Member Program Eligibility Report – Help with this Report

Document Scope

The Member Program Eligibility Report shows which members were eligible for each program during the selected reporting year and the TIP activity associated with that eligibility. It includes available filters, a distinct member count, eligibility counts by program, eligibility dates, TIP status counts, and member-level detail for export.

Document Purpose

This guide explains how to use the Member Program Eligibility Report’s filters, key performance indicator, chart, and data table to review program eligibility and associated TIP activity. It helps users interpret current, ended, and interrupted eligibility; distinguish member counts from TIP activity counts; reconcile TIP totals with component status counts; and export filtered data while observing Patient ID restrictions and applicable data-handling requirements.

Available Filters

Filter	Type	How to use it
Calendar Year	Year	Select the current or prior year. The year is driven by Program Eligibility End Date.
Program Name - ID	Multi-select	Select one or more programs.
Client Name - ID	Multi-select	Select a client.
Policy Name - ID	Multi-select	Select one or more policies.
Member ID	Search	Find a specific member.
Patient ID	Search	Internal-only search using the Outcomes Patient ID.

Outcomes Recommendation

Start with Calendar Year and Program. Add Client and Policy when the same program spans multiple payer populations.

Total Unique Members

This KPI displays the distinct member count for the active filters. Each member is counted once in the filtered population even when the detail contains multiple eligibility or program records.

Outcomes Recommendation

Use this KPI as the population baseline before interpreting TIP totals. TIP counts represent activities, not additional members.

Eligibility by Program

This horizontal stacked bar chart shows currently eligible and no longer eligible member counts by program. Each bar includes the two stack counts and the program total.

Outcomes Recommendation

Use the chart to compare active program reach with eligibility attrition. Then use the detail extract to identify the members and eligibility dates behind each segment.

Understanding Eligibility Dates

Field	Interpretation
Earliest Program Eligibility Start Date	First date the member became eligible for the program in the reporting year.
Current Program Eligibility Start Date	Most recent date the member became eligible for the program in the reporting year.
Program Eligibility End Date	Date the member’s eligibility ended in the reporting year. A blank value indicates current eligibility for chart purposes.

Outcomes Recommendation

When Earliest and Current start dates differ, review the record as an interrupted eligibility period rather than a duplicate member.

Understanding TIP Counts

Measure	Definition
Total TIP Count	Sum of the component TIP status counts for the program and reporting year.
Completed TIPs	Count of completed TIPs.
Unsuccessful TIPs	Count of unsuccessful TIPs.
Available TIPs	Count of currently available TIPs.
Unfinished / Review Resubmit TIPs	Combined count of unfinished and review/resubmit TIPs.
Withdrawn / Rejected TIPs	Combined count of withdrawn and rejected TIPs.

Outcomes Recommendation

Validate that Total TIP Count equals the five component status measures before using the extract for reconciliation or downstream reporting.

Data Table Breakdown

Section	Fields
Payer and program	Client ID, Client Name, Policy ID, Policy Name, Program ID, Program
Eligibility	Earliest Start, Current Start, End Date
Coverage	CMS Contract, PBP, Carrier, Account, Group
Member	Member ID, Patient ID for internal users, First Name, Last Name, DOB
Opt out	Opt Out and Opt Out Reason from the Member List logic
TIP activity	Total and component status counts

Exporting Report Data

Apply Calendar Year and program filters before exporting.
Confirm whether ended eligibility records are intended to be included.
Exclude the internal Patient ID from external distributions.
Handle member-level information according to Outcomes and client data-handling requirements.

Interpretation Notes

Topic	Guidance
Current eligibility	No Program Eligibility End Date in the reporting year.
No longer eligible	Program Eligibility End Date is populated in the reporting year.
Interrupted eligibility	Earliest and Current start dates differ after an eligibility gap.
Duplicate program filter	The requirements list Program Name - ID twice; implementation should confirm whether this is accidental.
Opt out	Uses opt-out details from the Member List Report.
Patient ID	Outcomes internal only.