OverviewTopPackage
Dimensional Warehouse Model Data Model

Package Claims

DescriptionTo analyze the adjudicatio and processing of claims in order to understand the numbers, amounts and types of claims received and paid and the impact of plan design and provider arrangements on claims. By understanding trends and variations in claims by sponsor, geography, processing unit, and other aspects, the health plan can better predict expected claim payments and identify potential process, technology and organizational improvements such as training for claims examiners, provider administrative staff, or product design modifications to better manage costs. The analysis also includes coordination of benefits and claim recovery to ensure that primary, secondary or tertiary liability is correctly assigned, and that the Health Plan is paying only what it is liable for.


Diagrams
BST - Claim Adjudication AnalysisBST - Claim Adjudication Analysis
BST - Claim Recovery AnalysisBST - Claim Recovery Analysis
BST - Claims Processing AnalysisBST - Claims Processing Analysis
BST - Compound Drug Claim AnalysisBST - Compound Drug Claim Analysis
BST - Coordination Of Benefits AnalysisBST - Coordination Of Benefits Analysis

Entities
Claim Adjudication AnalysisClaim Adjudication Analysis
Claim Recovery AnalysisClaim Recovery Analysis
Claims Processing AnalysisClaims Processing Analysis
Compound Drug Claim AnalysisCompound Drug Claim Analysis
Coordination Of Benefits AnalysisCoordination Of Benefits Analysis
OverviewTopPackage
Dimensional Warehouse Model Data Model