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Benefit Modeling/Claims Replay Software

The financial impacts of plan changes, benefit code implementation, and utilization patterns are all brought together to provide a complete and comprehensive picture of your situation, allowing you and all stakeholders in the health plan to make the most informed decisions.

  • Forecasting future health benefit costs based upon historical utilization
  • Providing flexible, user defined source data selection criteria
  • Defining selection criteria including co-pay, coinsurance, and contribution changes
  • Allowing addition/removal of catastrophic cases
  • Modeling by employee population, diagnosis, and health inflation
  • Analyzing variation in health plan design and insurance coverage
  • Producing key output data by total cost, employer cost, and employee cost
  • Customizing plan model scenarios using specific group claim experience
  • Costs that might be prevented by changes in wellness behavior
  • Create "what if" models using a variety of considerations
  • Estimate future benefit costs utilzing actual claim information

Comprehensive Medical and Rx Reporting

Your analysis can include standard reporting that can be shared with your customers. For deeper utilization investigation, use ad-hoc functions to build custom reports which drill down to provider, diagnosis, procedure, and individual EOB levels.

  • Standard and ad-hoc analysis and reporting
  • Benchmark plan performance in national standards
  • Health plan utilization and cost analysis by provider, diagnosis, and member
  • Frequency and cost information associated with key health services
  • Health expenditures for specified time period, by company or department
  • Graphical summaries of expenditure, discounts, and cost sharing arrangements
  • Comparisons to benchmark data by industry, location, and size
  • Prescription drug utilization resulting from preventable medical conditions
  • Summary-level trend analysis by diagnosis groups and employee age groups
  • Graphical and data analysis tools for managing high claimant situtations
  • Ability to export data to spreadsheets or database files