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.
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.
The Network Breakout shows the primary Preferred Provider Organizations (PPOs), other discount outlets and COB along with information on discount performance and usage.
- # 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.
- COB Savings: Reporting of other insurance coverage.
- Discount: The amount of savings through the PPO network and other out of network savings outlets. More.
- % Discount: The "discount rate" (percentage of total charge reduction through savings).
- Plan Paid: Total amount paid by Plan Sponsor.
- % 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.
- Non Discounted Claims: Claims that are non medical paid expenses (Rx, Fees, etc.), COB or dublicate charges.
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.