4.13 Top 30 Providers
The Top 30 Providers report lists the thirty most heavily utilized providers based on the total amount of sponsor dollars paid.
The bottom of the table includes a detailed summarization for the providers displayed. Additional provider information can be retrieved by clicking on "Show More".
**Note that clicking on a provider name drills down for further claim investigation. Please refer to the Drill Down section.
- # Claims: Total number of claims for each represented network and savings outlet used to monitor volume activity.
- 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.
Headers (Name, # Claims, Total Charge, Plan Paid, % Paid and % Usage) can be manipulated by clicking on the desired report header to create additional reporting outcomes.
To run a provider disruption report to evaluate/shop network performance or discounts, download to excel format by clicking on excel icon on the top of the screen.
The Provider report provides useful information when (re)negotiating network discounts.
Drill down provides top providers that fall outside a network. This will enable the provider to be identified for contract negotiations.
TPA can review report to see if an EPO type plan or smaller network, would work for employee population. Plans could be set up to select one hospital system over another.