7.3 Network Analysis

The Network Utilization Analysis is used to determine how network contracts (and other discount outlets) are being utilized by the covered population, how payment is distributed between plan and member, as well as the real discount rate being achieved.

Claims-review-network-analysis

The graphs above provide the number of claims to show the basis on how total billed charges are distributed between plan sponsor (green), member (yellow), and savings for both in and out of network charges (blue) providing totals. Please note that "Other" consists of Ineligible and COB charges.

Claims-review-network-breakout

The Network Breakout shows the primary Preferred Provider Organizations (PPOs), other discount outlets and COB along with information on discount performance and usage.

Helpful Hints:

This report helps in the identification of network utilization. It provides a performance check to ensure that the network is viable and that further benefit steerage is not required.

Identifies all the out of network programs implemented to show all avenues of claims savings exhausted.