HealthComp's Utilization Management provides a comprehensive reporting package electronically. Clients choose the types of reports that they would like. We then tailor the reports based upon those needs. The reports, which are available with or without identifying patient information, are sent via e-mail with password protection. There is no additional cost for these reports, unless otherwise specified.
Case Management Detail Reports
This report, which is an invaluable tool for Stop Loss Carriers, Brokers, and Employer Groups, identifies all members in Case Management for each group, showing: diagnosis, prognosis, current treatment plan, status of case (open or closed), charges for case management, detail of claims paid for current reporting period, and anticipated claims costs during the calendar year. It also summarizes both hard and soft savings achieved from Case Management interventions each month. Savings are obtained through bed-days saved, rate negotiations with non-contracted providers, denied pre-certifications, and obtaining lower-cost alternatives to care.
Individual Case Management Reports
This report provides an individual case management summary for each member, including current medical history, health problems, nursing interventions, treatment plan, and prognosis.
Utilization Review Report
This monthly report summarizes all pre-certification requests for each group and is helpful in identifying potential large claimants or in showing utilization of services and healthcare trends. The report shows both approved and denied pre-certs for the month. It also summarizes hard savings achieved within the Utilization Review Department each month. Savings are obtained through bed-days saved, rate negotiations with non-contracted providers, denied pre-certifications, and obtaining lower-cost alternatives to care.
Price Negotiations Savings Report
This monthly report summarizes all claims that have been sent for price negotiations in the reporting period and any savings realized. The report shows claim number, billed amount, negotiated amount, percent of savings paid and a comments section.
Medical Post Claims Review Savings Report
This report summarizes all savings achieved through the medical claims review process. Savings are realized by the “unbundling” of procedure codes on claims submitted for payment, upcoding, and retrospective medical necessity review of services not requiring pre-certification. The report provides total savings for the month, broken down for each employer group.
Wellness Management & Pharmacy Management Reports (Additional Fee)
A monthly census report, summarizing members who have been identified for the Wellness Management Program, is provided to the client. These members are listed in specific categories, such as Cardiac, Diabetes, Asthma Management, or Prevention. Our Physician Risk Advisor also provides a quarterly analysis report detailing “return on investment” and risk management information to the client.