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Transcripts For SFGTV 20140817

Accuracy. And again, things shading where uhc did much better with over all accuracy, from improving doing better than eight of the past, since the audits that we have completed. The payment accuracy, and this is one, where uhc barely missed our standard at 9748 uhc, our standard is 9950. So, because of the frequency, of errors, just barely missed or satisfaction level. And here is where we get into the over payment and the under payments for the errors. And for insample we have a total of 12 errors and 9 insample errors and three out of sample errors. Of the errors identified, four of the errors were manually adjudicated errors related to medicare coordination of benefit and two were related to charges that were incorrectly denied. And uhc did agree to all four of these errors and reprocessed the charges, prior to our audit and so uhc did know about these error and did correct them prior to the audit. We also have two errors, and regarding two out of sample errors. And regarding anxil

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Transcripts For SFGTV 20140818

Provide us with information to determine what is the over all impact. And are the over payments or under payments . And so that is just. Why dont you apply it . We dont believe in extrapolating out to say, because we had a 5 error here that means that it is 5 Million Dollar error in the universe. Why not . So it is just our they have done an analysis and determined that is not the process that we utilize and but we do work one on one. We do work one on one with the administrators to determine, the over all impact. And in the universe. So it does not mean that we stop at the sample, we work closely with them to determine, how many claims are affected. Other questions, from commissioners . So, you know, sample of the claims, what percentage of that in the total universe . It is, we use an error of driven formula, to select our sample. And it is not a, we are not taking a percentage of over all universe of claims. Understood, but what percentage of that 220, is two percent of the total un

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Transcripts For SFGTV 20140814

Of the dollar amount, right, exactly. And payment is just that an error was made. And any kind of payment error in the sample and so anything that is origin, it could be of any dollar size, and counts as an error. And over all, it is all kinds of errors, financial or payment or nonpayment error and we are looking at over Member Experience and you can have a situation where the claim is miskeyed for a date of service. And that particular claim may pay the right amount, but it could lead to a financial error at a later date because it could cause the duplicate claims to be paid and such, and so over all accuracy, we are looking at the frequency of any type of error in our sample. Thank you. Commissioner shlain . In your separate, and in your, and yeah, in the separate, so you did 220 general audits and you kind of come down into the ten, high dollar ones and then ten and the instage renal ones. And so i guess, i mean, end stage renal is expensive and so, when you do ten high dollar and t

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Transcripts For SFGTV 20140815

If everyone is up by 5 and it happens 55,000 times and we dont audit that because it is too small and we dont appreciate the frequency that leads to a big dollar amount. So, it is we randomly select within the each strata, bucket but we see a lot of the most frequent claims because there is a high volume. If you look at the high volume of claims and normally see the physical therapy and the office claims in the universe, those are going to end up in the sample. Through that random process. So you have your dollar strata and we have such a large portion of our selection, that are in that zero pay or the one penny to the 500 where the bulk of the universe is. So. Yes. And the claim is up one. And yes, claim, wise. And i think that we can in next years audit, we can add that. Yeah, i think that we can actually look at that from a statistical standpoint off line. Okay. Thank you. Thank you. In addition to our 220 claim audits, we have we also classify out of sample error, and it will be an

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Startek launches Generative AI Platform to empower agents and enhance customer experience

Startek launches Generative AI Platform to empower agents and enhance customer experience
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