This presentation will explore the various factors impacting claims trends, including utilization rates, unit costs, provider billing issues, claim payment mishaps, and inaccuracies in loading member benefits and provider rates. A key strategy to address these issues is the implementation of a robust payment integrity process. By combining the efforts of internal staff and expert vendors, payment integrity processes can significantly influence claims trends, thereby enhancing the overall profitability of health plans.
We will delve into specific examples to assess whether payment integrity efforts have successfully bent the claims trends or maintained them at a steady level. Additionally, the presentation will cover effective communication strategies with actuaries to ensure accurate data analysis and reporting. This dialogue is crucial for aligning strategic objectives and operational tactics with the actuarial insights necessary for informed decision-making in health plan management.
- Understanding of how to assess changes in claim trends
- How to effectively communicate with actuary teams to ensure accurate data analysis and reporting
