Patient Care Summary Displays

This help page illustrates the top of the Member Tab display of the Health Eligibility response and the first page of the Patient Care Summary report. For more extensive information about Health Eligibility responses, please see the Help pages for Health Eligibility Display.

Access the Patient Care Summary via Health Eligibility - Member Tab Display

The Health Eligibility Member Tab Display appears after entering successful search criteria for a BCBSNC member. A blue button that opens the member's Patient Care Summary Report displays at the top of the Health Eligibility response. Click on this button to open a copy of the Patient Care Summary in a PDF format (see image below).

Patient Care Summary button

Health Eligiblity Response - Patient Care Summary Button

Patient Care Summary Overview

The Patient Care Summary is a report of the patient's medical and prescriptive care treatments. Both the Prescriptions section and the Medical Care sections on the first page contain the most recent 10 instances of care or prescriptions on record. Subsequent instances, if there are any, will appear after page 1. Overall, the report captures the last 36 months of medical care and the last 12 months of prescriptions, based on claims data.

The second and subsequent pages of the report contains the last 36 months of medical care on record, including the procedure and diagnosis codes. The last page/s of the report contain descriptions of the procedure and diagnosis codes contained in the report. For more details and illustration of these subsequent pages, run the Patient Care Summary (PCS) simulation, available on the Blue e Home Page: "How Do I..." section.

Note: In accordance with Federal Substance Abuse Regulations, all claims related to substance abuse treatment are suppressed. Claims for elective abortions are also suppressed from the report.

See the table of elements below for details about each section of the report.

Patient Care Summary Report Display Page

Patient Care Summary Report Display Page

The Patient Care Summary Reports Display page contains the following elements:

Demographic Information Section Contains basic demographics of the patient: name, date of birth, gender, and subscriber ID.
Potential Gaps in Evidence Based Care The Potential Gaps section includes all open care alerts for which we have claims data.

  • The Condition column describes the chronic condition the potential gap is related or if the gap is for prevention.

  • The Potential Gap describes the evidence-based measure for which the member may have a gap in care.

  • The Months Overdue is the number of months the gap in care has remained open after it was first identified.

    • If there are no open care alerts for the member, then the following message is displayed under the heading: "Based on all available BCBSNC claims information we have not identified any open gaps in evidence based care for the conditions included in our program."

    Prescriptions The prescriptions section of the summary only displays the most recent 10 unique medication fill claims over the past 12 months.

  • If a provider would like to view a listing of all medications filled over the last 12 months, they may proceed to page 2 (detail section) of the report.
  • A complete RX history for the past 12 months will be displayed on the detail page of the report, which starts on page 2 and includes all fills, even if they are for the same medication and dose.
  • The Prescriptions section of the summary is sorted by date of most recent fill in descending order - that is, the most recent fill would be at the top of the list.

  • If the Prescriber column contains "N/A" (not available), the prescriber's name was not on the claim.

  • The Dose column describes the dosage of the prescription that was filled. If the dosage was not in the claim, the column will contain "N/A".

  • The Days Supply (#) column is populated with the days supply filled amount for the prescription, as well as a count.

  • This section excludes all medications that are used for substance abuse treatment in accordance with the Federal Substance Abuse Act.

    • Note: If a member's plan does not include pharmacy benefits through BCBSNC, or if a member has not filled any prescription in the past 12 months, the following message is displayed under the heading: "BCBSNC has no pharmacy claims for this member over the past 12 months.
    Medical Care The most recent medical care section of the Patient Care Summary Report (page 1) only displays the 10 most recent medical claims over the past 36 months. A complete medical care history of up to 36 months is provided on the detail pages of the report which begin on page 2.

  • The Medical Care section of the summary is sorted by date of visit in descending order. That is, the most recent date should be the first visit on the list.

  • The first and last name of the provider is displayed when available. If the provider (physician) name is not known, and the claim is associated with a practice, then the word "PRACTICE" displays.

  • The Primary, Secondary, and Tertiary diagnosis codes are displayed in that order.

  • The detail pages of the PCS include all medical claims (including claims for pathology, lab, DME, radiology, and anesthesiology) that were suppressed on the summary page. Claims related to substance abuse and abortions are suppressed on both the summary and detail section of the PCS.


    • The medical care section of the PCS summary page excludes the following:

  • Codes related to substance abuse in accordance with the Federal Substance Abuse Act
  • Codes related to elective abortion for sensitivity reasons
  • Claims for Pathology, lab, DME, Radiology, and Anesthesiology (These claims will appear on the detail pages of the report.)


    • Note: If BCBSNC has not received any medical claims over the past 36 months, the following message appears under the heading "BCBSNC has no medical claims for this member in the past 36 months."

    Provider Alerts (Optional Display) This section provides important information that your patient can take action upon. Information included in this section may not have been available to you, as a provider, in the past. You may feel this information is important to discuss with your patient as it provides additional resources available to them or opportunities for cost savings.

    Patient Care Summary Report - Print or Save Options

    The Patient Care Summary Report is a PDF (Portable Document Format) file that can be printed or saved using the appropriate icons at the top of the page or commands from the menu bar. To print the report, click on the printer icon at the top of the page, or select "File > Print". To save the report, click on the save icon at the top of the page, or select "File > Save As", and identify a location on your computer to save the report.