Friday June 23, 2006

Planwatch Launches Plan Modeler with Readjudication Engine

The Plan Modeler allows for the optimization of benefit plans with the complete re-adjudication of historical claim sets. Create various plan structure combinations in just a few clicks. Generate corresponding reports to view the financial impact of each plan dimension against the current plan. Show plan sponsors how and where changes to their plan will save them money.

Using the Plan Modeler, administrators are able to design hypothetical, or “what if,” benefit programs and completely readjudicate historical claim sets in order to better gauge the impact of specific modifications.

After a plan model’s claims are readjudicated, the simulated claims activity is analyzed and compared with historical claims activity to produce three reports:

  • Overall Comparison Analysis - provides a high level overview of change between the actual claims activity and modeled claims activity. This includes deductible, copay, coinsurance, ineligible charges, and plan contributions.

  • Benefit Comparison Analysis - shows the amount of change between actual and modeled plan broken down by benefit category.

  • Member Disruption Analysis - determine which members are likely to be impacted by the simulated changes and by how much.

Information gleaned from these reports can be used as evidence for (or against) proposed plan changes. The TPA or broker is able to present complex analytical findings using intuitive interactive reports. Plan sponsors can use reports to eliminate apprehension and ensure the new plan is utilized effectively.