, ins_carrier_code, round(avg(paid),2) as avg_paid from
(

select patno, date1, ins_carrier_code, sum(total_pmt) as paid from
(

select b.patno, b.date1, b.cptcode, b.trnsxno, ins_carrier_code,  p+c as total_pmt from
(
select a.patno, a.date1, at2.cptcode, at2.trnsxno, ins_carrier_code from
(
select patno, date1, cptcode, ins_carrier_code from archive_transactions where cptcode in ('99391','99392','99393','99394','99395','99381','99382','99383','99384','99385') and date1 between :start_date and :end_date and archive_flag = 1
)
a left outer join
(select patno, date1, cptcode, trnsxno from archive_transactions where date1 between :start_date and :end_date and archive_flag = 1
and cptcode not in ('90460','90461','90471','90472','90473','90474')
and cptcode not between '90600' and '90799'
and cptcode not in ('1','2','3','4')
) at2 on a.patno = at2.patno and a.date1= at2.date1
)
b left outer join
(select txnopaid, sum(payment) as p, sum(copayrecd) as c from archive_transactions where date1 >= :start_date and txnopaid >0 group by txnopaid) at3 on at3.txnopaid = b.trnsxno
) group by patno, date1, ins_carrier_code
) group by ins_carrier_code