Monday October 29, 2007
Planwatch gains a major addition today with Risk Analysis - fast, accurate disclosure and reporting for partially funded health plans and their stop loss carriers / MGUs.
Nearly all stop loss carriers now require an employer disclosure before
offering a new or renewal quote. Don’t let the growing demand for more
detailed and timely disclosure information put a strain on staff - meet new
disclosure challenges head-on. An efficient disclosure process means better
quotes and creates choice for the sponsor, while an unorganized process can
result in higher premiums and can potentially lead to future claim denials.
The Disclosure Listing has great depth and accuracy, is beautifully presented, and can be run in as little as one minute. Included in the list are all known participants who have exceeded a customizable dollar threshold, received certain diagnoses, are known high-risk / complex care cases, have incurred disability related claims or who are currently involved with case management … all in a detailed yet intuitive format:
The Disclosure List is based heavily on the SIIA and SPBA endorsed standard stop-loss disclosure form and ICD codes set. A 2006 Ernie Clevenger / MyHealthGuide Newletter article reported that 70% of the self-funding stop-loss market (representing over $2.3 billion in stop-loss premium) had adopted the standard form. In 2005, SIIA conducted a survey of 112 members of the self-funded community that resulted in 86% favoring adoption of the standard.
You’re In Control With Drill Down
Striking a balance between providing too much and not enough information is key to an effective disclosure process. That’s why we included advanced Drill Down capabilities in the design from day one. Click on any participant or trigger and receive detailed claims activity:
Without enough information, the underwriter is forced to assume the worst about the group’s potential future experience, leading to higher attachment points and premiums. With too much information, the underwriter is overwhelmed with irrelevant data, making it impossible to establish the most important contributions to the overall experience. Drill Down provides the best of both worlds and the worst of neither: a relevant and timely disclosure list and the ability to selectively control additional detail.
Plays Well With Others
Give underwriters, actuaries, and even nursing staff secure access over the web with a variety of collaboration controls, like limiting a user’s access to specific groups, or configuring Create and View vs View Only access to certain types of reports.
And That’s Only The Beginning
Of course, every aspect of Risk Analysis supports exporting to Excel so you can still pass files around in email or print a hard-copy when required. You can even export a multiple-worksheet version that includes each of the Risk Analysis reports in a single file for easy offline analysis.
In additional to the Disclosure Listing and Drill Down capabilities, Risk Analysis also includes other reports commonly requested by underwriters and MGUs:
Active Member Census: Provides detail on each currently active participant, including the member’s date of birth, age, gender, enrollment date and geographic location.
Age Banded Census: Shows the number of participants by age band and gender that are active in each of the following types of plans: Single, Single and Spouse, Single and Other, and Family.
Historical Claims and Active Lives Report: An account of the number of participants enrolled in Single, Family and Dental plans along with the total amount paid in Medical, Dental, Vision, and Rx coverage each month over a three-year period.
For more information on Planwatch Risk Analysis or the standardized disclosure form, please consult the following resources:
Planwatch Risk Analysis Help and Documentation - includes screenshots and detailed descriptions of various data items.
Standard Stop-Loss Disclosure Form (Ernest Clevenger et al.) - general information and resources related to the disclosure form and ICD-9 codes set, including downloadable PDF and Word templates.
SIIA Endorses Standardized Stop-Loss Disclosure Form and Codes - The Self-Insurance Institute of America endorses the proposed standardized stop-loss disclosure form and ICD-9 codes set.
Society of Professional Benefit Administrators (SPBA) - downloadable copies of the form and codes set along with other great information.
Planwatch Risk Analysis is immediately available for all new and existing customers.