Claims Review includes a set of high level reports that provide a balanced analysis of the major dimensions of a benefit program. Top level reports point to areas of the plan with the most financial impact and the drill down feature makes it easy to dig into more detailed claims activity. Aggregate all of the medical, prescription, dental and vision into one reporting engine.
Trend Analysis includes a set of high level reports that provide a breakdown of charges by specific categories over designated time periods. Evaluating trend information will aid in a proactive approach to controlling, predicting and containing future costs.
Risk Analysis enables TPAs to quickly and securely share medical and prescription health data information with excess risk insurers/MGUs for medical stop-loss underwriting. In addition to the disclosure listing and drill down capabilities, Risk Analysis includes active census and historical claims reports to ease stop loss submissions and filings.
Basic and multi-tiered/deductible are available to suit all plan styles. The plan modeler allows you to model medical, prescription, and dental benefits. Historical claims data is fed into the readjudication engine along with a modified plan design. The engine readjudicates each claim with the modified plan settings member-by-member, charge-by-charge. The resulting simulated claims data is then compared to the actual claims data and series of reports are provided for evaluating the overall impact of the plan design as well as member disruption.
Month End reports provide a detailed monthly and year to date summaries of enrollment, paid claim information by group, division and coverage type. These reports chart Network Utilization and Savings, provides a Lag and Adverse Claim report to provide estimates of unpaid claims and illustrate top claimants recent claim activity. This module features the ability to attach and share securely any internal reports or additional documentation.
Benchmarking establish a standard of excellence when providing analytics to reduce expenses and simultaneously improve product and service quality. Benchmarking module produces detailed reports for total quality management in which organizations can measure and compare its own claim activity against the Planwatch block of business and industry standards. Over fifteen viewing options available to drill down into for further investigation of detailed claim activity.
Cost drivers are characteristics of activities or events that cause an employer group to incur costs. By analyzing cost drivers one time parameter to another, one can better understand the correlation between utilization costs incurred and the activities that cause them. Furthermore, a cost driver provides the basis for cost allocation among various segments of healthcare services/diagnoses that directly benefit from the cost incurred.