Healthcare
payer reports:
Claims
Analyzed
processed claims and provided information on
·
Claims received per procedure code
·
Claims errors and manual processed claims - to reduce
administration cost
·
Claims per program - age group - area
Finance
Payment
towards Payees (providers and doctors)
Reports
on healthcare spendings by type of service
·
Hospital care
·
Physician services
·
Long term care
·
Prescription drug
·
Dental services
·
Other professional services
·
Mental health and other medical spending
Trends
on premium spending and cost drivers
·
To analyze premium towards a policy and spending on it - in a
benefit year
Healthcare
cost drivers - Includes
·
Admin, outpatient, inpatient, Rx, Other medical and physician
services
Marketing
·
Enrollees per area per plan
·
Age group calculation - to design the plans in upcoming years
·
Enrollment from different channels
HEDIS
·
Medicaid - HARP, SNP, HMO
·
QHP - EPO, PPO, HMO
·
Commercial - PPO, EPO, EP, HMO
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