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Res 1999-134
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Res 1999-134
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8/23/2006 9:04:27 AM
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8/23/2006 9:03:42 AM
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City Clerk
City Clerk - Document
Resolutions
City Clerk - Type
Contract
Number
1999-134
Date
6/28/1999
Volume Book
137
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<br />2. Savings reports on COB, subrogation, duplicate charges, deductibles, <br />coinsurance, or eligibility. <br /> <br />3. Utilization reports showing total number of hospital days and the average <br />duration of stay by diagnosis and by hospital. Provider <br />information such as inpatient versus outpatient services, surgical <br />procedures, accidents and PPO usage by number of patients and <br />dollars incurred versus charged by facility. <br /> <br />4. Turnaround report. <br /> <br />5. Provider comparisons such as hospital, doctors, drugs, and diagnosis. <br />(Top providers, top diagnosis codes, network discount reports. <br /> <br />6. Physician data including diagnosis/cause coding. <br /> <br />7. Claim lag study/analysis. <br /> <br />8. PPO utilization report detailing use, savings, and provider name. <br /> <br />9. Specific claims - (all cumulative claims exceeding 50% oflSL). <br /> <br />10. Actual fixed costs and claims costs by employee, spouse, and child. <br /> <br />11. Top 10 providers and payments made to each provider. <br /> <br />(d) Annual; <br /> <br />1. A claims report showing the number of claims by dollar breakout such <br />as $500, $1,000, $2,000, $10,000, $15,000, and $25,000. <br /> <br />2. A list of the top 25 claims. <br /> <br />3. Summary reports on quarterly information. <br /> <br />4. Specific claims. <br /> <br />(e) Additional Reports: Additional reports could become necessary in the future. <br />The Claims Administrator shall provide the additional reports, if requested in <br />writing by the Plan Administrator, at a cost agreed upon by the parties. Should <br />the additional reports be obtainable from the Claims Administrator's system in a <br />compatible form, the Claims Administrator shall not charge for the reports. <br /> <br />6 <br />
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