4.4 Benefit Analysis
The Benefit Cost Analysis report charts the break down of charges, expense, and usage across each benefit category. These benefit categories have been customized to your internal designated charge types. Each category may include multiple "charge types" (sometimes referred to as "benefit codes"). The multiple charge types are rolled up into benefit categories to accommodate your internal payment schedule.
The Benefit Cost Analysis is designed to simplify the task of explaining the distribution of responsibility for each benefit category. The above chart provides a visual colored depiction on the breakdown of charges and usage per each customized benefit category and scaled for identification of utilization. The colored areas then correlate to the legend area by benefit category number, showing actual dollar amounts and percentages of utilization.
**Note that clicking on a specific benefit category drills down for further claim investigation. Please refer to the Drill Down section.
Chart illustrates the breakdown of charge responsibility by benefit category.
Green - Plan
Yellow - Member
Blue - Discount
Benefit category number along the bottom of the graph can be matched back to the number (#) column in the table.
- Category: Customized benefit categories.
- Total Charge: Original total amount billed by provider before any network or other claim payment consideration. More.
- Plan Paid: Total amount paid by Plan Sponsor.
- % Paid: The percentage of original billed charges paid by the plan sponsor. More.
- % Usage: The percentage of total dollars paid by the Plan sponsor. This is a measure of how much of total plan payment went to a specific item and is a useful indicator of how plan dollars are distributed between network and non network. More.
This report provides an understanding of how the covered population is using various types of benefits and can help determine the impact of modifying coverage.