The Recent Claims Summary section in a member’s profile provides real-time visibility into service utilization. This feature is essential for tracking billable units to ensure your team stays within the approved limits for specific programs like Community Health Worker (CHW), Enhanced Care Management (ECM), or Community Supports (CS).

How to locate remaining units

To view a member's current status: Navigate to the Member Dashboard. Scroll down to the Recent Claims Summary section. Locate the Units Left column. This column automatically calculates the difference between the member's assigned billing cap and the claims already submitted or edited. As your team documents new activities, this number updates in real time to reflect the most current data.

Tracking program-specific limits

Monitoring the "Units Left" column helps prevent overbilling and ensures compliance with program-specific constraints: CHW Programs: Typically limited to 12 units per year. You can see at a glance if a member is approaching their annual cap. ECM/CS Programs: Units may vary based on encounter frequency (e.g., 5 monthly visits) or variable claim amounts. The summary helps you adjust outreach based on what is still billable for that period.

Using filters for utilization trends

You can further refine your view using the time-based filters at the top of the Recent Claims section. Toggle between Week, Month, or Year to: Identify patterns in service delivery. Spot members who are under-utilizing available services. Flag members who may need an adjusted care plan because they are exhausting units too quickly.