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Network Analysis with Disruption Reporting

Posted by Susan Donegan on Fri, May 19, 2017

Network_Analysis_Pyramid_Cover.pngThis method of network analysis correlates historical provider utilization and claims experience for a group of employees to the providers in a different network. If you assume that a population will utilize the same set of providers at the same frequency, you can estimate the amount of future utilization that will be in-network. Disruption Reporting is also used as a predictor of future financial experience, with more in-network claims (at a discount) resulting in lower overall claims expenses.

The utilization or claim file required for this method of analysis must include demographic data for each utilized provider, to determine if that provider is in the prospective network. Ideally it would also include quantitative statistics on how much treatment each provider performed, such as:

  • Submitted claims (number and/or amount)
  • Paid claims (number and/or amount)
  • Number of procedures performed
  • Number of patients treated

This type of utilization or claim file is generally only available when the company requesting it has at least 200 employees enrolled in that benefit plan.

Considerations

There is tremendous variation in the format and quality of the utilization and/or claim data files that are included with requests for disruption reports. Unfortunately, it is very common for key provider identifiers to be omitted:  

  • Tax Identification Number (TIN)
  •  National Provider Identifier (NPI)  
  • State license numbers 

In addition to the variation in the utilization and claim data files, there is a tremendous amount of variation in the matching criteria used when these reports are produced. When some networks use looser criteria than others, employers and employees don’t get a clear picture of network access.

Download our whitepaper, The Network Analysis Pyramid for an overview of the most widely used methods to analyze provider networks.

Tags: disruption reporting, data analysis, provider networks, claims data, repricing analysis, discounted fees, network analysis

The Role of Repricing Analysis

Posted by Susan Donegan on Thu, May 11, 2017

Network_Analysis_Pyramid_Cover.pngRepricing Analysis is the least frequently available network analysis method by a wide margin, but when it is available, it is a very good predictor of future financial experience. Repricing Analysis begins with Disruption Reporting, but goes a step further. Once an in-network provider that matches a record in the claim file is identified, the discounted fee arrangement under which that provider is contracted is applied. For out-of-network providers, the reasonable and customary (R&C) charges for the area are applied. Reports from different networks are compared based on the overall cost of the claims for all providers (in-network and out-of-network) and the amount of savings each network would achieve.

Considerations

Because Repricing Analysis is an extension of Disruption Reporting, all of the considerations that affect Disruption Reporting affect Repricing Analysis in the same way.

In addition, Repricing Analysis requires an extremely detailed claim file. In order to apply the discounted fees, the file must include a record for each procedure performed by each provider.

Are you using repricing analysis to help win new business and save retention threats? 

Download our whitepaper, The Network Analysis Pyramid for an overview of the most widely used methods to analyze provider networks.

Tags: disruption reporting, data analysis, provider networks, repricing analysis, discounted fees

 

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