4.2 Analysis Overview
The Analysis Overview report provides a breakdown of claims activity as well as information on which areas of the plan have the greatest amount of impact on the plan sponsor and member.
The Charge Breakdown is designed to simplify the task of explaining the distribution of responsibility between each of the various payer entities. The pie chart provides a visual colored depiction of how the total billed charges were adjudicated. The colored areas then correlate to the legend area showing actual dollar amounts.
- Total Charge: Original total amount billed by provider before any network or other claim payment consideration. More.
- Ineligible: The total amount of ineligible charges due to non eligible participation, invalid submission, duplicate claims, etc.
- Savings: The total amount of savings due to primary network discounts, out of network programs or negotiations (Secondary Network), coordination of benefits (COB), and reasonable and customary (R&C)
- Member Paid: Member's Responsibility for deductibles, copays, coinsurance and non-covered services. More.
- Plan Paid: Total amount paid by Plan Sponsor.
Impact Overview - Provides a high level financial overview of plan dimensions that have the greatest impact for the plan and member. The Plan Impact table takes the most costly items for the plan sponsor while the Member Impact table takes the most costly items for the member population as a whole.
The Impact Overview provides a recap into the remaining report sections by showing the most costly category or entity for each of the major areas of plan analysis. These Impact Overviews are further defined in the various Claims Review Report Sections.
Network Utilization* - Charts the breakdown of network and non-network charges to reveal how network contracts and other discount outlets are utilized by the covered population.
Benefit Analysis* - Charts the breakdown of charges and usage per customized benefit category.
Benefit/Network Analysis - Comparison of charges from in and out of network providers for each customized benefit category.
Paid Claims Distribution - Charts the number of members who incurred claims and the associated dollar costs.
Diagnosis Analysis* - Charts the distribution of cost across high level diagnostic categories.
Lifestyle Analysis* - Charts the cost distribution among custom lifestyle ICD categories.
Member Relationship Analysis* - Medical enrollment and expense analysis by member relationship and gender.
Enrollment Activity - Comparison of active members within a selected two year period charting enrollment activity by age band and gender.
Member Age Group Analysis - Medical enrollment and expense by member age and gender.
Member Age/Relationship Detail* - Medical enrollment and expense analysis by age, relationship and gender.
Top 30 Providers* - Details the costs associated with the thirty most heavily paid providers utilized by the member population.
Provider Cost Allocation - Detail report on charges from providers and facilities both in and out of network.
Facility Analysis* - Summary of charges originating from facilities utilized by member population.
Physician Analysis* - Summary of charges originating from Physicians utilized by member population.
**Indicates reports available with drill down capabilities for further claim investigation.*