9.6 November 2007

This release introduces a new top-level report designed to simplify the process of Stop-Loss/Reinsurance Disclosure and Reporting for TPAs. Also included in the release are numerous other enhancements and defect corrections.

Risk Analysis Reports

Planwatch's Risk Analysis Reports are designed to improve the accuracy and timeliness of disclosure and reporting of claims for self-funded employer health benefit programs. The reports facilitate the sharing of health data information between self-insured entities/TPAs and stop-loss insurers/MGUs for the purpose of medical stop-loss underwriting.

See the Risk Analysis Documentation for a thorough look at all features available.

Risk Analysis consists of the following reports:

Disclosure Listing: based on the SIIA endorsed standard Disclosure Form and diagnosis "hit list", the disclosure listing shows each member that matches one or more of the following criteria:
1. Members that have received medical services within the configured experience period, the cost of which exceeds a user configured disclosure amount (default: $50,000).
2. Members that have been diagnosed with or treated for any of the codes included in the SIIA endorsed list of ICD-9 codes for disclosure notification.
3. Members that have incurred Case Management related claims.
4. Members have have incurred Disability related claims.
Active Member Census: A standard list of active employees with age, gender, age / date of birth, enrollment, and geographic location information.
Age Banded Census: reports on the number of active members enrolled in Single, Single + Spouse, Single + Child, and Family plans by age band and gender.
Claims and Medical Active Lives by Month: reports on the number of members enrolled in Single, Family, and Dental plans along with the total amount paid by the plan in Medical, Dental, Vision, RX, and Fees each month over a three year period.

As with all Planwatch reports, Risk Analysis includes the following advanced features:

Secure: all reports are accessed over a secure (SSL) connection and can be configured to disallow access to personal health information (PHI).
Drill-down: the user may click on any member or diagnosis reported on the disclosure listing to get more detail on individual claims.
Excel Export: all reports can be exported to excel on a page-by-page basis or as a single Excel file with multiple worksheets.
Underwriter Access: TPAs may grant underwriters direct access to the online reports. Access can be controlled on a group or report type basis.

Other Enhancements and Defect Corrections

Added new user type: Underwriter. Underwriters have access only to Risk Analysis reports by default.
Date range input fields (e.g., Paid Date / Incurred Date) now accept MM/YY formatted input. When a MM/YY value is provided in the starting period field, it's assumed to be the first day of the month. When a MM/YY value is provided in the ending period field, it's assumed to be the last day of the month.
Most reports can now be sorted by any of the fields displayed. Simply click the column header to sort by the field.
A new report, Paid Claims Distribution, has been added to Claims Review. For more information on the report, see the Paid Claims Distribution documentation.
Fixed that report chart images would not update properly in some cases after editing a report's settings.