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Monthly Operations Report

ACHIA

Operations Report

March 2019

Alaska Comprehensive Health Insurance Association

Levels of Service

April 2018 - March 2019

Levels of

Service

Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19

Enrollment Standards

1. 14-day Clean Application Process 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

2. 14-day ID Card Issuance 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

3. Accuracy 99% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Billing Standards

4. 14-day Paid-to Status Update 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

5. Accuracy 99% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Claims Standards

6. 30-day Clean Claim Process 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

7. Clerical Accuracy 97% 100% 100% 100% 100% 100% 100% 99.9% 100.0% 100% 100% 100% 100%

8. Financial Accuracy 98% 100% 100% 100% 100% 100% 100% 99.9% 99.9% 100% 100% 100% 100%

Customer Service Standards

9. 45 Sec. Speed of Answer* 45 sec avg 51 33 55 50 41 27 45 36 38 32 50 23

10. 5% Abandonment Rate* < 5% 0.9% 2.4% 3.2% 4.9% 4.2% 0.0% 0.9% 1.2% 1.3% 1.6% 2.0% 0.8%

* Reporting began January 1, 2007

Measurement of Standards

Standard 1 - If the date received compared to the date approved for all clean applications approved during the reporting month is less than 14-days.

Standard 2 - If the date received compared to the date mailed for all applications approved during the reporting month is less than 14-days from receipt of eligible application to

issuance of identification card.

Standard 3 - 99% or greater accuracy rate for enrollment coding of premium, plan and age rate categories for all approved applications during the reporting month.

Standard 4 - 100% scoring of (10) member audit of 14-calendar days or less from premium receipt to update of eligibility file paid-to-status

Standard 5 - 99% scoring of (10) member audit of accuracy for posting of correct payment, implementation of rate changes and premium account reconciliations during the

reporting month.

Standard 6 - 100% of clean claims processed within 30-calendar days during the reporting month.

Standard 7 - 97% or greater accuracy of a (20) claim audit for proper clerical coding of claims during the reporting month.

Standard 8 - 98% or greater accuracy of a (20) claim audit for proper clerical coding of claims during the reporting month.

Standard 9 - 45 second or less average speed of answer for all telephone inquiries received during the reporting month.

Standard10 - 5% or less call abandonment rate.

1


Number of Claims Received

April 2018 - March 2019(as compared to Previous Year)

0

100

200

300

400

500

600

700

800

Apr-17

Apr-18

May-17

May-18

Jun-17

Jun-18

Jul-17

Jul-18

Aug-17

Aug-18

Sep-17

Sep-18

Oct-17

Oct-18

Nov-17

Nov-18

Dec-17

Dec-18

Jan-18

Jan-19

Feb-18

Feb-19

Mar-18

Mar-19

2


Service Code Analysis*

For the Month of March 2019

Submitted PPO or Other Deductible Coinsurance Total Claim

Code Description Charge Discount Ineligible Amounts Amounts Paid Lines

ANCILLARY CHARGES 225,547.48$ 4,350.07$ 207,049.66$ 1,729.26$ 400.36$ 12,018.13$ 158

AMBULANCE 1,734.34$ 520.30$ -$ -$ -$ 1,214.04$ 2

PART B CO-INSURANCE 6,590,666.35$ 39.30$ 6,531,380.30$ -$ -$ 59,246.75$ 2

CHIROPRACTIC 1,570.00$ -$ -$ 432.18$ 227.56$ 910.26$ 869

DIAGNOSTIC TESTING 18,686.67$ 1,630.01$ 4,300.97$ 930.99$ 947.51$ 10,877.19$ 32

ER PHYSICIAN 1,050.00$ 21.00$ -$ -$ -$ 1,029.00$ 109

EQUIPMENT 969.74$ 67.60$ 260.86$ 32.88$ -$ 608.40$ 6

EMERGENCY ROOM 631.22$ 31.57$ -$ -$ 119.93$ 479.72$ 9

HOME HEALTH MISC. 3,000.00$ 780.00$ -$ -$ 444.00$ 1,776.00$ 7

INJECTIONS 752.00$ 43.76$ 457.97$ -$ 46.65$ 203.62$ 6

IMMUNIZATIONS 95.00$ 21.47$ -$ -$ -$ 73.53$ 3

MISC CHARGES 10,630.56$ 87.50$ 4,337.77$ 968.21$ 1,006.13$ 4,230.95$ 26

M/N OUTPATIENT 310.00$ 9.30$ -$ -$ 150.35$ 150.35$ 1

OFFICE VISIT 5,352.79$ 336.58$ 1,026.91$ 986.11$ 275.95$ 2,727.24$ 1

PRESCRIPTION DRUGS 75,349.48$ -$ -$ 3,110.84$ 7,143.90$ 65,070.77$ 1

SURGERY 6,353.08$ 45.25$ 5,163.81$ 61.74$ 15.14$ 1,067.14$ 3

UB ANESTHESIA 3,969.00$ 1,091.47$ -$ -$ -$ 2,877.53$ 320

UB DIAG TESTING 5,951.46$ 1,538.34$ -$ -$ -$ 4,413.12$ 19

UB PHYSICAL THERAPY 660.00$ 181.50$ -$ -$ -$ 478.50$ 78

UB SURGERY 19,845.00$ 5,457.38$ -$ -$ -$ 14,387.62$ 2

UB CANCER THERAPIES 3,517.81$ 967.40$ -$ -$ -$ 2,550.41$ 2

WELLNESS EXAM 216.00$ 10.80$ -$ -$ -$ 205.20$ 1

TOTALS 6,976,857.98$ 17,230.60$ 6,753,978.25$ 8,252.21$ 10,777.48$ 186,595.47$ 1,657

* Represents claims adjudicated in the month. May not tie to the financials depending on the timing of voids and adjustments.

3


Service Code Analysis Year to Date

January - March 2019

Submitted PPO or Other Deductible Coinsurance Total Claim

Code Description Charge Discount Ineligible Amounts Amounts Paid Lines

ANCILLARY CHARGES 1,032,999.34$ 45,448.53$ 740,188.07$ 3,345.87$ 1,466.75$ 242,550.12$ 185

AMBULANCE 2,768.34$ 520.30$ -$ -$ -$ 2,248.04$ 4

ANESTHESIA 2,702.00$ 187.50$ 1,380.48$ -$ -$ 1,134.02$ 2

PART B CO-INSURANCE 15,532,041.24$ 51.72$ 15,316,003.34$ -$ -$ 215,986.18$ 1,341

CHIROPRACTIC 4,863.00$ -$ 8.00$ 1,692.18$ 257.56$ 2,905.26$ 49

DIAGNOSTIC TESTING 68,158.91$ 6,370.52$ 19,174.10$ 1,273.67$ 4,113.42$ 37,227.20$ 149

ER PHYSICIAN 6,582.00$ 163.16$ -$ 1,346.38$ 552.47$ 4,519.99$ 7

EQUIPMENT 969.74$ 67.60$ 260.86$ 32.88$ -$ 608.40$ 6

EMERGENCY ROOM 11,315.42$ 1,462.11$ -$ -$ 1,278.73$ 8,574.58$ 12

HOME HEALTH MISC. 18,375.00$ 5,336.25$ -$ 1,731.30$ 1,156.14$ 10,151.31$ 9

INJECTIONS 6,228.10$ 908.53$ 457.97$ -$ 157.90$ 4,703.70$ 9

IMMUNIZATIONS 484.38$ 68.28$ -$ -$ -$ 416.10$ 5

MISC CHARGES 29,787.14$ 274.54$ 11,319.94$ 5,213.70$ 1,462.39$ 11,516.57$ 39

MAMMOGRAM 207.00$ 10.35$ -$ -$ 39.33$ 157.32$ 1

M/N OUTPATIENT 495.00$ 9.30$ 168.82$ 16.18$ 150.35$ 150.35$ 2

MULTIPLE SURGERY 1,900.00$ 1,045.00$ -$ -$ -$ 855.00$ 1

OFFICE VISIT 24,389.94$ 1,263.26$ 5,015.56$ 3,506.85$ 973.97$ 13,630.30$ 79

PHYSICAL THERAPY 470.03$ -$ 447.73$ 22.30$ -$ -$ 1

RX MEMBER REIMBURSE 1,245.02$ -$ -$ -$ 210.74$ 1,034.28$ 3

PRESCRIPTION DRUGS 197,422.82$ -$ -$ 38,654.00$ 18,304.26$ 140,418.05$ 493

SURGERY 33,831.95$ 3,078.75$ 14,881.34$ 4,227.91$ 828.54$ 10,815.41$ 25

UB ANESTHESIA 3,969.00$ 1,091.47$ -$ -$ -$ 2,877.53$ 1

UB DIAG TESTING 26,766.81$ 4,595.99$ -$ 520.72$ 2,184.54$ 19,465.56$ 93

UB SPEECH THERAPY 884.00$ 214.46$ -$ -$ 133.90$ 535.64$ 2

UB PHYSICAL THERAPY 660.00$ 181.50$ -$ -$ -$ 478.50$ 2

UB SURGERY 19,845.00$ 5,457.38$ -$ -$ -$ 14,387.62$ 2

UB CANCER THERAPIES 3,517.81$ 967.40$ -$ -$ -$ 2,550.41$ 2

UB PULMONARY REHAB 454.00$ 110.14$ -$ -$ 68.77$ 275.09$ 2

WELLNESS EXAM 576.00$ 10.80$ -$ -$ -$ 565.20$ 2

WELLNESS TESTING 465.00$ 20.26$ -$ -$ -$ 444.74$ 3

TOTALS 17,034,373.99$ 78,915.10$ 16,109,306.21$ 61,583.94$ 33,339.76$ 751,182.47$ 2,531

4


Top Provider Report For the Month of

March 2019

RANK DESCRIPTION

# OF

CLAIMS

SUBMITTED

CHARGES PAID BY PLAN

1 PROVIDENCE HEALTH & SERVICES WASHINGTON 30 $ 286,329.05 40,567.05$

2 DENALI DIALYSIS 17 $ 1,979,054.69 13,429.36$

3 LIBERTY DIALYSIS ALASKA 16 $ 2,533,473.92 12,676.68$

4 DIALYSIS ASSOCIATES OF ALASKA 39 $ 64,861.00 7,488.06$

5 IMAGING ASSOCIATES LLC 1 $ 5,772.08 5,483.48$

6 FRANKLIN E ELLENSON MD 9 $ 85,515.00 3,643.05$

7 FRESENIUS MEDICAL CARE SOUTHWEST 5 $ 369,612.30 3,127.13$

8 BOND PHARMACY INC 3 $ 6,940.00 2,371.20$

9 ALASKA RADIOLOGY ASSOCIATES 14 $ 3,670.00 2,025.05$

10 PROVIDENCE IMAGING CENTER 4 $ 8,755.00 1,952.06$

11 SOUTHEAST ALASKA REG HLTH CONS 1 $ 3,137.85 1,819.76$

12 RENAL CARE GROUP WASILLA LLC 2 $ 221,006.13 1,785.79$

13 ALASKA UROLOGY LLC 6 $ 18,200.75 1,733.56$

14 ALASKA HOSPITALIST GROUP LLC 22 $ 35,813.00 1,583.58$

15 GALEN HOSPITAL ALASKA INC 5 $ 2,133,368.65 1,452.31$

16 ST LUKES REGIONAL MEDICAL CTR 2 $ 24,820.90 1,386.69$

17 LIFEMED ALASKA LLC 1 $ 1,734.34 1,344.11$

18 FRESENIUS MED CARE SOLDOTNA 2 $ 115,605.17 1,249.26$

19 DENALI EMERGENCY MEDICAL ASSOC 3 $ 3,414.00 1,085.42$

20 KIDNEY AND HYPERTENSION CLINIC 42 $ 31,159.00 1,077.38$

21 LIBERTY DIALYSIS HAWAII LLC 2 $ 143,973.82 1,059.45$

22 ORTHOALASKA LLC 3 $ 30,643.00 992.98$

23 PAIRMORE & YOUNG SYNERGY CHIRO 13 $ 1,305.00 910.26$

24 RENAL CARE GROUP ALASKA INC 2 $ 207,289.28 897.00$

25 ANCHORAGE NEIGHBORHOOD HEALTH 5 $ 1,211.00 857.82$

26 EDWIN RHIM MD 1 $ 1,131.00 685.30$

27 FAIRBANKS MEMORIAL HOSPITAL 3 $ 1,536.82 560.40$

28 PROVIDENCE ANCHORAGE ANESTHESIA 5 $ 11,726.00 527.92$

29 PROVIDENCE CONTINUING CARE SERVICES 1 $ 8,111.24 511.50$

30 ANDRZEJ R MACIEWSKI MD 2 $ 624.74 499.94$

Top 30 Total 261 8,339,794.73$ 114,783.55$

5

RANK DESCRIPTION

# OF

CLAIMS

SUBMITTED

CHARGES PAID BY PLAN

1 RENAL CARE GROUP ALASKA INC 33 1,872,216.60$ 236,941.30$

2 PROVIDENCE HEALTH & SERVICES WASHINGTON 80 1,147,736.53$ 60,661.92$

3 ST ELIAS SPECIALTY HOSP 1 702,356.16$ 45,895.00$

4 LIBERTY DIALYSIS ALASKA 45 5,947,467.42$ 31,774.38$

5 DENALI DIALYSIS 38 3,667,571.19$ 20,810.12$

6 DIALYSIS ASSOCIATES OF ALASKA 102 166,375.00$ 17,618.28$

7 FAIRBANKS MEMORIAL HOSPITAL 24 84,486.88$ 14,238.08$

8 BOND PHARMACY INC 10 22,630.00$ 11,838.51$

9 IMAGING ASSOCIATES LLC 9 18,222.88$ 10,730.25$

10 RENAL CARE GROUP WASILLA LLC 15 1,272,653.07$ 10,007.38$

11 MEDICAL GROUP OF ALASKA 12 27,800.00$ 9,496.39$

12 FRANKLIN E ELLENSON MD 25 205,995.00$ 7,526.33$

13 ALASKA HEART INSTITUTE LLC 45 51,954.50$ 7,380.42$

14 ADL INC 4 8,900.00$ 6,269.94$

15 FRESENIUS MEDICAL CARE SOUTHWEST 17 1,292,234.02$ 6,190.58$

16 GALEN HOSPITAL ALASKA INC 12 2,346,477.32$ 6,112.01$

17 PROVIDENCE IMAGING CENTER 15 26,470.00$ 4,775.68$

18 GENEVA WOODS PHARMACY INC 1 5,142.58$ 4,564.05$

19 PROVIDENCE CONTINUING CARE SERVICES 2 76,565.46$ 4,364.00$

20 FRESNIUS MEDICAL CARE 7 683,646.49$ 3,999.61$

21 CLARIBEL TAN 7 3,606.00$ 3,576.00$

22 HAWAII LIFE FLIGHT LLC 3 126,848.40$ 3,446.64$

23 ALASKA RADIOLOGY ASSOCIATES 46 35,444.00$ 3,438.23$

24 ALASKA SURGERY CENTER A HEAL 1 7,742.66$ 3,352.31$

25 ALASKA HOSPITALIST GROUP LLC 54 70,404.00$ 3,301.10$

26 KIDNEY AND HYPERTENSION CLINIC 138 91,512.00$ 3,220.65$

27 EDWIN RHIM MD 11 8,417.30$ 3,215.61$

28 FRESENIUS MED CARE SOLDOTNA 8 467,930.16$ 3,198.18$

29 REHABILITATION MEDICINE ASSOCI 6 1,647.00$ 3,155.25$

30 ALASKA UROLOGY LLC 16 26,746.75$ 2,712.69$

Top 30 Total 787 20,467,199.37$ 553,810.89$

Alaska Comprehensive Health Insurance AssociationTop Providers Year to Date

January - March 2019

6


Average Cost Per Non Medicare Plan Claim Paid


$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

$5,000


$1,000 Deductible $1,500 Deductible $2,500 Deductible $5,000 Deductible $10,000 Deductible $15,000 Deductible $1,000 Std Deductible

7


Average Cost Per Medicare Plan Claim Paid


$0

$100

$200

$300

$400

$500

$600

$700

$800

$900


Carveout Med Supp A Med Supp I Med Supp F

8


PPO Savings Analysis


PPO Network Charge PPO Discount % of Discount

First Choice Health Network 5,346,292$ 898,294$ 16.8%

9

Month / Year Case Provider Total Billed Total Paid

Total

OOP

Date of

Service

Date

Received Date Paid Primary Diagnosis

April 2018 None

May 2018 None

June 2018 None

July 2018 None

August 2018 None

September 2018 None

October 2018 None

November 2018 None

December 2018 None

January 2019 None

February 2019 None

March 2019 None

12 Month Average

Amount Billed: $0.00

12 Month

Average

Amount Paid: $0.00

Alaska Comprehensive Health Insurance Association (ACHIA)High Dollar Paid Claims Report


Includes claims with paid amounts ≥ $100,000

10


Plan Age Distribution Summary

March 2019

Traditional Plan

Age Carveout Med Supp A Med Supp I Med Supp F Age $1,000 Age $1,000 $1,500 $2,500 $5,000 $10,000 $15,000

0-17 0 0 0 0 0-17 0 0-17 0 0 0 0 0 018-29 0 0 0 0 18-29 0 18-29 0 0 1 0 0 0

30-34 0 0 0 2 30-34 2 30-34 0 0 0 0 0 0

35-39 0 0 0 2 35-39 0 35-39 2 0 0 0 0 0

40-44 1 0 0 0 40-44 0 40-44 0 0 0 1 0 0

45-49 1 0 0 0 45-49 0 45-49 0 0 3 0 1 0

50-54 2 1 0 6 50-54 0 50-54 0 0 1 4 0 0

55-59 2 1 0 12 55-59 2 55-59 0 0 1 1 1 2

60-64 5 1 0 23 60-64 1 60-64 1 0 3 1 2 1

65-69 0 0 0 12 65-69 0 65-69 0 0 0 0 0 0

70-74 0 2 0 9 70-74 0 70-74 0 0 0 0 0 0

75-79 0 1 0 4 75-79 0 75-79 0 0 0 0 0 0

80-84 0 0 0 3 80-84 0 80-84 0 0 0 0 0 0

85+ 0 0 1 1 85+ 0 85+ 0 0 0 0 0 0

Total 11 6 1 74 Total 5 Total 3 0 9 7 4 3

123

.

;

TOTAL ENROLLMENT:

Medicare Plans PPO Plans

0

10

20

30

40

50

60

70

80

11 6

1

74

5

3 0

9 7 4 3

Carveout Med Supp A Med Supp I Med Supp F Traditional $1,000 Plan $1,500 Plan $2,500 Plan $5,000 Plan $10,000 Plan $15,000 Plan

11


Total Enrollment Activity


125133

135130 132

128 128126

128 129 130

123

0

50

100

150

200


12


Enrollment Activity by Plan - Non Medicare Plans


0

5

10

15

20

25

30


A $1000 Deductible B $1,500 Deductible C $2,500 Deductible D $5,000 Deductible

E $10,000 Deductible F $15,000 Deductible $1,000 Std Deductible

13


Enrollment Activity by Plan - Medicare Plans


0

10

20

30

40

50

60

70

80

90


Carveout Med Supp A Med Supp I Med Supp F

14

Alaska Comprehensive Health Insurance AssociationEnrollment Activity

March 2019

Month Start Adds

Pended

Adds* Terms

Retro

Terms** End Net Change

Apr-18 122 4 1 1 - 126 4

May-18 126 7 1 - 1 133 7

Jun-18 133 5 - 2 6 130 (3)

Jul-18 130 - - 1 1 128 (2)

Aug-18 128 5 - 1 2 130 2

Sep-18 130 - 1 2 1 128 (2)

Oct-18 128 1 - 1 1 127 (1)

Nov-18 127 2 1 3 2 125 (2)

Dec-18 125 3 - 1 1 126 1

Jan-19 126 3 - - 2 127 1

Feb-19 127 2 - - 5 124 (3)

Mar-19 124 1 - 2 - 123 (1)

563 80 656 387

Enrollment is reported by month of initial effective coverage.

* Pended Adds represent pended applications that were approved in the reporting month but have a prior effective date.

These enrollees are reported in the row representing initial effective coverage date.

**Retro Terms represent terminations that were processed in the reporting month but have a prior termination date.

These terminations are reported in the row representing the actual month of the termination.

Count Percent Mar-19

Pended

Adds*

132 21% - -

130 20% - -

297 46% 1 -

83 13% - -

642 100% 1 -

Count Percent Mar-19

Retro

Terms**

7 1% - -

18 2% - -

42 4% - -

2 0% - -

146 14% 1 -

47 5% - -

92 9% - -

336 32% 1 6

345 33% - -

1,035 100% 2 6

Too costly

Deceased

Totals since June 2011

Qualifying Event Reasons (data from 6/1/11 - 3/31/19)No other health insurance - HIPAA eligible

Rejection of other health coverage due to pre-existing condition

Pre-qualified health conditions on the list

Medicare / Medicaid

Moved out of state

Unknown - Letter sent to request reason for termination

Non-payment

Obtained other coverage

Total

Lifetime Max

Reinstated

Total

Termination Reasons (data from 6/1/11 - 3/31/19)Free look period

15


Plan Age Distribution - NEW ENROLLMENT

March 2019

Traditional Plan

Age Carveout Med Supp A Med Supp I Med Supp F Age $1,000 Age $1,000 $1,500 $2,500 $5,000 $10,000 $15,000

0-17 0-17 0-1718-29 18-29 18-29

30-34 30-34 30-34

35-39 35-39 35-39

40-44 1 40-44 40-44

45-49 45-49 45-49

50-54 50-54 50-54

55-59 55-59 55-59

60-64 60-64 60-64

65-69 65-69 65-69

70-74 70-74 70-74

75-79 75-79 75-79

80-84 80-84 80-84

85+ 85+ 85+

Total 1 0 0 0 Total 0 Total 0 0 0 0 0 0

1

(Not included in New Enrollment count)

Medicare Plans PPO Plans

TOTAL NEW ENROLLMENT:

REINSTATEMENTS: 0

16

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